Monthly Archives: October 2011

Where Does Medicine Go From Here?

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In my most recent post “The Last To Know” http://www.spiritofhealthcare.com/?p=246 I pointed out how both the general public and the medical profession are being controlled by a growing government healthcare system that robs both parties of their freedoms to use their own judgment and to determine their own fate. To suggest that this is basically an addiction may have seemed a bit extreme to some, but I believe its true nonetheless. Addiction is defined as “a strong and harmful need to regularly have something or do something.” It doesn’t have to be a drug. How about being addicted to a regular, all be it declining, government or insurance paycheck?

Physicians have traditionally been fairly well compensated for their efforts and thus have enjoyed many of the comforts of modern life. Most would agree that this is the result of years of hard work, perseverance, intellect and dedication. In general these are also traits along with professional integrity, which have raised physicians to a position of relative prominence and trust within our society. But in recent years that social position and economic security have begun to decline as healthcare services have come to be characterized as a basic human right. This philosophy is the direct result of various third parties becoming interposed between the patient and their physician for the sole purpose of guaranteeing payment.

Whether the payer is Blue Cross, Aetna, or the government, the impact is the same; the third party ends up influencing medical decision making, ultimately to their own ends. About 9 years ago I made the conscious, all be it impulsive decision to resign from every private insurance contract. I believed then, and still believe today, that these contracts with their pre-authorizations and denials of payment were inappropriately influencing a wide variety of medical decisions. Plus, under these contracts I had no say in determining what the actual value of my services should be. I was essentially an employee of the insurance companies since they were the ones who paid me, according to their fee schedules. So I quit, and boy did everything change. I was suddenly “Out of Network,” the equivalent of a medical “Scarlet Letter.”

Almost immediately most of my referring physicians quit sending me patients. I had worked with many of them for 20 years or more. In many cases I‘d provided surgical care for their family members and even the docs themselves. When I asked them why they stopped sending patients my way the answer was “You don’t take insurance.” I tried to explain, “I still file claims for patients, I’m just not bound by the insurance companies’ fee schedule, which means I have the freedom to individually contract with each patient.” This concept seemed beyond the grasp of many who somehow believed it inappropriate for a physician to actually bill the patient directly. Others offered words of encouragement with statements like, “I wish I could do that, but my practice is different.”

Perhaps the most enlightening moment of my professional career occurred a few weeks after dropping off the insurance roles. I had two separate patients call and tell me they wanted to come to me for their elective surgery but they said they “couldn’t.” I assumed it was because they couldn’t afford to pay me. When I explained that I’d be willing to work with them on my fee they both issued the same rather startling statement, “My insurance company won’t let me come to you.” What? That’s right! Since I wasn’t willing to play by the companies’ rules, they were going to do whatever they could to ensure that their policyholders didn’t become my patients, even if they had “out of network” benefits. I wondered, was this some form of coercion to force me back into the fold or was it just a prudent business practice? Either way, it was clear that they controlled the patients and if I wasn’t willing to play by their rules I would have a tough time seeing enough patients to maintain a viable practice.

One afternoon as I was rearranging my office I happened upon my framed copy of the Fellowship Pledge of the American College of Surgeons; something I had recited many years before upon induction into the college. As I read it again I was struck by the third paragraph, which began, “Upon my honor I hereby declare that I will not practice fee-splitting.” Obviously, this was written nearly a century ago by the founders of the college as they formalized the basic principles of conduct and ethics they wanted their Fellows to abide by. Splitting one’s fee with another doctor in order to secure a referral was considered unethical, so the college included specific language in this pledge, emphasizing that such behavior would not be condoned. As I pondered this idea, it occurred to me that the reason I was no longer seeing insured patients had nothing to do with my skills, bedside manner, reputation, availability or even my fees. It was because I had the audacity to tell insurance companies that I was no longer willing to “split my fees” with them.

