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Health-Care Reform Must Include ‘Basics’
By JOHN D. KELLY IV, M.D., For The Bulletin
I applaud President Obama’s fervor and resolve for improving health-care delivery in this country. However, any mention of substantive health-care reform must include several key elements; otherwise it is doomed to be merely “window dressing.”
Accountability: Health-care coverage has simply become too “cheap” for Americans. Patients devour health-care resources needlessly — because they can. I regularly see patients who fully recovered from an injury but “kept the appointment anyway.” There is no consequence for over utilization of services. Only when individuals become more accountable for their health expenditures, will we see considerable savings. If Americans have any measurable control over their health-care costs, savings will naturally follow.
Malpractice Reform: Most Docs find themselves subconsciously ordering tests and procedures for fear of litigation. Current bills in Congress advocating health-care “courts” to settle malpractice claims and “safe harbors” of practice, are truly on the mark. However, without caps on pain and suffering for malpractice awards, the gains in savings will be meager. Caps have literally transformed the practice environment in both California and Texas. The evidence for their effectiveness in transforming health-care “cultures” is overwhelming. We, as a country, can simply not afford to continue with the status quo.
Incentivizing: The current health of Americans is deplorable. There is no incentive for the attainment of health and wellness. Only when Americans become more responsible for their health and well being will we see a change in behavior. Just as good drivers get rewarded for safe driving records, so too should Americans be incentivized to stay fit, obtain preventive services and think twice about what they are putting into their bodies. A reduction in insurance premium for smoking cessation would effect positive change beyond measure.
Eliminate the Middle Man: Doctors, not bureaucrats, should make medical decisions and the layers of bureaucracy the system endures is simply not sustainable. In an effort to save costs, insurers have added layers and layers of “pre-certs” and “approvals” before tests and procedures are allowed. The costs of this “ultra-regulation” are needless. Let doctors care for patients and allow them to prescribe what is necessary — not what will protect them from a lawsuit. Best practices are to be encouraged so that efficient and effective care is rewarded. If doctors are granted measurable malpractice relief and “best practices” are both publicized and promoted, we will see a precipitous drop in tests and extravagant spending. Unbridled utilization of technology will halt as docs already hold true that every ankle sprain does not need an MRI. Furthermore, if doctors were assured that potential savings on less utilization of excessive diagnostic tests would be passed on to providing for the poor and less advantaged, the insurance “crisis” would be eradicated. Today, most know that “savings” are passed to insurance company profits — not for service to the needy. Left to their own designs, most doctors know which tests will truly potentially affect treatments vs. which ones are performed for “defensive reasons” or to “indulge a patient so they won’t sue me.” I cannot tell you how regularly I hear the refrain, “I wouldn’t normally order this test, but in Philadelphia (with its malpractice climate) I feel obliged to.”
Consider how many childhood vaccines for example, could be distributed with the $1,300 savings obtained by foregoing one unnecessary MRI?
Self-Regulation: For our part, health-care providers need to do a better job of “policing” themselves. Who better to recognize unfavorable behaviors than one’s peers? If a surgeon, for example, may not be acting in the best interests of his or her patients, fellow surgeons are obliged to address and correct the problem and discipline the offender, if necessary. The American Academy of Orthopedic Surgeons has been proactive in defining ethical and responsible care. It has released detailed standards of professionalism by which every practicing orthopedic surgeon is called to adhere to. Until doctors institute their own improvement standards they will continue to be subjugated to the whims and false notions of those less informed.
Culture: Any mention of health reform must address the degradation of values in this country. If government wishes to encourage health, it needs to reinforce the “fundamentals” — faith, family, self-care and respect for the dignity of each individual. With the abandonment of school prayer, the dissolution of marriage and less reverence for the dignity of the disabled and elderly, Americans have lost their “moral groundedness.” Consequently, we are seeing increases in anxiety and depression like never before. Children are eating themselves into oblivion to ease the pain that only a sound moral “center” and rich family life can bring. The incidence of diabetes is skyrocketing and the drain on health-care resources will be incalculable. Many of today’s youth are not familiar with the notion that only by living an honorable life will true self respect, and love, be gained. Only when the administration recognizes that getting back to the “basics” — the values which our forefathers treasured — will true health-care savings be realized.
Let the healing begin!
John D. Kelly IV, M.D. can be reached at John.Kelly@uphs.upenn.edu.
Accountability: Health-care coverage has simply become too “cheap” for Americans. Patients devour health-care resources needlessly — because they can. I regularly see patients who fully recovered from an injury but “kept the appointment anyway.” There is no consequence for over utilization of services. Only when individuals become more accountable for their health expenditures, will we see considerable savings. If Americans have any measurable control over their health-care costs, savings will naturally follow.
