Why is President Obama ignoring the doctors when it comes to health reform?

by Ernesto Gutierrez, MD

There is a lot of discussion about what Obama did right and wrong in managing the politics of passing health insurance reform. What strikes me as the most obvious is the failure to engage physicians. Sure there was support from the AMA, ACP, and AAFP, but the support was lukewarm at best. The position letters sent out to society members outlining their support seemed forced and mandatory. Physicians were simply not moved to voice their support.

Health care insurance reform, as envisioned by Obama, does nothing to help strengthen the physician-patient relationship that is crucial for managing disease. The failure to understand that the fear of malpractice, in addition to the financial pressures from third party payers (that in other circumstances would not be tolerated if it were not for the fact that physicians cannot organize into unions and negotiate as a class), drives a culture of medicine that finds it too easy to order more labs, studies, and consults, makes it difficult to practice medicine as we were taught in medical school, and leads to scores of unsatisfied physicians and patients is a monumental failure of a president eager to establish his role as a positive force in American history.

Many physicians witness a friend or colleague who is taken through the legal system’s method of using litigation to reach justice, and they see how easy it is to for a physician think of a challenging patient as a liability rather than as a suffering human being. Why not cover your ass, send them along, order the pan-CT, pan-consult again? It’s much easier than sitting down, listening again, re-examining what you have, or explaining again what you know about disease to the human being in from of you in ways the patient can understand.

It is hard to see how Congress’s attempts to “reform health care,” which is really the realignment of third party payers and the rules that govern them, pertain to the practice of medicine. That’s not to say that some ideas are long overdue—the idea that risk pool must be expanded, that “pre-existing conditions” must be accepted, that reliance on employer based health insurance can be a competitive disadvantage for domestic companies in a global market, and the realization that health care costs must be controlled. But how, exactly, is political posturing in Washington supposed to help me practice better medicine when they can’t even see what is obvious to most physicians?

The failure of Obama to capture this is either a failure of imagination, a sellout to the trial attorneys lobby, an utter disregard for physicians, or a mixture of all three. Needless to say, it is a blow to physicians who care about patient. And even if malpractice reform does little to reduce the costs of health care, why did Obama politically ignore it? It’s a slam dunk. Throw the physicians a bone.

Regardless of what you think, I love what I do behind the closed door of my exam room. And I often wonder who is going to be my doctor. I am so far healthy, late thirties, and have not needed any serious acute or chronic long term medical care. But when I do, will my doctor see me as a liability? Will medicine attract bright diagnosticians, talented surgeons, and dedicated nurses?

Although medicine is a calling and many will answer, I am not sure the current proposals from our politicians give me hope that I can walk into a medical office or be carried into an operating theatre or emergency department with confidence that my treating physicians and nurses will have my best interest in their hearts.

Ernesto Gutierrez is a rheumatologist.

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  • http://www.twitter.com/matthewbowdish MatthewBowdish

    He’s not ignoring us…I get the feeling he sees us as part of the problem, especially when he accuses us of amputating limbs or performing unecessary tonsillectomies just to make a few shekels instead of taking the time to manage chronic diseases like diabetes or allergic rhinitis. This President is a huge diappointment.

  • Doc99

    The President’s ill-thought out comments about doctors’ yanking out tonsils to balance the books or surgeons’ making $30-50K from amputating diabetics’ feet told me all I needed to know about the President’s true feelings. I’m not with the “Party of No.” I’m with the “Party of Hell No.”

  • Philip

    Totally agree…couldn’t have said it better!

  • Matt

    He’s probably looking at the evidence of the past attempts at the liability reform physician groups have proposed a/k/a caps on damages, and seeing that it has not been shown to reduce healthcare costs in the least, or “defensive medicine”, or testing of any kind, and so can’t figure out why he would limit people’s rights even further just to save some liability carriers a few dollars.

    Just to throw the physicians a bone? Let’s toss out a constitutional right just so physicians get a feel good measure that does nothing for them or the public? Perhaps he’s not listening to you because you want legislation that does nothing for you, so why should anyone take you seriously? Instead of things that might actually affect your lives, like payment reform, this is what you’re worried about.

    Or maybe he’s heard physicians’ anti-government in healthcare cry, and he’s decided that they’re right. And if government can’t be trusted to handle healthcare, why would we let it decide the value of lawsuits when none of the politicians has heard the evidence?

    All viable reasons for not making the lives of those injured by malpractice even harder in the name of insurer profits, I would say.

  • ninguem

    MatthewBowdish – This President is a huge diappointment

    I’d say he’s performing exactly as advertised.