In 1913 the leaders of the surgical profession considered fee splitting to be unethical, but is it really still an issue of ethics today? If not, why not? Over the last few years I’ve asked many of my colleagues that question, and I typically get a nod of agreement, or some actually say, “You’re right, but that’s just the way the system is today.” Perhaps this is in part because for decades our leadership has spent most of its time and efforts lobbying our government for more crumbs from their healthcare budget. (Payments to physicians account for only about 12% of Medicare payments) What they should be demanding is a return of the basic American freedom that would allow all physicians to determine their own fees for the services they provide. Instead, our organizations, led by the American Medical Association, have actively participated in the actual creation of the current payment system based on fixed fees, which are solely determined by the government based upon its willingness to allocate resources. No other component of our economy, and no other individual professionals are subject to this level of government control, so its not surprising that the best and the brightest of our nations youth are choosing careers other than medicine.

Perhaps organized medicine may have finally begun to challenge the status quo. At the annual meeting of the AMA in June of 2010, a resolution was passed by an overwhelming margin calling on the AMA to write its own legislation that would allow for physicians and patients to privately and individually contract for healthcare services within the Medicare program, without penalty to either party. The result is the “Medicare Patient Empowerment Act,” a bill, which is currently under consideration in both the US House of Representatives and the Senate. I’m not sure whether the delegates who voted to have the AMA take this unprecedented action actually recognized it or not, but to me what they were saying is that the key to the patient/physician relationship, traditionally the core of our American healthcare system, lies in the ability of both parties to deal fairly and honestly with each other without being inappropriately influenced by any third party.

Whether it’s Medicare, Medicaid or private insurance, all third parties have successfully interposed themselves between patient and physician, and over time physicians have become economically addicted to that system despite the massive regulations and impersonal controls they impose. While many are now crying out for “the right to privately contract” with their Medicare patients, and justifiably so, very few have actually seized that opportunity with their non-Medicare patients, even though to do so is perfectly legal. It seems that perceived economic security is indeed a strong opiate. Perhaps all physicians, as well as all our professional organizations, should step back from the pursuit of better contracts and more secure government payments, and reevaluate our true roles within the healthcare system. In doing so, one basic question must be asked – does contracting with third party payers, including government programs, actually constitute a compromise of our professional ethics?

 

 

 

The opinions expressed herein are my own and do not necessarily reflect or represent the policies or opinions of any medical organization or group.

Check out my web site at www.robertsewellmd.com

The Last to Know

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Have you ever seen someone walking down the street looking like they were in a daze; confused and disoriented? You know this guy is “on something.” If you ask him where he’s going he doesn’t know, but its obvious he’s just trying to find his next fix, or drink, or joint; take your pick. This is the difficult life of an addict. The sad thing is that everyone can see it except the addict. He is always the last to know, and if you ask him how it happened, he’ll likely tell you someone gave him his first taste for free. This is precisely the mechanism used to create a variety of “social” addictions in America. Various government programs have been created over the years, which offer to those “in need” something of value for free. Soon, the recipient of assistance no longer views it as a handout; rather it becomes something to which they believe they are actually entitled. But, for the government to provide a benefit to some of its citizens for nothing it must first take a comparable something away from others.

How can a government justify taking stuff (money) from one and giving to another? The argument often includes a not so subtle implication that those who have stuff must have gotten it illegally or immorally or because they were born into a position of privilege. Likewise, those who are “underprivileged” must be victims of bad luck or discrimination or oppression. The objective is to create a subconscious guilt among the “haves” even if they have no logical reason to feel that way, and a sense of entitlement among the “have nots” even though they have no right to what the government is offering. We are seeing this play out today on the streets of America in the form of “Occupy” everywhere.

In the last couple of years the process of addiction to government has focused largely on healthcare, but the problem is far bigger. Here in America we have created a society filled with countless “pushers” and “enablers” for everything from Federal unemployment insurance to backroom deals that loan millions to businesses building solar panels that no one wants to buy. But the unasked question is why? Why is this happening? At least in the world of drugs the answer is obvious – follow the money. It isn’t some malicious attack on our youth that motivates drug dealers to offer a kid his first taste of marijuana or crack cocaine; its the potential profits that come from the sale of those drugs once the user has been hooked. In the case of government offerings the real currency is not just money, its also political power.

