The media is abuzz about President Obama's "unprecedented" presence yesterday on five network and cable interviews to make his case for health reform, to be followed tonight with an interview on the David Letterman show. As President Obama continues to make his case to the American people, might I be so bold as to suggest that he take note of an op-ed that appears today in the Atlanta Journal Constitution, written by ACP's own President, Joe Stubbs, MD? I am biased, but I think Joe makes as good a case as anyone, on why reform is imperative. He writes:
"I take care of patients in a general internal medicine practice in Albany, as I have done for the past 27 years. I take enormous professional pride and satisfaction in keeping my patients healthy, helping to heal them and providing comfort and relief when they are nearing the end of their life. I also share their frustrations with a health care system that is stacked against us both; a system that is unacceptable and unsustainable. Examples readily come to mind to support this point. By 2017, an average middle-income family will spend $4 out of every $10 they earn on health care alone, putting it out of reach for most. Just three years later, the number of uninsured is expected to climb from today's 46 million to 60 million, which is about one in five of our population. And, those with insurance will not be able to find a primary care doctor because of a growing primary care physician shortage of tens of thousands ...
Within our grasp is the achievement of health reform legislation that makes coverage affordable by building upon and improving our current employer-based system, providing incentives for young doctors to go into primary care, reforming and improving Medicare physician payments, and reducing the costs associated with our broken medical liability system. Let's not let the opportunity slip away."
If Joe is right that rising costs will exceed the ability of families to afford coverage - and I have no doubt that he is - then why does the public not seem to have the same sense of urgency? Ezra Klein writes in yesterday's Washington Post that the cost of health care to individuals and families is masked by the fact that employers pick up (most) of the tab. But when employers pay more for health care, they pay their employees less in wages. Health care costs arguably may be the biggest cause of decades of wage stagnation for middle and lower class families.
The political dilemma is that since the public doesn't readily see the impact of rising health care costs on their livelihood - unless they are among the unfortunate millions who have no health insurance coverage or have experienced personal bankruptcy because of a personal health care catastrophe - they don't want to hear about the need to control costs. When even relatively mild ideas to control costs are proposed - like funding research on the comparative effectiveness of different treatments, or reimbursing doctors and patients to sit down together to discuss advance directives - they are demagogued as "rationing" by some politicians.
This is why the political debate is shifting to things that are relatively popular with the public - like prohibiting insurers from turning them down if they have a pre-existing condition or cancelling their insurance if they get sick - instead of controlling costs. The idea seems to be to sell the public on the gain from insurance that can't be taken away, while postponing a discussion of the pain involved in controlling costs. Even though, as Joe Stubbs wrote, the cost of the current system is not sustainable for his patients and their families.
Today's questions: What do you think of the views expressed by Dr. Stubbs? How would you recommend engaging the public in a discussion of the cost of health care?