Obama's Healthcare Reform Speech

September 10, 2009
Jeff Brown

Jeff Brown weighs in on President Obama's speech before Congress yesterday evening, and discusses what he feels are the four most pressing issues in today's renewed healthcare debate.

I've got to weigh in on this thing. It's on top of the news and it affects the health and pocketbook of every taxpayer, employer, patient, and, of course, doctor. Doctors' financial lives are, after all, the subject of this site and column. And docs and everybody else are talking about it.

Now I don't know what will work its way through the 5 congressional committees involved. Nor do I know what actually might come to fruition. But I can reel off some of the issues around the central theme of cost control and some potential helpful changes. I know full well that not all of them are possible, let alone likely. But they need to see the light of day and, happily, making them happen is out of my purview.

Let's first acknowledge some disclaimers. Healthcare in its multiple forms is wound through the fabric of every aspect of American life. We can't factor every single thing in and so there will be the inevitable Unintended Consequences that will pop up. But healthcare reform is an ongoing process, not an event, and we will no doubt have to be revisiting the subject indefinitely. Science will come up with game changers and the shifting sands of politics are always undermining our attempts at a stable footing.

I am also going to avoid the philosophical question of how much of GNP (currently 17% and rising) devoted to healthcare is "too much." Suffice it to say that our stated goals are to:

1) reduce or cap off current expenditures (some argue it's enough just to slow the rate of growth)

2) provide health services not currently deemed accessible by 40+ million of our fellow citizens

3) make the healthcare delivery process easier and more efficient for all

4) establish some sensible provision for quality improvement.

I know there are a zillion sub-issues, but these 4 are enough for now. Let's enumerate some of the cost drivers and you decide which ones you want to get emotional about.

I want to start by dispensing with technology and research as a problem. This is our collective future hope and, if anything, we need to spend more. Sensibly and with accountibility sure, but let's not throw the baby out with the bathwater here.

Next, a mention of the malpractice situation. The studies tell us that all insurance and litigation is but 1% of the cost of healthcare. Because of the lack of universally-accepted best practices in medical care, it has been impossible so far to objectively establish how much defensive medicine itself costs us. But every doc reading this knows the number is not small. It would be nice to have national guidelines for a no-fault, low-hassle arbitration process that would give full recompense to any individual injured by actual malpractice. Malpractice needs to be dealt with in a timely and responsible way including identification of the doc at fault and appropriate remedial action taken. I do fully realize that this will not likely happen soon thanks to the American Trial Lawyers Association whose ox would be gored, but good.

We know that employers have been on the hook for providing insurance for employees since WWII. This currently makes no sense, as it unnecessarily adds a thick layer of bureaucratic hassle and expense. Employers themselves would be happy to be rid of this millstone (and drag on their profits) and we see evidence every day as they let their feet vote for them as they drop the responsibility. This is one major cost driver that has a real chance of being eliminated eventually.

Another cost driver that's under the radar that can be remediated is medical training curriculum reform. I've written before how the utter lack of appropriate instruction by medical schools and residencies on finding a job, running a business, or functioning optimally within a medical organization costs docs and their patients some large, unknown amount of money and is potentially preventable for the next generation of docs in training.

We know about the potential for improvement in communication and record keeping that electronic records can provide. Quality could go up and the big, hidden costs of unnecessary duplication and delay resulting from slow or absent record transfer can be avoided. But we're all aware, some of us painfully, that it is hugely expensive and disruptive to convert from paper. And the systems are vulnerable, quirky and worst of all, don't "talk" to each other. And each major medical school, group and medical center has so much money, and ego tied up in their own proprietary system that we are at a standoff. The free market hasn't been able to resolve the issue so we're left with the government being forced to decide the standard and the means of implementation.

I've done it again. I've gone on a tear and am out of space to finish. So, as Rocky and Bullwinkle could have said, "We don't need doctors in Frostbite Falls. But tune in again next week anyway."