Politicians have learned that the best way, and in some cases the only way, to get elected is to promise their constituents a government solution to a specific problem. The bigger and more wide spread the problem the more appeal the solution will have. Healthcare is a prime example. Everybody needs it, everybody thinks it is too expensive and they believe they can’t get it on their own. So, the adroit politician devises a plan that uses political influence to allocate public funds to pay for private services. To sell the idea he uses a highly emotional personal story about how Mrs. Jones was unable to see a doctor until it was too late. The narrative then follows, “How can we, the most prosperous nation in history, sit idly by and let this happen?” With the problem now well defined, the solution is obvious. The good guys in the white hats, government bureaucrats, must develop a complex system that keeps this from happening. Voila! – Medicare, Medicaid and now Obamacare, with the unsuspecting masses rapidly becoming reliant on Uncle Sam to provide for their healthcare services.

But wait! The government can’t actually prescribe you a medication or take out your appendix. Only a licensed physician can do those things, and those guys want way too much money, right? Enter government price-fixing and the entire system is now under the absolute control of politicians and bureaucrats. By way of demonstration, the single most common phrase contained within the new healthcare law (Obamacare) is “The Secretary of Health and Human Services shall…”

Most Americans and most American physicians have become addicted to the government healthcare system because we have empowered them to control the flow of our money. That control is maintained through a combination of political promises, continued emotional appeals and economic coercion. The modern phrase used to describe this process is social engineering, and healthcare has become the prime example of what is clearly an expanding phenomenon throughout our society.

Sadly, a side effect of any addiction is the individual’s loss of control of their own decision-making, but an even more important effect is the loss of passion and enthusiasm to be the best they can be. The cumulative effect of addictions is to make a person weaker and less self-reliant. This is precisely what is happening throughout America and, yes even in the Medical profession. It was that American spirit of self-reliance reinforced by the internal satisfaction that only comes from personal accomplishment that made this nation great. We are watching that spirit be systematically crushed by the social engineers who believe they know what is best for each individual and for society as a whole. And, like all addicts, the unsuspecting and overly trusting American people, along with their doctors, are indeed, The Last to Know.

 

 

The opinions expressed herein are my own and do not necessarily reflect or represent the policies or opinions of any medical organization or group.

Check out my web site at www.robertsewellmd.com

Medicare, Obamacare and the “Super Committee”

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In late July and early August the political wrangling in Washington, DC was in overdrive. President Obama, Mitch McConnell, the Senate minority leader, and John Boehner, the Speaker of the House were engaged in an historic showdown over raising the debt ceiling. The compromise they ultimately agreed to, authorized raising the debt limit by $1.2 Trillion, enough to avoid having this same issue come up again until after the 2012 election. It also required both the House and Senate to vote on a Balanced Budget Amendment, something that hasn’t happened yet. But, the most controversial part of this “bipartisan accord” was the formation of what has been called the “Super Committee” to find $1.2 Trillion from within the Federal budget to offset the agreed to increase in our national debt

This unprecedented “Super Committee” is comprised of twelve members of Congress; six Senators and six members of the House of Representatives, evenly divided with six Republicans and six Democrats. The party leaders from each house subsequently appointed the actual members. Perhaps the most controversial aspect of this mini-Congress is the agreement, which was made in advance, requiring the recommendations of the committee to be brought to both the House and Senate for an up or down vote without the possibility of any amendments. If the committee’s recommendations are not passed by the entire Congress, a mandatory $1.2 Trillion cut in Federal spending will automatically take place with half the cuts coming from the Defense budget and half from the healthcare budget (Medicare and Medicaid).