Malpractice Reform: Most Docs find themselves subconsciously ordering tests and procedures for fear of litigation. Current bills in Congress advocating health-care “courts” to settle malpractice claims and “safe harbors” of practice, are truly on the mark. However, without caps on pain and suffering for malpractice awards, the gains in savings will be meager. Caps have literally transformed the practice environment in both California and Texas. The evidence for their effectiveness in transforming health-care “cultures” is overwhelming. We, as a country, can simply not afford to continue with the status quo.
Incentivizing: The current health of Americans is deplorable. There is no incentive for the attainment of health and wellness. Only when Americans become more responsible for their health and well being will we see a change in behavior. Just as good drivers get rewarded for safe driving records, so too should Americans be incentivized to stay fit, obtain preventive services and think twice about what they are putting into their bodies. A reduction in insurance premium for smoking cessation would effect positive change beyond measure.
Eliminate the Middle Man: Doctors, not bureaucrats, should make medical decisions and the layers of bureaucracy the system endures is simply not sustainable. In an effort to save costs, insurers have added layers and layers of “pre-certs” and “approvals” before tests and procedures are allowed. The costs of this “ultra-regulation” are needless. Let doctors care for patients and allow them to prescribe what is necessary — not what will protect them from a lawsuit. Best practices are to be encouraged so that efficient and effective care is rewarded. If doctors are granted measurable malpractice relief and “best practices” are both publicized and promoted, we will see a precipitous drop in tests and extravagant spending. Unbridled utilization of technology will halt as docs already hold true that every ankle sprain does not need an MRI. Furthermore, if doctors were assured that potential savings on less utilization of excessive diagnostic tests would be passed on to providing for the poor and less advantaged, the insurance “crisis” would be eradicated. Today, most know that “savings” are passed to insurance company profits — not for service to the needy. Left to their own designs, most doctors know which tests will truly potentially affect treatments vs. which ones are performed for “defensive reasons” or to “indulge a patient so they won’t sue me.” I cannot tell you how regularly I hear the refrain, “I wouldn’t normally order this test, but in Philadelphia (with its malpractice climate) I feel obliged to.”
Consider how many childhood vaccines for example, could be distributed with the $1,300 savings obtained by foregoing one unnecessary MRI?
Self-Regulation: For our part, health-care providers need to do a better job of “policing” themselves. Who better to recognize unfavorable behaviors than one’s peers? If a surgeon, for example, may not be acting in the best interests of his or her patients, fellow surgeons are obliged to address and correct the problem and discipline the offender, if necessary. The American Academy of Orthopedic Surgeons has been proactive in defining ethical and responsible care. It has released detailed standards of professionalism by which every practicing orthopedic surgeon is called to adhere to. Until doctors institute their own improvement standards they will continue to be subjugated to the whims and false notions of those less informed.
Culture: Any mention of health reform must address the degradation of values in this country. If government wishes to encourage health, it needs to reinforce the “fundamentals” — faith, family, self-care and respect for the dignity of each individual. With the abandonment of school prayer, the dissolution of marriage and less reverence for the dignity of the disabled and elderly, Americans have lost their “moral groundedness.” Consequently, we are seeing increases in anxiety and depression like never before. Children are eating themselves into oblivion to ease the pain that only a sound moral “center” and rich family life can bring. The incidence of diabetes is skyrocketing and the drain on health-care resources will be incalculable. Many of today’s youth are not familiar with the notion that only by living an honorable life will true self respect, and love, be gained. Only when the administration recognizes that getting back to the “basics” — the values which our forefathers treasured — will true health-care savings be realized.
Let the healing begin!
John D. Kelly IV, M.D. can be reached at John.Kelly@uphs.upenn.edu.
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Beltway Bob wrote on Jan 24, 2010 7:26 AM:
The Institute of Medicine estimates there are 100,000 deaths a year from malpractice. But in 2008 there were only 3,613 malpractice payments in cases involving death. Only one in 25 malpractice deaths resulted in a payment! The ratio for malpractice not involving death was probably even lower.
So, is the real problem too many malpractice payments or too much malpractice?
We do need more accountability -- more accountability for physicians for malpractice. Only two percent of physicians have been responsible for over half of the money paid out for malpractice since 1990. Quite often these physicians have multiple payments in their records but no action to restrict or revoke their licenses by state medical boards. Licensing boards need to hold them accountable and start acting to protect the public from repeat malpractice. "