Bob Doherty reports on the White House Health Care Summit – What a difference a 15 years makes!
I will write more about the summit in future posts, but a few first impressions:
1. This President really, really wants health care reform. He believes – as he said in his opening remarks – that the U.S. has reached the point where "there no longer is a debate about whether to have health care reform, but how that reform should look and work."
2. He rejects the notion that the economic crisis works against health care reform. To the contrary, he made it clear that you can’t fix the economy or sustain entitlement programs, like Medicare and Medicaid, without controlling health care costs.
3. He is willing to take on liberal activists, pointedly telling them that they are not going to be able to achieve universal coverage without controlling costs.
4. He understands the importance of primary care. During the question and answers period, he unequivocally stated that, "We have to produce more primary care physicians." Amen!
While I fear health care reform as an unknown, I hope for health care reform because our current health care delivery is flawed. I have written often about the negative externalities of our current payment system. I have written about the undesirable incentives for physicians and patients.
I hope that the wonks understand that the problem with primary care can only be addressed if we address payment. We must make outpatient medicine a better career. It can be done, and I really believe it will help patients greatly.
{ 3 comments… read them below or add one }
Sure he understands : he will pay primary care less, not more. He will employ them, pay them whatever and suck the life out of them for the better good, of course. Because for a true socialist, the better good comes before the individual. And you are just an individual, your dreams and your personal happiness do not count. We’ll talk again in 2 years if we are still around.
Socialized medicine will bring down physician salaries in primary and specialty care. Many patients feel physicians are overpaid. Primary care ranges from the low 100s to 200,000+ annually. Specialists usually make from $200,000 to $700,000 a year. These salaries seem out of touch to the patients who make $15,000-$70,000 annually. I am a primary care physician and likely would see my salary decrease under government run medicine.
The advantages of government employment would be government funded malpractice insurance, cases before an impartial judge with payments covered by the taxpayers, health insurance provided by the government, and likely provided EMR software/hardware by the government. I also would get a fixed vacation time each year, sick days, a retirement plan, and government employee discounts. Currently I pay for all my benefits/insurance. Despite never being sued, my IL primary care without major risks procedures insurance is $35,0000 annually.
Disadvantages would include longer wait times to be seen as patients, limited services, rationing of health care, and longer wait times for labs/studies. There is a reason wealthy Canadians travel to the US for faster care and access to MRIs/labs that are rationed by the Government.
Overall I think it will be difficult to satisfy the 50 countries inside the US with any national plan. Medicare would work for me, if it were extended to everyone. Unfortunately, most plans call for an extension of Medicaid, which does not cover my costs to see a patient. In my area, the majority of FP/IM doctors do not accept new Medicaid patients. Likely a government run program would require physicians to see any government insured patients. I think it will take years before any program passes.
I agree with country solo doctor.
The idea of private insurance is to design it well and not abuse it. The reality is that government insurance can be heavy handed and top down. A government insurance program if designed well can have bottom up elements that create a nice balance. But that may be hard to achieve.
I also agree that we may get more out of a government health care system if there is preservation of regional character. My impression is that you have to take into account regional culture and variation. In Minnesota medicine may be able to continue much as today since it ia a high performance state. Whereas poor southern rural or Southwest Hispanic communities may benefit from a community medicine approach that is innovative.
We have to have government guarantees, but we do have to preserve local flexibility and creativity. Canadians are tolerant and patient. We tend to be more opinionated and more proactive. Part of reform must be engagement of our best creative instincts and cooperation. Resistance to change may do much damage.
I also think that we need to make continuity of care possible. People constantly changing insurance plans and primary care doctors in order to get a covered service is terribly destructive.
Bohdan A. Oryshkevich MD, MPH
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