Obviously, this “Super Committee” has been given a unique responsibility and incredible power. Whether this form of governance is allowed for under the Constitution is another question, but their deliberations are already well underway. The deadline for this process to be completed is November 23rd, just one month from tomorrow. There has been much speculation as to what their recommendations will be, assuming these highly partisan politicians can come up with any cuts that a majority can agree to. The obvious and most logical approach would simply be to repeal the Patient Protection and Affordable Care Act of 2010 (Obamacare). It is the most recently enacted entitlement program and it has a price tag of at least $1 Trillion. For the most part Obamacare has not yet been implemented, so repealing it would not be removing any significant benefits that people have grown accustomed to, and the majority of Americans have opposed the law since long before Mrs. Pelosi told us “we need to pass it so we can find out what’s in it.” The House of Representatives has already passed a bill repealing the law shortly after the Mid-term elections when the GOP seized the majority, but the President and the Democrat majority in the Senate see this healthcare reform act as their landmark piece of Progressive legislation. They simply will not give it up as long as they are in control.

From a healthcare perspective Obamacare is not the only big issue in front of the “Super Committee.” For the last 13 years the Medicare payment system for physicians has been regulated by an incredibly arcane system ironically named the Sustainable Growth Rate Formula (SGR). It is neither sustainable nor growth promoting. (See The Future of Healthcare in America – May 27, 2011 http://www.spiritofhealthcare.com/?p=52) Under this formula Medicare payments to physicians are scheduled for a 29.5% across the board reduction on January 1, 2012. Every Medicare beneficiary would immediately feel the effects of such a draconian action by the government since many physicians would be forced to stop participating in the program all together. Even at current payment levels many physicians view Medicare as little more than a “break-even” proposition. If payments drop by 30% many will be forced to close their doors to Medicare patients, something that no one wants to see. Unless of course the real plan is to ration care.

To repeal the SGR and create an alternative physician payment system requires Congress to permanently wipeout the associated deficit, which has accumulated under the current system since 2002. That number is about $300 Billion. So for the Super Committee to include the SGR repeal in their recommendation would raise the total budget cuts required to $1.5 Trillion. (Isn’t it amazing how basic math has a way of eventually catching-up with you?)

A few months ago the Democrat party ran a television ad showing an elderly lady (gramma) in a wheelchair being thrown off a cliff, presumably by Representative Paul Ryan of Wisconsin. His budget proposal to rein-in spending and balance the budget would fundamentally change the Medicare program over the next decade. It is unclear whether Americans have the collective will to make any fundamental changes to our largest government program in order to save it, but one thing is perfectly clear. Given the likely inaction of the “Super Committee” and the vast philosophical differences within our current Federal government there appears to be little chance of avoiding the imminent collapse of Medicare. As bad as all this sounds, the economic and political turmoil we are currently experiencing trying to sustain the Medicare program will pale in comparison to what the next generation will have to deal with once all Americans come to realize we have purchased a European style healthcare system (Obamacare), with our once cherished individual freedoms.

 

 

 

The opinions expressed herein are my own and do not necessarily reflect or represent the policies or opinions of any medical organization or group.

Check out my web site at www.robertsewellmd.com

Creeping Socialized Medicine

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The impact of the Patient Protection and Affordable Care Act of 2010, commonly referred to as Obamacare is already being felt here in our community. Section 6001 of the act prevents physicians from owning hospitals in which they work. Our hospital in Southlake is a joint venture between Texas Health and a group of physician investors and under the law our ownership group is grandfathered, but we are prevented from expanding. In fact we had a $15 million expansion project ready to go last year but on March 23, 2010 that expansion became illegal. The logic used to support this part of the healthcare reform law was that physicians are basically unethical and will perform procedures on patients in facilities they own, simply for their own profit. Based on this hypothesis the law cost our local economy $15 million in new construction and approximately 75 new full time employed positions.

If we take a broader look at healthcare reform it appears to me we must first ask the question; is healthcare a basic human right and therefore the responsibility of government to provide for its citizens, or is it a benefit developed through the efforts of a civilized society, which is available to those who exercise their individual responsibility to obtain it. For the last 50 years our healthcare system has evolved without actually answering this fundamental question one way or the other. Instead, we have been attempting to provide healthcare using both philosophies. On the one hand, Medicare and Medicaid are basically government provided health insurance programs, and on the other, private insurance offers payment for healthcare services for those individuals who either purchase their coverage directly or receive it as a benefit of their employment. But in both instances, problems arise because there is a clear disconnect between payers, patients and providers. In the end the golden rule has once again applied. “Whoever has the gold makes the rules” including the federal government, and everything about their healthcare reform efforts ends up being more about how we finance healthcare than it is about quality or access to care.

