Month: January 2010

Massachusetts Election a Tragedy and People Should Know Why!

My blog readers already know I am a big believer in healthcare reform and they also know Rubinhealth.com is not about politics.  It’s about explaining to people how our current healthcare system works today and how it would work tomorrow after reform.  I have been very upfront that there is enough in the current versions of the House and Senate Bills for everyone to hate.  I have said that because it is true.  The bills are far from perfect.  I have also said, and I believe it to be true more today than ever before, that doing nothing is far worse.  We have between 40 and 50 million uninsured Americans in this country.  There are 25 million more who are underinsured and most of these people do not even know it until they get sick.  16% of all money spent in this country is on healthcare and that cost is growing every year making healthcare more unaffordable to many.  Yet somehow this message was lost during the debate on the bills.  The public became frustrated and now the Senate lost it’s 60 seat majority.  Healthcare reform is once again in serious jeopardy of failing.  More so today than ever before.

Our politicians let us down with the convoluted and highly political negotiating process.  They fought and could not find a way to work together and craft a bill that would put this country on a path forward.  So instead of getting a bipartisan bill, we got a democratic bill that had no republican support.  The fighting got worse, the horse trading to get votes became distasteful, and the public became sick of the process.  In the end, we forgot what this whole reform was about.  This country has lost a great opportunity to fix our severely broken system.  We could have addressed the bad/flawed parts of the bill after we passed this initial legislation.  Instead the future is as cloudy and unknown as ever before.  Sadly, more and more Americans will lose their healthcare insurance, file for more bankruptcies, and fall victim to pre-existing conditions and unaffordable healthcare.

What a sad day it is for all of us and I am still not sure we all fully understand why.  I hope those who are against the current bills never become victims of the very system they thought they needed protect.

Paying doctors Less is not always more

I have had heard over and over again that doctors make too much money and one of the best ways to reduce costs in the healthcare system is to cut their reimbursements.  Let me tell you why that is not the right answer.  We live in a country where we want and feel entitled to the best healthcare when we need it most – at times of sickness.  It is our physicians that we rely on to heal and protect us when we are most vulnerable.  I for one want to make sure we have the best and brightest individuals working in the most noble of professions.  Doctors study for many years and invest tremendous sums of money into their training and careers.  Most physicians end up with over $300,000 in educational debt by the time they complete medical school.  This is even more than the cost of a very nice house in most parts of the country.  Further, given the amount of time it takes for physicians to finish school and their training, many do not start making a living until they reach their mid-thirties.  It can take a very long time to pay that debt back.

It takes a very special person to invest that amount of time and money in their education to take care of us, perfect strangers.  But the dedication does not end there.  My father is a physician and I saw first hand how hard he worked to provide for his family.  He often worked 7 days a week.  I would go to the hospital with him on the weekends when he would check on his patients in the hospital.  I was at the dinner table when he returned the phones calls of sick patients after he got home from a full day of work.  He never questioned his role or responsibility in taking care of his patients.  Can we put a price tag on that amount of work?

There are certainly cases of extreme compensation in this country.  It is not limited to physicians.  Just think of our current banking system.  These extreme cases are distasteful.  There is no question.  But in medicine, these cases are the exception to the rule.  It is easy to feel uneasy when we hear or see people taking advantage of the system.  Ordering tests that may not be needed solely to generate additional income.  Yes, this happens and it’s terrible when it does.  Just remember, these situations are the exception, not the rule.  Most physicians spend endless hours being available to us.  We need to make sure we preserve as best we can the existing system so we can ensure they are there for us in the future.

I spoke to a group of physicians in training this morning on the future on healthcare in this country.  I assured them there would be changes.  I also assured them that Medicine remains one of the most noble professions.  I also told them they have a responsibility to participate in the reform process and contribute to the process and conversation to reduce waste and enhance efficiency in the system.  The process is just beginning and it will take years to changes.  Let’s just hope we continue to attract the best individuals to the profession.

Getting into the details of healthcare reform

The healthcare reform debate is about to heat up again as the Senate and House start to reconcile their bills into one.  This process is going to be highly political and you are going to be hearing a lot about the various differences in the bills.  This information is already pretty well known and while the outcome is still uncertain, I think it’s reasonable to expect to a final bill in the next few weeks.  The key issues to reconcile include:

1. New Taxes – what  taxes are going to be implemented pay for this reform
2. Abortion Coverage – how restrictive will the language be in the final bill
3. Individual Mandates – what threshold will be established to make sure all Americans carry health insurance
4. Employer Responsibility – what penalties (and incentives) will be in place for employers to provide health insurance
5. Structure of Cost Reforms – what process will be implemented to review how we spend healthcare dollars today in order to reduce costs in the system

To me, this last item is probably the most difficult to understand and most likely will not impact a final bill.   There is some irony involved with cost reforms.  It is probably the most important component of healthcare reform, yet it is without question the least understood part.  Further, the implications of cost controls in healthcare reform are enormous.  Whatever changes take place, they will have a tremendous impact on how healthcare is delivered in this country.  I get more questions than you can imagine on cost controls.  My answer is frequently the same:  it’s complicated.  Understandably, it’s complicated is a very unsatisfying answer.  Over the next few weeks, I will start telling you what cost controls mean in terms of healthcare reform.  I will explain both sides of the issues and you will be able to see why it is going to be so difficult to accomplish without some form of sacrifice.

The first component to cost control will be a new group looking at how various diseases are treated/managed and make recommendations on best practices.  This is known as comparative effectiveness.  It would seem obvious to many that we reward/pay doctors and hospitals based on what is understood to be the best and most effective way to treat a condition.  While it is still unknown how this group will work, who will be included, and what power they will ultimately wield, we do know they will be looking at various types of diseases and conditions and making recommendations on routine protocols.  I have to believe the recommendations from this  commission will eventually lead to a change in reimbursement for specific drugs in treating certain conditions .  To be clear, this commission will not be able to limit Medicare reimbursement.  This power will remain with Medicare.  That being said, this commission will look at all available data to make the most informed recommendations that I can imagine will lead to a great deal of controversy related to their work.  While this group cannot say “drug A” is not allowed to be used (that will remain with the FDA), I do see situations where Medicare will take the commission findings and no longer reimburse a certain drug if the benefit is not scientifically and statistically proven to be worth the cost.  Since most insurance companies follow Medicare guidelines, it would become a defacto reimbursement policy.  As a society, we will be faced with the promise of new drugs and technologies against the realities of limited budgets.   For example, can we as a country afford $100,000 in drug costs to extend life for 2, 3, 4 or even 5 months?  What is the quality of that life in the last few months and how is its value determined?   I do not expect this to be the focus of the commissions work in the beginning of healthcare reform.  However, I think we would be naïve in thinking this is not going to come down the road.  It already happens in western nations.  It seems to be to be fair to look at all costs associated with treating illnesses.  It also seems reasonable that many will want to try anything and everything to save a life.  There is no right answer.  We know we can no longer afford the healthcare system we have today and this is only one of many concepts yet to be faced.  Stay tuned for more.

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