Now please don't misread what I'm saying. I voted for Obama, and consider myself to be a middle-of-the-roader. I generally identify as a social liberal, fiscal conservative, and part of the democratic party... but if I really loved a Republican candidate I'd vote for him or her.
So as a catch-up to those of who who aren't in touch with the news, President Obama's healthcare plan is on the table, and he's pushing to get it through legislation by the beginning of August. He wants it approved before the congressional annual holiday in August.... essentially so the plan doesn't get stale and forgotten. The three parts of his plan are:
2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
3. Promoting Prevention & Strengthening Public Health
Now, I'm not a political analyst... so these are just my thoughts. #1 sounds good. Basically Americans who have a plan that works for them get to keep their current plan (generally paid for by their employers). Americans who don't have a plan would be able to receive government healthcare benefits in the form of a plan similar to Medicaid or Medicare. Ok, sounds ok.
Skipping to #3 Promoting prevention and strengthening public health. Seems a little lofty, but overall a nice notion. However, what does this mean in terms of the government? Funding for what? Wellness and public health programs? Now, as someone who has a degree in public health, I am a huge proponent of the ideas that propel public health. But after being part of many large scale public health programs, I have seen such disgustingly huge wastes of resources that I nearly felt ashamed to be part of the program. And yes, folks, they were government sponsored programs. Oddly, I have often found that privately financed programs often fare better and accomplish more. Maybe because there isn't a never-ending governmental scholarship that will fund the program regardless of results. In my opinion, many programs have merit, but many many more are a huge waste. Ultimately prevention is something that must be initiated and maintained on an individual level. But for the sake of this discussion lets just go with it and say that wellness programs are a plus.
Ok, now #2 really makes me nervous. The text sounds like something I would completely agree with. Healthcare needs an over-hall... and by modernizing healthcare so many things could be incredibly efficient. For example, Obama has mentioned electronic medical records. Duh. Should have been implemented years ago. For any of you that have worked at a private hospital with primitive (or none at all) electronic medical records, you'd be shocked to see whats going on over at the VA. Completely electronic medical records, user friendly, readable, you can access the patients entire medical chart. Pure bliss. Now tell me that doesn't save money when you are ordering yet another MRI because the system doesn't show that the patient had one yesterday. $2700 down the drain.
So the part that makes me nervous? What does this mean for physicians. With all the talk out there these days, who knows? The big topic is getting rid of the fee-for-service system. Meaning that a doctor gets paid for what he does. If he orders additional tests, he gets paid more. Which has a bit of circular reasoning to it. You could easily point out that this policy just provides physicians with incentive to order unnecessary tests. Maybe. But the fact is that physicians have a huge burden to shoulder, and that is the threat of litigation. Being sued. For every little thing. It's pretty rare these days to find a physician who hasn't been sued for something. Because American culture is sue-happy, physicians spend more time covering their ass than actually addressing the issues. So maybe the answer is dealing with the threat of litigation. Mayo clinic pays their physicians a flat salary, so that tests are ordered on behalf of the patient, not the doctor's wallet. Some systems have a cap on liability for physicians. This might work.
Maybe getting rid of fee-for-service would be a plus... but what about other aspects? There is some talk of basing physician salaries on patient feedback and health improvement. WHAT??? Now that might sound perfectly reasonable to middle-classers who go to private hospitals and like filling out suggestion cards. But as someone who has worked in community hospitals, inner-city teaching hospitals, and other non-sensical places... this would be the kiss of death. First of all, no one is EVER satisfied in these places. These type of facilities are generally overbooked and understaffed.... and the physicians are always blamed. Not to mention, depending on your specialty, you may have a patient population who in general never gets better. Working in GI, very few of my patients actually "got better". Much of medicine isn't about healing or curing, it's about managing a condition to the best of our capability. Managing hepatic carcinoma, pancreatitis, and Crohns is MUCH different that curing syphilis or pneumonia. And who's responsible for the treatment outcomes of patients who have detrimental lifestyle behaviors? I don't want to be held responsible for the outcome of a patient who is a chronic smoker or who is morbidly obese.
As for my own financial concerns, I really don't care if my future salary is less than what doctors make now. Fee for service, salary, whatever. As long as I can live reasonably. I am concerned, however, about how to pay off my crap-load of educational debt if we are going to start paying physicians significantly less. And what's up with that paying for loans during residency stuff? Can we do away with that please?
Anyway, the point of this post was simply to point out that with all due respect, President Obama, I think your timeline is a little premature.
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