CNN op-ed: Health reform passes, but what’s next?

Welcome readers from CNN.com.

Health care reform passed the House last night, but that only marks a new chapter in the conversation to fix our health system, not the end of the debate.

CNN op ed: Health reform passes, but whats next?My take on health reform was published today on CNN.com. Much more work needs to be done to ensure that there is enough primary care access to meet the needs of the 30-35 million newly insured patients, and also to improve the plight of individuals harmed by medical mistakes:

[W]ith a critical shortage of primary care providers, these newly insured patients may have nowhere to turn for medical care. Massachusetts, the only state that offers universal coverage, suffers from some of the worst primary care wait times in the country despite having the highest concentration of doctors nationwide …

… [and] the mere $50 million allotted to medical malpractice reform doesn’t help patients hurt by medical mistakes, who are trapped in a dysfunctional system where one in six receives no financial compensation, the average case takes five years to resolve, and 54 cents of every awarded dollar go to pay legal fees. These individuals deserve an improved liability system that more fairly expedites compensation and helps doctors reduce errors and improve patient safety.

Enjoy the piece, and feel free to also read my other health reform commentary:

1. Should doctors support Congress’ health reform efforts?
2. Would I vote for the Senate healthcare bill? Here’s where I stand on reform
3. Injured patients deserve medical malpractice reform

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  • Ninah

    So what you were saying on CNN is that this Health Reform is problematic because it expands access to coverage for many more American citizens, and that puts a burden on a health care system that has a shortage of primary care providers, and too many medical students and new doctors choosing specialized medicine?

    So you favor a health care system in which fewer Americans can get medical care so it won’t be a burden on doctors?

    Maybe if more Americans get better preventative and early-stage care, there will be LESS of a burden on the medical system? Maybe if more medical students and new doctors who are truly concerned with helping people (and not just getting rich) see a system that is better providing for people in need, better allowing for regular checkups, preventative care, rather than an onerous system that disregards people, they will be motivated into general practice?

    Certainly, those doctors who worry about having to see patients that aren’t rich, worry about medical care not being limited to the most desirable patients with the biggest insurance payoffs, will simply be able to align their practices (continue to align their practices) with those concerns.

    • dizzle

      Hold up, are you a doctor? Did you get accepted to medical school, pass the 4 years of very rigorous (probably the most difficult doctoral degree) medical education, and endure 3-7 years of 80 hour residency weeks?

      Calculate the net worth of somebody that didn’t make money for all those years and incurred significant debt. Incorporate the taxes that physicians pay, also. (Yes, residency entails a small stipend but if you devote all of it to paying off debt, you still will be significantly in the hole)

      After devoting all those years to work, are you really that rich?

      “Maybe if more medical students and new doctors who are truly concerned with helping people (and not just getting rich)”

      dizzle

  • Doc99

    Don’t count your insureds so fast. There’s a significant lag time built into the bill.

  • http://www.skincancercenter.com Dermatologist Los Angeles

    @Doc99 is absolutely correct. This will take a while to move into motion. We’ll see how it shakes down.

  • D. Turner

    The CNN article mentions that 54 cents of every dollar awarded to a medical malpractice victim goes to pay legal fees. I would point out to your readers that this statistic applies to the SUCCESSFUL medical malpractice case, those where the court found that the doctor made a harmful mistake. The reason that it costs 54 cents per dollar of recovery to prove the case is that doctors unreasonably defend meritorious cases. The cost would go down if the doctors would admit their mistakes and make fair offers to pay the claims. Instead of recognizing this to be the solution, the medical malpractice reforms espoused by the doctors all seek to limit the compensation to the injured.

    • MillCreek

      I work on the defense side of malpractice claims. Not every mistake or adverse outcome reaches the level of malpractice. At this time, there is pretty much no such thing as ‘no-fault’ malpractice insurance. You have to be able to prove fault to a legal standard before being able to make a determination if the claim is meritorious. Many claims do turn out to be error that reaches the level of malpractice, and most insurers do settle those promptly.

      For the cases in which both sides do not agree that malpractice occurred and go to trial, physicians win about 70% (+/- 5% depending on your jurisdiction) of the time. Does that suggest that the original claim was not meritorious and the plaintiff attorney unreasonably brought the case? Those cases still have to be defended and incur costs for the insurer.

  • Mike87

    Where are the primary care physicians that the mandated-to-be-insured 35+ million are supposed to have access to now?

    I see a large disconnect between reality and fantasy. This bill is a stepping stone. But a lack of political cajones in combination with the culture of reactive care (not just health care wise, but in every facet of society)… truly a sad state of affairs for my peers in Generation Y as there will only be band-aids applied every so often.

    At the end of the day, the question remains… “Where is the money for this?” To steal from the hard sciences, the conservation of energy and mass remains constant. Finite resources demand prudent expenditure. The time and financial investment medical students put into their training demand fair compensation. You can NOT force someone to do a job (yet), so if the doctors feel they are not getting fair compensation for their services and time, power to them for leaving! It’s impossible to have a practice that is hemorrhaging money at every patient, you’ll be bankrupt, so how would your family feel?

  • http://fertilityfile.com IVF-MD

    During this battle I heard the supporters touting that passage of this bill would be a victory for the little guy against those greedy insurance companies. After all, they said, health care costs are too high because of those profiteering hospitals, insurance companies and pharmaceutical firms.

    The opponents argued something quite differently, that this bill was being shoved down the public’s throats by those very corporations lobbying the politicians, eager to reap a huge profit by enlisting the might of the government to take money from the public and force it to be spent on the hospitals, insurance and pharmaceuticals that the government directs the $$$ to.

