OCTOBER 5, 2009
What We Would Have Told Obama
By DONALD J. PALMISANO,
WILLIAM G. PLESTED II
AND DANIEL H. JOHNSON JR.
We aren't among the doctors invited to a Rose Garden event today to "join the President in pushing for health insurance reform this year and [who] have offered their help and support," as a White House press release put it. It's unfortunate only supporters of the president's plans will be there. Mr. Obama has missed an opportunity to learn more about the real issues facing patients and doctors and to formulate a plan that truly puts patients in control with doctors as trusted advisers.
The United States has the best health care in the world today, and thanks to the ever-expanding frontiers of science and medical innovation the brightest days are ahead. It is true that there are Americans who fall through the cracks of our medical system every day—and as a caring nation, we must do what we can to expand access to medical care to those who need it. But this can be accomplished without a costly and inefficient government overhaul of the entire system. One easy reform would be to enable individuals to buy policies offered in any state, not just where they live. This will enhance competition. But more government-run health insurance will only lead to disaster.
Today, Medicare already reimburses doctors less than what many of their treatments cost to provide. Now the government is saying that additional Medicare cuts are coming—thus forcing doctors to try and make up the difference in volume, by seeing more patients. If you ask patients about this, they understand that more volume means less time with the doctor. That's something that all patients and doctors should oppose. In time, it will be difficult to find a physician.
If the goal of reform is to provide the best possible patient care, let's take the government-controlled "public option"—and any legislative trick that could lead to a public option—off the table. It will result in long waiting lines to see a doctor, substandard care, and an end to medical discovery.
There are many other ways to expand access to health care for uninsured Americans. We could strengthen incentives to purchase low-cost health savings accounts, provide tax credits for individuals and families buying health policies on their own, and extend subsidies for those who need financial help. Also, the right of patients to privately contract with physicians to ensure they have the medical care they want, without penalty—regardless of what the government pays—must be recognized and protected. Today, if a doctor wants to bill a patient for additional payment over the Medicare reimbursement, he has to withdraw from Medicare entirely for two years. A patient who agrees with this arrangement can't receive any Medicare money for that service, either.
We need to maintain a plentiful supply of medical expertise. But cuts in payments and bureaucracy could mean fewer individuals entering the medical field—and a dearth of health-care professionals down the road as specialists retire early or limit their practice. Every patient wants to be taken care of by the best medical professional possible. A patient with cancer wants to see a doctor who has had years of training in oncology and is knowledgeable about the latest ways to beat the cancer. But in some provisions in the proposed legislation (such as the medical home model of HR 3200), physician assistants and nurse practitioners may get the authority to make important medical decisions.
The federal government should also continue its investment in medical research through agencies like the National Institutes of Health, and it should better reward innovative discovery in the private sector with tax incentives and patent protection. Americans are living longer, healthier lives thanks to the trillions of dollars in public and private research investment in medical devices, pharmaceuticals, and advanced surgical techniques. We must not put future progress in jeopardy.
Finally, the nation needs comprehensive medical malpractice reform. It is the surest and quickest way to slow down the rising cost of health care. Statistics from private insurers, as well as a Justice Department report of 2007, indicate that upwards of 80% of malpractice cases are closed without payment—and when there is a trial, the physician-defendant wins 89% of the time. Yet these lawsuits, even when dismissed or closed without payment, cost doctors time and money, and encourage defensive medicine. This adds billions to the cost of medical care. It also increases malpractice insurance premiums, the costs of which get passed on to patients. In too many cases, the malpractice environment forces doctors to leave communities, depriving patients of their trusted medical advisers or specialists whom they might need in an accident or other crisis.
The drive to reform health care has led to an acrimonious and often divisive debate. Yet we still believe that doctors, patients and legislators working together with goodwill can improve the medical system and extend its benefits to all Americans.
—Dr. Palmisano, president of the American Medical Association from 2003-2004, is spokesman for the Coalition to Protect Patients' Rights, a group of more than 10,000 physicians. Drs. Plested and Johnson were presidents of the American Medical Association from 2006-2007 and 1996-1997 respectively.
health care reform
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