Obviously my view of healthcare reform is that of a physician, not a politician, and even if I understood it all it would be impossible for me to summarize all aspects of the law so I’m not going to try. There are 10 separate titles in the 2,000 page law, and it is expected that by the time all the regulations are written they will easily exceed 100,000 pages. So, I think the best way to simplify it is to recognize that Obamacare is very much an expanded version of its predecessor, Medicare. And as the Philosopher George Santayana explained, “Those who do not remember the past are doomed to repeat it.” So, I’d like to offer a brief review of the history of Medicare, since it was enacted in 1965 as an amendment to the Social Security Act.

Medicare was originally touted as a government sponsored insurance program for elderly Americans that would take the place of employer-sponsored group insurance upon retirement. Very specific language was included in the original legislation preventing Congress from interfering with the free practice of medicine or regulating what physicians could charge for any specific service. But over the years, Medicare has evolved, and in 1984 The Deficit Reduction Act established a new process whereby physicians were required to declare whether or not they would “participate” in the Medicare program. In so doing, participating physicians were compelled to accept assigned payment by Medicare for any and all covered services, effectively eliminating their right to “balance bill” the patient for any amount above what the government set as an appropriate fee.

Then in 1988, in an effort to control the rising costs of healthcare as our population aged, and based on a Harvard work group recommendation, the AMA and virtually all its component member organizations agreed to work with the government to establish the Resource Based Relative Value System (known as RBRVS). Over the next three years a standard “Medicare Fee Schedule” was created under the guise of fairness. It further codified the government price fixing system for physician services. It is interesting to note that the country is actually divided into several different areas with somewhat different payment schedules based on regional differences in the cost of living. It is also important to recognize that in the wake of this action by the AMA, physicians began leaving that organization by the droves. Today, fewer than 17% of American physicians actually belong to the AMA.

In 1997 – Using the “Balanced Budget Act” Congress enacted further controls over physician payments by establishing the Sustainable Growth Rate formula (the SGR), which tied any adjustments to physician payments directly to how much money was available year to year. However, Congress failed to appropriate enough money to actually sustain the growth based on the increasing Medicare population and the unbridled demand for healthcare services. As a result, in 2002, The SGR called for an across the board reduction in Medicare payments to physicians of 5.4 %. But due to concerns that physicians would opt out of the Medicare system, Congress intervened at the eleventh hour to halt the cuts. From 2003 through 2010 the SGR mandated cuts every year of 3.3% to 5.0% but at the end of each year, just as the cuts were to take effect on January first, Congress voted either to maintain existing payment levels or increased them slightly.

Today the sum total of the required, across the board cuts to physician payments under the SGR is now up to almost 30% and continues to grow. As you may have heard recently on TV and radio, the AMA is calling on Congress to fix the problem permanently. Lawmakers are faced with either enforcing these legally mandated cuts the end of this year, or once again delaying their implementation for political reasons. They are not likely to permanently eliminate the cuts because to do so would require them to come up with about $220 Billion in a budget that is already deep in the red. But if they allow the cuts to go through it will precipitate a real crisis of physician unavailability. A recent Texas Medical Association survey indicated that nearly 50% of Texas physicians will consider dropping out of Medicare if the 30% cuts take effect. All this is taking place amidst the backdrop of Obamacare where the Medicare budget is being cut by another $500 billion over the next 10 years. Obviously, the only way that can occur is through implementation of more price controls, more participation regulations, less personal care and limited access.

I’m often asked why doctors don’t just opt out of the Medicare system and some actually have. While it is true that physicians are free to opt out of the Medicare program, it comes with a severe penalty. By law if a doctor makes the decision to opt out of Medicare, he or she is dropped completely from the program for all patients and must remain out for a minimum period of two years. Also, under the existing Medicare payment process patients are not allowed to obtain care from any physician who is outside the Medicare system unless the patient is willing to pay 100% of the physician’s bill. So, for doctors who opt out of Medicare few if any patients would be willing to pay for their services assuming they can go elsewhere and Medicare will pay for it. But sooner or later the inability of patients to find a doctor will be Medicare’s Achilles heel. People will eventually come to realize that this system of government coercion has robbed them of their fundamental rights to freely contract with their physician. In the meantime, most physicians feel trapped between their sworn oath to provide care without regard for payment, and the financial realities of meeting their payroll and making a living.