    If the first scenario were true, you would except to see these companies stock prices reeling from the blow that now their profits would be cut and health care costs would drop and the public would no longer be hostage to those evil corporations.

    So is that what we see today? Heck, no.

    Health Management Associates and Tenet up more than 8% each!! Medtronic, St Jude Medical and pharmaceuticals all up nearly across the board. Surprise!

    While we don’t have any compelling photos of Reid, Pelosi and these companies’ CEO’s partying it up and giving each other high-fives over popped champagne bottles, and laughing about the gullibility of American people, I’m wondering what the people think now about this bill supposedly sticking it to those “greedy corporations”. Hmmm.

    Also, it’s important to remember that by the time our future generations are feeling the economic hurt from the repercussion of this legislation, these politicians will be safely out of office and drawing a pension and/or earning fat paychecks lobbying or “consulting”. Things make sense when seen in the light of basic human motivation.

    There is still hope in that websites like this one afford the peaceful free flow of information so that people can have their say and enlighten each other. Everyone has a say, not just politicians and the establishment. The mainstream media’s monopoly is crumbling. Newspapers which spew false propaganda are in danger of losing their power and credibility and that’s a very good thing for honest freedom-respecting people. Stay strong. There is still plenty of hope :)

  • amy

    “So you favor a health care system in which fewer Americans can get medical care so it won’t be a burden on doctors?”

    Actually, americans get more medical care than people in other countries. The beauty of a truly efficient state system is that the waiting time is so long and the workers so rude that it discourages usage. In such a system, people who want faster and better care pay cash.

  • Primary Care Internist

    D.Turner –

    What about all the totally baseless cases that settle before trial because

    a) plaintiff-friendly venue (e.g. Bronx NY)
    b) lazy defense lawyer working mainly for malpractice carrier than the doctor
    c) paid-off professional “expert” witnesses who make 10x as much money testifying as they do seeing patients
    d) elderly or infirm physicians, possibly foreign with thick accents who won’t sound as pleasing to the ear as John Edwards and co.

    Remember, John Edwards amassed a fortune of over $25,000,000 suing OBs for what is universally regarded as “junk science” now. We all know what a stand-up guy he is, now don’t we? And what about all those OBs – why is nobody suing Edwards on behalf of them as a class-action? Because lawyers find ways to protect themselves and their payday, even anticipating their own unethical behavior, all the way through to the top, to the hallowed halls of Congress.

    I would say 54% is an underestimate, particularly if you factor in the fees that go to DEFENSE lawyers too. Remember, their golden paycheck also relies on the current system. They’ll never cry for tort reform either, for that reason.

    Of course, there’s an easy way to compensate genuinely injured patients and protect doctors against baseless suits – eliminate contingency altogether; have a reasonable hourly rate ($75/hr?) to the lawyers with a “loser pays” rule. Of course, this’ll never happen either, as some guys will lose big:

    http://www.fitzinjuryattorneys.com/
    http://www.nydailynews.com/opinions/2010/03/22/2010-03-22_the_911_lawyers_deserve_praise.html

  • Mark

    I’m going to try to do some simple math here. Bear with me. 30 million newly insured. Static number of primary care providers or slightly *less* assuming some element of truth to the NEJM frightening statistic of early retirements/career changes for physicians, etc. Wait times to see primary care physicians…go..up? Or down? Hmmm..just can’t wrap my head around these numbers here.

  • DJ

    The situation right now were I practice is not good. There are not enough primary care doctors even now, and if you don”t want to wait a couple weeks for an appointment, you have no option but to head to one of the local urgent care facilities, or the more expensive emergency room.

    Thus, the local Urgent Care facilities are often swamped with 2-4 hour waits, because in order to make any money (their raison d’etre) they will only hire one Doctor to staff them at any one time (at least that’s the way it works around this part of the dying rustbelt Midwest… with very high unemployment and medicaid HMO’s making up a good part of the ‘insured’, most of which are either of uneducated Appalachian heritage or poor urban Black.)

    The situation now will only get worse, so I suspect there will be a push to open more urgent care facilities to meet increased demand. This is problematic because they can’t provide the quality continuity of care that’s required to manage any chronic illness. It’s only for episodic, acute care, but that’s a concept many people don’t fully comprehend.

    This is really going to be messy for a while. I don’t envy those who work in urgent care… as it’s going to become a nightmare for a single Doctor to try to see everyone in the community who gets sick acutely, especially during the Flu season, etc, until they can expand the numbers of PCP’s working in the trenches to take some of the load off.

  • hawk

    Dj

    You dont understand the beauty of the socialist system. there will not be any more doctors, because now the politicians can say that THEY gave everybody insurance, and it is the greed of those in the health profession who are not content to see patients for the measly, unrealistic fees they provide with that insurance. once again, we will be portrayed as the ‘bad guys’ to the american people. and you know that, they will believe it, because in todays beyonce, hip hip world, the concept of sacrifice and working for what you achieve or want just does not exist.

    I have worked in other countries under a socialist system, the access to care there is by limiting the number of providers in the system. who cares about the wait, health care is a fixed cost, and the person who has to wait six months to be seen by a limited number of providers is somebody who may potentially die or be foisted onto next years budget. These are countries where you often wait 6 to 12 years to gain the status of ‘attending’, and while away the rest of your time at residency wages in the hospital system.

    Oh well, it is what the people wanted.