Op-ed: Health reform is missing malpractice and primary care fixes

The following op-ed was published on March 22nd, 2010 in CNN.com.

With health reform passing the House, a comprehensive overhaul of our health care system draws another step closer.

Coverage will expand to cover nearly 95 percent of legal U.S. residents. With a recent study showing that patients without health insurance have a shorter life span, coupled with the number of uninsured approaching 50 million in 2010, that is perhaps the biggest reason to cheer.

But with 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.

Health reform tries to help, mostly by modestly increasing both Medicaid and Medicare payments to primary care clinicians. But it’s not nearly enough to convince medical students, already grappling with crippling school debt, who continue to gravitate toward lucrative specialty practice.

And what about the current primary care work force, where, according to a study in the Annals of Internal Medicine, more than a quarter of doctors reported being burnt out and 30 percent indicated they would leave the field within five years? Health reform gives few solutions to alleviate the bureaucratic obstacles and time pressures that frustrate doctors and impede their relationship with patients.

Finally, 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.

Although it’s worth celebrating that the United States is close to joining the rest of the industrialized world in providing near-universal health coverage, the health reform conversation must continue — both to improve the plight of injured patients and to ensure that the millions of newly insured have access to quality primary care.