To address this situation the Coalition of State Medical and National Specialty Societies, a loose consortium within the American Medical Association pushed for a change in the Medicare law. This lead to a bill entitled the Medicare Patient Empowerment Act being authored by the AMA and subsequently introduced in both the House of Representative as HR 1700 and the United States Senate as Senate Bill 1042 back in May of this year. This bill attempts to fix the glaring inequities in the Medicare system by establishing a new payment option that would allow patients and physicians to independently contract for non-emergent physician services for a fee that differs from the fixed fees currently paid through Medicare Part B. Under this proposed law, Medicare would pay the same amount it would otherwise, but the patient and physician would be free to agree on any difference without penalizing either party. Every physician would be able to treat each patient individually, including having the flexibility to “write-off” or discount a portion of his or her bill based on an individual’s ability to pay. And patients would be free to negotiate independently with their physician ensuring continued access to those services. Under the current Medicare payment system none of this is legal and for a physician to do so invites prosecution under the fraud and abuse statutes. Most of us are not interested in a federal investigation or jail time so this new bill would be a welcome change if it were to be passed into law.

Obviously there are many other opinions on the issue of healthcare reform, but I believe the fundamental question remains unanswered in our country. Is healthcare a right, a privilege or a responsibility? I would simply say to those who argue that healthcare is a right, it then follows that the government is obligated to ensure that right, even if it means taking away your freedom to choose the when, what, where, who, and how you access your own personal care. And in the process of guaranteeing access, the government ends up taking away the rights of those who actually provide your care. Under such a system physicians simply cannot be allowed to use their professional judgment if it deviates from a government established “best practice” standard. Likewise, to remain within a politically determined budget, expensive treatments will ultimately need to be allocated based on a cost/benefit analysis. The end result is physicians and nurses will become government functionaries with salaries and wages fully regulated by the government.

I believe the best approach to avoid Obamacare becoming another creeping socialized medicine program like Medicare, is simply to repeal the entire law and start over with a patient centered approach that encourages individual control through personal responsibility.

 

 

The opinions expressed herein are my own and do not necessarily reflect or represent the policies or opinions of any medical organization or group.

Check out my web site at www.robertsewellmd.com

Getting More Healthcare Value

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How to Improve Our Nation’s Health and Lower Cost at the Same Time

As a physician I obviously see healthcare from a different perspective than the average American. Perhaps that is why I remain so frustrated over the politicization of what is actually an individual personal service. In recent years, healthcare has become a very emotional topic, generating strong opinions on all sides. Heated arguments continue over basic questions such as who should pay for it, who should receive it and who should profit from it. The American healthcare system has become a complex milieu with numerous moral, social and political overtones. Extremists on both sides of the political spectrum are so far apart they will never agree on any proposal. However, I believe that there is a way to both improve the quality of healthcare and lower the cost no matter who is providing the services or paying the bills; its called education.

This morning I was listening to a radio talk show when the host was explaining how the Taliban has systematically destroyed schools throughout Afghanistan, insuring the population remains uneducated and thus can be more easily manipulated. For centuries repressive regimes have recognized that the biggest threat they face is an informed and enlightened population. Whether by design or neglect, the American public is, by and large, uninformed and under educated in the basics of healthcare and thus  are more easily manipulated.

A few years back I recall hearing an ad for a discount clothing store that said, “An educated consumer is our best customer.” What they were implying is that informed consumers will naturally seek value for their money and this company believed they offered a better value than their competitors. Webster defines value as “relative worth, utility, or importance.” But the problem with applying the value logic to healthcare is the fact that most patients are disconnected from the process of determining value. Third party payers offer an economic buffer between the patient and the actual cost of a test or treatment. This third party payment system also offers an effective means of controlling access to healthcare services through contractual relationships with providers, and whether they acknowledge it or not, controlling access is used by payers as a means of controlling costs.