  • http://www.futurewaredc.com Chuck Brooks

    Doctors are no longer relevant, just as customer/patients are assumed to be passive. It’s not about health insurance, either acturial or entitlements; it’s all about raw political power. Today it’s doctors’ charges; tomorrow it’ll be about the imagined high price of plastic for the prescription containers, leading to the petrochemical industry, and from there to the stars.

  • Scott

    I honestly couldn’t agree more. I’m a young physician still in residency and finally starting to see what it’s really like to practice medicine. Although I’m still fairly sheltered in my training, it’s very disheartening seeing our president’s treatment of physicians and it scares me to think what could happen if we are treated with such disregard in the future. Certainly the field won’t be attracting the best and brightest.

  • RRheuma

    Have you been following this healthcare reform debate at all? Obama did offer to include malpractice reform in the agenda, right in front of a meeting with Republicans, and in his speech in front of the AMA. It was Republicans who spurned this gesture, choosing instead to pick the path of misinformation, fear, and stonewalling.
    Even if a healthcare bill with every Republican talking point were written, Republicans would vote against it, in order to see healthcare reform fail under the Obama presidency. Republicans have once again put party above country, and our country, physicians and patients will suffer for it.
    You want to see how insurance company, pharma, and hospital CEOs continue to marginalize the physician-patient relationship in medicine? What what happens now that hope for serious healthcare reform crumbles.

  • http://drpullen.com Edward

    The biggist issue facing the US move to reform health care is cost vs. autonomy. It’s all about money on the one hand and patient and physician individual choices on the other. With an employer based system the cost of our services and goods is not competative, but patients or employers have more choice. With defensive medicine incentivised by trying to avoid malpractice court and no incentive for primary care physicians to take the time to manage patients without CYA tests and consultations costs escalate. With our insurance functioning not as insurance to avoid economic disaster, but as prepaid comprehensive medical care the patient has no incentive to contain costs, yet the attempts by insurers to limit costs are despised by patients and phsicians alike as trying to take away our autonomy. Essentially every other developed nation has a single payer government funded healthcare system, with less patient choice, less physician autonomy, and lower overall cost. I don’r really think we can have it both ways, with costs limited and patient choices and physician autonomy minimally limited.

  • David

    I honestly laugh just before I get enraged when I even hear the term healthcare reform. This had nothing to do with reforming the corrupt system of insurance care rather it is just another ploy to make people dependent on the government and less responsible for themselves. Several issues that need to be addressed but never will because so many hands are in the pockets:
    1: The total amount of time and money wasted on 3rd party parasites such as state boards who do nothing to protect the doctors, state insurance boards who never confront the insurance companies, the ridiculous process of having to be re-credentialed every year even though nothing changes, the changing of codes every year , and much much more.
    2: The ability of insurance companies to disregard state practice acts and to further their agendas by relying on case laws. Why do I pay the state license fees for services I can not be reimbursed for by the monopoly of BCBS? Same holds true for “capitated sites”. It makes no sense for me to have the expense of an xray machine in my office when I can not charge %75 of the insured patients that I see.
    3: The unscrupulous tactics of insurance salespeople who sell policies without explaining exactly what they entail , but tell people they are “covered”, which can mean anything.
    4: The ability of an insurance company to increase premiums and copays and yet reduce their reimbursements to providers. Why is it that the same insurance company can offer different plans, even through different sub companies, and demand that I take differing amounts to provide the same service?
    5: The Non-Profit abuse needs to be addressed. Why do these companies who molest the non profit status but pay out tens of millions of dollars to executives get to run roughshod over everyone? Why does Blue Cross need to own the best property in every city, or have billboards on stadiums, ads on buses and all of the other wasted fanfare?…because by spending money it allows them to pay more to the top.
    6: Where in the constitution does it provide for the right to try and hit the medical jackpot? Does my right to pursue happiness get trumped by some lawyers right to roll the dice? The only reason tort reform doesnt bring down costs is because, once again, the insurance companies are in the driving seat. Has anyones insurance gone down since the seat belt nazi’s where unleashed? Do you pay less now with passenger side airbags, safer cars or laws restricting cell phone use? Frivolous lawsuits do not deter bad practices nor promote better outcomes.
    7: Medicare and medicade are simply a joke. Who can understand what is expected, required or illegal when you have to deal with reps on the phone who have no stake in the matter except to put in their 20 years and get a fat pension. I could visit the Chinese governments website and probably learn more about rick shaw repair than I could visiting CMS to find out what modifier to use for my increasing , government driven headaches!
    8: The stark laws need to be reviewed. The incestuous practice of in house referral merry-go-round is an ever increasing problem. This is paramount to the oil barons controlling every aspect of oil production…from owning the wells, to making the barrels to housing the employees….The PC sends the patient to the radiology department of the hospital they are affiliated with only to get back results which are then sent, along with the patient to the specialist who then refers them to pt,rt or some other therapy that they either own or are affiliated with.
    I am sorry for my rants, but not for my passion. As the original article pointed out, why is it our voices are not heard? How did we tumble so far down the ladder that we are sitting back, waiting for our lives to be dictated to us?
    Perhaps we are the sickest of the bunch?

