Wednesday, February 17, 2010

"An unconscionable abdication of responsibility by our elected leaders"

Today, I joined with ACP President Joe Stubbs at a press conference to release a major new ACP report that finds American health care is "facing an unprecedented challenge of affordability and sustainability." Dr. Stubbs observed that "by many measures, the State of America's health care is in decline" with "too many uninsured persons, too few primary care physicians, while the cost of health care is rising faster than families, small businesses, and taxpayers can afford." Yet a "highly-partisan and polarized debate over health care reform legislation regrettably has taken the country's 'eye off the ball' - from the urgency of implementing reforms to make health insurance coverage more affordable, available and secure; to ensure a sufficient supply of primary care physicians and other specialties facing shortages; and to reform payment and delivery systems to achieve better value."

In my remarks, I asked reporters to imagine what health care will look like if reform is not enacted.

"Fast-forward to 2018, a new President is in the White House and ...

"The number of people enrolled in Medicare has increase to almost 60 million, but the ratio of taxpayers paying into the program to support each beneficiary is at its lowest point. Medicare's hospital trust fund is out of money.

"Unrestrained Medicare and Medicaid spending has led to out-of-control deficits and an explosion of public debt, leaving little money for other national priorities.

"At the same time, rising premiums have put health care out of reach for many middle-class families. Small businesses are dropping coverage in droves. 60 million people have no health insurance coverage.

"Because of a shortage of tens of thousands internists and family physicians, it takes many weeks - even months - to get appointments. And because of continued cuts in payments that do not cover their costs, most physicians are not accepting new Medicare and Medicaid patients.

"What's the new President to do? The President might have no choice but to propose huge payroll tax increases, cuts in Medicare benefits and eligibility, and reduced payments to physicians and hospitals. Stringent controls over health care spending are needed, but anything that would make a big and immediate dent - like putting limits on services - would be fiercely resisted by patients and physicians alike."

All of the above is almost certain to happen, unless we change course now.

ACP offered five steps to make health care sustainable and affordable (1) build and improve on the bills. preserving key elements to provide coverage to most Americans, increase the numbers of primary care physicians, and pilot test reforms to improve health care delivery; (2) develop bipartisan proposals to reduce the costs associated with the medical liability tort system; (3) fund programs to expand coverage, train primary care physicians, and encourage testing and dissemination of models to improve health care delivery; (4) end the cycle of Medicare physician payment cuts caused by the Sustainable Growth Rate (SGR) formula; and (5) use the President's executive authority to require that federal agencies and contractors develop policies to increase the numbers of primary care physicians and reduce the time that clinicians and patients spend on health plan administration.

Dr. Stubbs concluded by saying, "The alternative to moving forward on comprehensive health reform is an unconscionable abdication of responsibility by our elected leaders to ensure that high quality health care remains available and affordable for American families today, tomorrow and for years to come."

Today's questions: Do you agree with Dr. Stubbs?


Arvind said...

I find that somehow you are speaking from both sides of your mouth. These two statements could not be any more illustrative - "the cost of health care is rising faster than families, small businesses, and taxpayers can afford" and "And because of continued cuts in payments that do not cover their costs, most physicians are not accepting new Medicare and Medicaid patients."

Can anybody explain how "health care costs" can go out of control when Medicare pays so little that it does not even cover cost of providing care?

If you or Dr. Stubbs would consider not toeing the government line and getting to the truth, you would make it clear to the public that the real problem is unrestrained rise in health insurance premiums despite actual decline in physician reimbursements over the past decade or more; and complete erosion of the physician-patient relationship (primarily due to governmental efforts over the past 15 years). It takes guts to come out say the truth; far easier to just echo the White House lines. I would call this "An unconscionable abdication of responsibility by the non-elected leaders of physician organizations".

Steve Lucas said...

Cleveland, Akron, and Canton form the buckle in the Rust Belt. Two recent articles in the Akron Beacon Journal by Cheryl Powell illustrate the issues facing medicine and the patient /consumer.

In the first article, Feb. 11, It’s a challenge to shop around for health care, a retired police officer is told to bring $2,191.39 as his part of the co-pay for stress test for his wife. Questioning the charge he is told there are no further discounts. Shopping around he finds that other hospitals will not offer a set price due to potential “complications.”

Ultimately he came up with a hospital that would do the test for $600 out pocket applied to a charge of a little less than $1,000.

In the second article Feb. 14, Patients are finding facility fees for visits to doctors, we find this quote:

“At some of our outpatient facilities we were not billing as if they were provider-based facilities even though they met the Medicare requirements and were entitled to do so,” Phillips said.”

What local hospitals are doing is purchasing private practices and then naming them satellite facilities of the hospital to garner larger fess. Fees not disclosed to patients seeking services

So we are seeing an increase in cost to the patient/consumer while the private practice sees a decline in reimbursement. Insurance companies work on a cost plus basis so any increases in cost by service providers is simply passed on in the form of higher premiums.

This is a loose, loose for the doctor and patient and a win, win for the service providers, not-for-profit hospitals and insurance companies.

We have to get this under control. In an area with above average un and under employment, no growth in technical or skilled jobs, we are already seeing an increase in Medicare and Medicaid patients.

The social cost is tremendous. Young women seeing no hope for a skilled or professional position are choosing to become pregnant. This has lead to a large number of single parent homes, all supported with government funding.

Health care reform will have a large impact not only on cost and patient access, but also on other social programs.

Steve Lucas

Jay Larson MD said...

Elected officials are stuck with a hot potato that is going to leave behind 3rd degree burns no matter what they do. This health care crisis is the culmination of decades of a dysfunctional (and greedy) system. Let’s face it, to “fix” the U.S. health care system will take an act of nature of biblical proportions. Our elected leaders know this and are understandably not jumping into this dung pile enthusiastically.

Besides, it is not just elected officials that need to be responsible for health care reform, we all do… insurance companies, hospitals, patients, physicians, pharmaceutical companies, medical equipment manufactures, etc.

The only way we are going to “ensure that high quality health care remains available and affordable for American families today, tomorrow and for years to come” is to seriously change the incentives and refocus on health, not just profit. Just adding people to insurance pools will not fix the high cost of health care. It will only dump more money into the current profit driven feeding frenzy that is currently taking place.

The U.S. health care system rewards procedures, gadgets, and newer treatments. Last night I was at a pharmacy and therapeutics committee meeting. We reviewed a new biological agent for treatment of psoriasis. There are now 3 biological agents for psoriasis. The annual cost of each agent is about $20,000 per year. When I get hammer by insurance companies to change a medication to save them a few bucks and then pharmaceutical companies can charge $20,000 for a skin condition treatment, it makes me just shake my head. (BTW, I would not wish psoriasis on anyone. It is not their fault that treatments are so expensive.)

If general internal medicine and other cognitive specialties are going to survive, there has to be incentive to think. The primary care force will continue to dwindle (no matter how many residency slots are opened for primary care) so long as there is no value for what they do.

Rich Neubauer MD said...

I was thrilled to see Dr. Stubbs courageous statement.

I am increasingly fed up with many of our elected leaders who do indeed appear to be abdicating their responsibility to govern in favor of their lust to be re-elected.

Both houses of congress appear to have sunk into a deep and dark swamp. Dedicated organizations like ACP are throwing them ropes in hope that they may be rescued and pulled from the abyss. I can only hope they will grab one of the ropes, emerge from the swamp and redeem themselves by seeing the plight of the country they are supposed to be leading.