Stanley Feld M.D.,FACP,MACE
Shortly before President Bush’s state of the union address the AMA President Ronald M Davis M.D. published the AMA view of the state of health care.
The AMA is for universal healthcare for all.
“Every American deserves health care coverage, and we need to build on the strengths of our system to make that happen,” said AMA President Ronald M. Davis, MD “As the nation’s largest physician organization, the AMA is leading the fight to get all Americans covered through our Voice for the Uninsured campaign.” www.VoiceForTheUninsured.org
The AMA’s call for action needs to be implemented with a system that includes patients responsibility for their care, and ownership of their healthcare dollar. The healthcare model of a third party payer is an anachronism. It has proven to be inefficient, ineffective and abused by all the stakeholders. Patients are the only ones who can set up a competitive environment for other stakeholders. If the third parties (government or healthcare insurance companies) created incentives for people to take care of themselves to avoid the complications of chronic disease the cost of healthcare would fall dramatically.
Implicit in the AMA’s recommendation is the creation of government driven public service campaigns to discourage obesity, smoking, pollution, and other environmental hazards to health.
“A leading cause of rising health care costs is treatment for patients with chronic conditions such as diabetes and hypertension. “We need to make an investment in helping patients quit smoking, avoid alcohol abuse, improve diet and increase exercise levels, as these lifestyle changes will not only lead to healthier lives, but lower health care costs,” advised Dr. Davis. “National rates of obesity and diabetes have doubled over the past 25 years, if we can get folks off the sofa and away from the pantry we can reduce these growth rates.”
In the past I have outlined suggestions to decrease the complications of chronic disease. The key is to educate the patients so they are the “Professor of Their Disease”. In my view the government is trying to reduce costs by penalizing the wrong stakeholders. Physicians cannot afford to care for Medicare patients’ because overhead is rising and reimbursement is falling. The result will be seniors on Medicare will not have access to care.
“Congress made a promise to America’s seniors to provide them with health insurance through Medicare, but that promise means little if seniors can’t get in and see the doctor,” said Dr. Davis. An AMA survey found that 60 percent of physicians would be forced to limit the number of new Medicare patients they can treat if the 10 percent cut occurs this July. “Medicare’s physician foundation is at terrible risk because of a short-sighted payment plan that will cut physician payments 15 percent over the next year and a half, beginning this July.”
At the present manpower levels America is facing a physician shortage. This physician shortage will become worse with Medicare’s reimbursement cuts. As practice cost increase it is impossible for physicians to afford investments in technology to create efficiencies in practice.
“Before the cut begins in July, Congress must take action to replace 18 months of cuts with payment increases that reflect medical practice costs. This will give Congress time to begin creating a new Medicare physician payment system that is based on medical practice costs.”
The AMA has outlined four broad strategies to achieve greater value for healthcare spending.
“The strategies are; reduce the burden of preventable disease; make health care delivery more efficient; reduce non-clinical health system costs that do not contribute to patient care; and promote value-based decision-making at all levels.”
The healthcare system needs governmental support to promote these strategies as well as the introduction of more innovative strategies. Andy Grove, ex CEO of Intel spoke of some innovative ideas that can be achieved with available technologies.
“The cost of caring for the elderly is huge and will only grow as our population ages. Of the $440,000 the average American spends on health care in his lifetime, $280,000 will be spent after age 65.”
Some say the longer people live the more they cost the healthcare system. This is a glib remark. The real issue is the better a person’s quality of life, the less ill those people will be, and the less they will cost the healthcare system.
I believe this is an underestimate of spending after age 65. Most people would like to stay in their own homes and be independent as long as they can. Present day technology can help make that happen.
Probably 50% of that post-65 outlay goes to assisted-living facilities and nursing homes. So it stands to reason that if there were a way to keep elderly patients in their own homes longer – without degrading quality of care – we’d have a cheaper and better system.
“I’m talking everyday, low-cost technology – the sensors, microchips, small radios you’d find in today’s PCs, in cell phones, and in Bluetooth earpieces. It’s not too difficult to use this stuff as monitoring tools. Not to spy, but to detect trouble. For example, did the patient go outside to get the newspaper or did she wander away? Has the patient taken his meds?”
Would seniors be opposed to this surveillance? I doubt it. Can these tools be used as teaching tools for a motivated population to maintain health and avoid the complications of chronic diseases and subsequent assisted living? Does Medicare, the provider for most seniors have any interest in supporting initiatives such as this? We have not seen any sign of it. The initial reaction is these maneuvers open the door to more bureaucracy and subsequent abuse. I do not think so. If patients were in charge of their healthcare dollar and were responsible for their healthcare expenditures the system would be efficient.
“Can we afford all this? Let’s do the math. In my estimation, the ER plan can be implemented for $20 billion per year, paid for with the 1% surtax I suggest. As for the elder-care plan, the savings achieved by keeping just 10% of the aging population in their homes can amount to a savings of $30 billion a year.”
America must afford innovations that can save $30 billion dollars or more a year. The more people are kept out of nursing homes the more money would be saved. It would also force the nursing homes charges to decrease.
The Presidential candidates have not introduced this or any obvious innovative solutions to Repair The Healthcare System.