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Maybe because those of us who have been-there-and-done-that are not saying what the President wants to hear?

    http://drjshousecalls.blogspot.com/2010/02/national-health-services-corps.html

  • http://beccacamp.tumblr.com Becca Camp

    Here we see an example in which doctors are “part of the problem”. If indeed doctors are prevented from practicing medicine as they were taught in med school, and if indeed the culture of medicine results in the inability to deliver the best care to patients, how can the most influential and knowledgeable people in the health care field not be moved to try and overcome this? Attributing an epic failure to our President seems irresponsible.

    I do not abandon the efforts to reform health care through legislation. But I do support the mobilization of doctors and patients to begin the transformation of health care from the inside.

    A solution that would scale: training our physicians in humanities and the art of care delivery, starting in pre-medical undergraduate education. Change medical school curricula to operate in the realm of innovation and awesomeness. And, as a first step, engage and network future doctors who want to see a change in the status quo.

  • David

    Becca, those are fantastic ideas, but what anyone learns in school or in practice is rendered obsolete by the insurance companies.
    The problem is that the “most influential and knowledgeable people in the health care field ” are beholden to these very same insurance companies, insurance panels and the legislators themselves.
    As Chiropractor I have watched my state association exert three times as much energy to protect itself than it does looking out for the welfare of its members. As a board member, I met with my counterpart from the states medical association and found that the same issues applied to them.
    Legislation does nothing but line the pockets of legislators and lobbyist. The insurance industry has much more money to spend than all of the health care providers combined. That combined with the slow, almost gentrification like brainwashing of the public to expect their health to be paid for by others, is almost making the actual providers obsolete.
    One alarming trend I see within almost any discussion about healthcare is that every example is the extreme. The discussion seems to always point to 9 year old Sally who can’t afford a liver transplant, or Ed, the eighty year old who can’t afford his heart medication. What about all of the people in between? Nearly every policy being sold anymore is catastrophic care. The high deductibles and copays are understandable if a chainsaw is dropped on ones foot, but they create a terrific barrier to catching problems before they get to the end stages and run up costs.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Becca, I am sorry. I have been writing government officials and politicians for twelve years about what happened to me in public service. Pleading for help. I should have been invited to testify before Congress a very long time ago.

    I do agree with you on one point. The people that are supposed to be “representing” the rank and file sold us out long ago. The “advocacy” arms of the AMA/various medical society should do something more than turn a blind eye and a deaf ear – just for a seat at the President’s table.

    My situation, which could have been fixed with a few well-placed phone calls in the very beginning, could STILL be fixed if ANYONE ANYWHERE would enforce what is ALREADY law.

    So PLEASE do NOT preach to me about innovation and fighting the status quo. Because my battle scars in that department are fairly deep and some of the wounds still bleed.

    Since the days of Hillary’s village, I’ve been listening to smug Democrats (a good many of them lawyers) tell me that my profession is selfish and we need to sacrifice more to serve the common good. They’re all full of “great” ideas, but they do not want to hear anything that might tell them they are wrong. Obama is the latest and the worst of the whole bunch – behaving like some two-bit, third world dictator when it came to almost cramming a healthcare bill that almost nobdy had read or even understands down our throats.

    And I, for one, am sick of it:

    http://drjshousecalls.blogspot.com/2010/01/obamas-first-year-way-too-much-time.html

  • http://wsj.com DrJM911

    OK, here’s a quiz.
    All of you out there who received a call over the past 12 months from Nancy Pelosi or Harry Reid asking for your comments regarding “Health Care Reform,” including what Congress might to to ease the daily burden of your work raise your hands!

  • Primary Care Internist

    A call from pelosi or reid? on the contrary, pelosi slipped into the healthcare bill a provision that disallows caps on attorneys’ fees in any pilot project on malpractice reform.

    What a huge disappointment all of them are. Although I could’ve told you that BEFORE the election. Just like now, how much a politician (campaigning or already in office) talks is directly proportional to how much he lies, and inversely proportional to how much he knows.

    This administration is bought and sold, perhaps even worse than the Bush white house.

  • Matt

    “on the contrary, pelosi slipped into the healthcare bill a provision that disallows caps on attorneys’ fees in any pilot project on malpractice reform.”

    Aren’t physicians looking to have the government get out of the way when we are talking about what they charge? Why would they want to encourage the government to get involved in other private contracts if so?