News/Commentary

“10 Things I Hate About Health Care Reform” is title of an Opinion article in the Sunday’s Washington Post.

The headline does not do it justice—-it sounds like another rant from left or right—–but it is not.

The author, Arthur M. Feldman, is a heart specialist and chairman of the department of medicine at Jefferson Medical College, which is in Philadelphia. He is the author of Pursuing Excellence in Healthcare: Preserving America’s Academic Medical Centers.”

One of the things that is hard about health care reform is grasping that each piece of the health care delivery system is essential—- yet we keep treating this like a game where there must be winners and there must be losers.

Now, nobody is proposing to do away with any of these building blocks of health care, but the way the proposals may play out stand to harm some of them and badly.

• We can’t not have pharmaceutical companies. Yes, we know all about their tricks, thanks to some court settlements this year, but many people are unquestionably alive today because of medications which enable them to live well with conditions which could have killed them—-and not all that long ago.

• We can’t not have health plans. Yes, we know some things about their tricks, too, thanks to Andrew Cuomo, attorney general of New York. But we need their infrastructure and their ability to manage an unwieldy process on behalf of employers who still do provide the bulk of people’s insurance.

• We need more transparency and accountability from both of these sectors but we can’t do without them either.

• But we can’t not have enough primary care physicians and nurses at the community levels. Current proposals acknowledge the looming shortages but at the expense of others we can’t afford to have go missing either.

• Yes, we need specialists, too. Medicare’s way of paying primaries more is to pay specialists drastically less. No, no, no, a thousand times no. This is simply moving chess pieces on a board when you know you are losing the game, which is staying viable. Medicare, due much credit, is struggling. To fail to face that in this discussion is to fail to have an honest one.

• We can’t not have regional medical hubs to provide the sophisticated care that has become the standard for so many conditions—-bypasses? No big deal. Once those were only done in academic medical centers. Depending on reimbursement formulas, they can be hurt and hurt big because these are specialty-centric.

• We can’t not have academic medical centers, by which we mean medical schools (and one hopes, more nursing schools) linked to teaching hospitals and outpatient centers, where faculty also do research.

• Research, for its own sake and our sake, must also be a priority. The FDA is a train-wreck of an agency, the product of many years of neglect, poor oversight and a host of other problems. The NIH needs funding that it can count on and funding that does not tend to reward the most cautious studies because money is so scarce. The NIH needs politics to get out of the science business, period, regardless of who is in office.

Dr. Feldman isn’t into the political wars, which is why he is worth listening to.

He is talking about the essentials of providing health care to, likely, the most diverse population in the world, one which still is growing.

Although his article gives equal time to all 10 of his reasons for unhappiness with the current proposals, let’s hammer hard on one of his big 10: Prevention, everyone’s favorite way to “save” money. Except, it does not.

Prevention does not save money in the old-fashioned ways we were taught. Sure, brushing your teeth right prevents cavities. But, keeping someone living well with a chronic condition? Not a money-saver.

How can that be? “An ounce of prevention is worth a pound of cure.” No longer. Before medications and minimally invasive surgeries and a host of other advances came along, patients did not have many options after a certain point.

So, yes, prevention did save money back then.  So many patients had only the most expensive care were they to be ill. There was no in between.

Fast forward to today. Men used to drop dead of heart attacks all of the time. Now, as one researcher was quoted as saying at an international cardiology conference, “It is hard to die of heart attack.”

That great news is accompanied by greater costs. Statin drugs to bring down cholesterol levels. Not cheap. Blood pressure medication. Pacemakers.  The list of treatment alternatives is long, thank God. But they are not cheap.

That is why elected officials and the American people should not keep telling themselves prevention saves money. No, now it doesn’t. But it does save lives. It does make those extra years better.

Read Dr. Feldman’s advice about health care reform.

You likely will be glad you did, unless your mind is made up.

Unfortunately, it is not enough to identify what one does not like in these proposals. One has to be for a plan because we cannot go on the way we have.

But we do not have to get  on the bullet train, either. It is absurd to grade a president or a congress for struggling with this. No president before has gotten reform through. No congress should be expected to glide through this process, either, however hapless they may appear on any given day.

We have a shot at one reasonably good bill, which then can be tweaked over five years or so to get it right.

Reasonably good is not what people asked for but that will be a victory if that is what we come out with.

We can get that if people will stop shouting and start thinking harder.

Labels won’t get us there. Name-calling won’t get us there. Score-settling by politicians will not get us there, either.

As we still are absorbing the results of an economic crisis which could have been far, far worse than it was, let’s not bungle our way into another.

Far more important than my views from experience down in the trenches, however, are Dr. Feldman’s. Read on.

Washington Post

“As a cardiologist and the administrator of a large practice that includes general internists and specialists, I spend much of my time trying to figure out how to provide care for a growing number of uninsured or underinsured patients. I also have to battle billion-dollar private insurance companies that don’t adequately cover patients with preexisting illnesses and often deny coverage for necessary treatments.

“On a basic level, I’m with the president: Our health-care system needs to be changed so that all of my patients, and all citizens, have access to the care they need. But I don’t agree with how he wants to fix things. Most of my colleagues and I strongly oppose the health-care reform bills that Congress will take up again this week. The proposals leave enormous gaps unfilled.(Emphasis added)

“Before President Obama addresses a joint session of Congress on Wednesday, I hope he will consider these 10 major reasons why I — and doctors like me — worry that the legislation on the table will leave us worse off.”

Source: Washington Post, Outlook, September 6, 2009