Wednesday, July 1, 2009

No we can't! No we can't!

The defining symbol of Obama's campaign was thousands of people joining together to chant "Yes we can! Yes we can!"

The defining symbol of health care reform, at this critical juncture, could be the growing chorus of "No we can't!" to health care reform - or, at least to the parts of reform not to a particular group's liking.

Hospitals are saying "No we can't!" to Medicare pay cuts to fund health care reform.

Labor unions are saying "No we can't" to taxing health benefits (above a certain premium cost) to pay for health coverage for the uninsured. They also are saying "No we can't!" to health reform that doesn't include a public plan option like Medicare - and some unions are even attacking Democrats who disagree.

Insurance companies are saying "No we can't!" to health reform that includes a public plan option like Medicare.

Employers, for the most part, are saying "No we can't" to mandates that they provide coverage to employers or pay into an insurance pool. Today's announcement that Walmart supports an employer mandate is one welcome, and highly notable, exception.

To be fair to the groups mentioned above, most of them say they want health care reform to happen this year. Some have shown a great deal of leadership in promoting positive reforms in the health care system. They would tell you that their objections to specific elements are in the spirit of getting a "good" bill passed.

What about physicians? My sense is that there is a broad range of opinions on issues like the public plan. Most physicians still believe reform is necessary, but some are focusing on the things they don't like (like expanded roles for nurses), and there is a vocal minority of doctors who are hoping that the whole thing "tanks" (as one physician commented yesterday in response to my blog post on Obama's views on primary care).

For its part, ACP believes that health care reform is imperative, and we support the broad outlines of the draft proposal being considered in the House of Representatives: sliding scale subsidies for people to buy affordable coverage through a health exchange, insurance market reforms, and payment reforms and funding for primary care.

It is one thing to express concern about particular elements of reform, but it is another thing to issue non-negotiable, take-it-or-leave it, line-in-the-sand, my-way-or-the highway statements that leave no room for consensus or compromise. There will come a point where the chorus of "No we can't" on particular elements will begin to drown out the more compelling reasons why we need health care reform, and undermine public support in the process.

Health care reform is about making sure that each and every American has access to coverage at a price they can afford, that no one is turned down because they have a pre-existing condition, and that they have access to a personal primary care doctor. It is also about creating a health care system that won't bankrupt American families, businesses, and taxpayers. In my mind, we can't afford not to achieve those goals.

Today's question: Do you think that those who are laying down firm markers on what they can't support will ultimately derail health care reform?


PCP said...

There is one difference amongst the stakeholders in this debate, compared to physicians, esp. Primary care physicians. The other players in this debate such as Insurers, Big Pharma, DME suppliers, Hospitals, Specialty services, PBMs, Ancillary services like PT, Home health, Office administered Drugs(Biologics and ChemoTx), Medical device industry, Medical imaging etc have all lived high on the hog.
Doctors, especially those dependent on E&M codes have greatly suffered over the last 12-13 yrs with the SGR along with other administrative hasles. Fees adjusted for inflation have fallen. Incomes have fallen adjusted for inflation. We have seen all stick and no carrot.

Contrast that with the stock performance of United healthcare $4 in July 1996 and $25 now (inspite of the recent market meltdown). Look at Lincare(DME supplier) $7 in 1996 and $24 now. Express scripts $2 in 1996 and near $70 now. Look at Genentech $6 in 1996 and over $80 now. Look at the massive expansion in capacity/services at your local Hospital especially in Specialty care capacity. There are countless examples of such companies in the stock market. I tried to pick out a company representing each of these sectors. The reason I mention all this is that these hefty stock price gains demand earnings to sustain them. I wish I had the foresight to see these trends 12 yrs ago for my own portfolio, but I digress.

These trends have consequences, and Primary care has faced the brunt of it. Contrast the good fortune of these players with the dearth of medical students choosing Primary care, the falling incomes/revenue for primary care practices. Follow the money.
So, since we can establish that the last 12 or so yrs have been less than kind to primary care doctors while others have lived high on the hog, then our concerns cannot just be lumped in with everyone else's grouses. I believe we have a far more legitimate grouse that must be addressed, we have little left to yield. So we must stand firm in our demands.

Jay Larson MD said...

Health care reform continues to march on. The hard line nay sayers will not stop the process, though they may bend it a bit. Every one pretty much knows the bottom line...if health care reform does not get through then our health care system will just be too expensive to afford. As PCP has pointed out, there are several factions of the health care system that have lived high on the hog. When they say "No we can't" now, Americans will reply in 10 years "No we can't" can't pay medical bills, can't afford medications, can't go to work due to illness, can't see a primary care doctor.

Unknown said...

Problem is so many lobbyists withpharma industry and HMOs and Hopspitals, who hve been pouring monies in politicins PAC that much of the changes Obama wants to reuce the cost of car is not happening. For example, not being able to make wholesale deal with Pharma industry for medicare drug coverage? HMOs wnat to get their extra 15% when Medicare pts join medicare advantage? for what?
You wish only if oour politicians were working in best interest of people and balancing with business needs..
I have no doubts that Obam will deliver new healthcare system and it may not be perfect and ideal for general population but it will be a good start and new changes will be made is it goes into effect.