The only safeguard the average patient has is the moral compass of their doctor who has taken a solemn oath to put the patient’s interest above their own. However, since physicians are typically paid by third parties based on specific services they provide, it only follows that some, if not most, physicians tend to order more tests and perform more procedures than they would if the patients were actually paying their own bills. Many physicians agree with this assessment. In a survey published in the Archives of Internal Medicine, September 26, 2011, forty-two percent of US doctors believe that their patients are getting too much medical care, while 28% of physicians said they felt they were treating their patients too aggressively. Only 6% said their patients were receiving too little care.

Clearly, excess utilization is contributing significantly to the overall cost of healthcare, but before we put all the blame on those “greedy doctors” this is not the whole story. Patients often request or even demand healthcare services despite the fact that they may not be absolutely necessary. Likewise, the practice of defensive medicine has led to the routine ordering of costly diagnostic studies by almost every physician, just to avoid being blamed for not testing for that rare or obscure condition. Numerous device manufacturers, pharmaceutical companies and hospital systems have successfully marketed directly to the public with the universal call to action being “Ask your doctor about x, y or z.” Armed with this new information from a TV ad, patients go to their doctor requesting a specific treatment with little regard as to the cost. The only question the patient typically asks is “Will my insurance pay for it?” This is neither an effective nor appropriate way to control costs and ensure quality care.

Our current system is quite simply an unstable and unsustainable “three legged stool” with the patients, physicians and payers each appearing to have different incentives and objectives. A fundamental change is needed, and most experts agree that healthcare reform should focus mainly on putting the patient back in charge of their own decision-making. But for patients to assume responsibility for their own healthcare choices assumes they have a basic understanding of those choices. In other words, the general public must be empowered through education.

Healthcare consumers are obviously hungry for a better understanding of all things related to their health. Witness the popularity of web sites like WebMD, and television programs like “The Doctors”, “Dr. Oz”, “Gray’s Anatomy”, “House ” and many others. But these entertainment based programs offer only tiny snippets of information based on entertainment value. True health education should start at an early age with simple but effective lessons on how the human body works. As an example, a better understanding among school children regarding practical issues like nutrition and physical fitness would help reverse the rising trend of childhood obesity. Likewise teaching children how communicable diseases are transmitted would help them assist in controlling the spread of the common cold, influenza and various other illnesses. The program would need to be continued for Junior High and High School aged students as well. These should be required courses with the objective of making every American fully aware of the basics of human anatomy, physiology and common pathologies by the time they graduate from high school. Armed with this knowledge, individuals will be able to assess their own health related situations more objectively and become better value-based healthcare consumers as adults.

Obviously a “Health” curriculum already exists in both the public and private schools, but it is grossly inadequate. Most of our kids don’t study advanced biology and even those who do may have a difficult time making any connection between the dissection of a frog and their mother’s gallbladder surgery. To develop a practical program that can achieve this objective will require a shift away from the athletic coach or physical education teacher who may currently teach a class in Health. Practicing physicians and nurses should become actively involved in the development of a more robust and practical curriculum that would be appropriately entitled “Human Health Education – a Users Guide to Your Body.” The American Medical Association along with its various Specialty Societies is the obvious organization through which such an effort should arise. They certainly possess the knowledge and given their mission statement should have the motivation. http://tinyurl.com/3gzozcc

There is another major side benefit that would most certainly arise out of this practical health education effort. More exposure to the art and science of healthcare will undoubtedly renew enthusiasm for careers in nursing and medicine. In the past, most physicians encouraged their own children to pursue the medical profession, if not directly at least indirectly, through early exposure. However, in the last few decades that trend has been reversed, in no small part due to the negative impact of third party contracts and growing government regulations on all healthcare professionals. By revealing to all young people the vast wonders of the human body and how it works, many more will be inspired to carry on the traditions of Hippocrates and Florence Nightingale providing greater value and benefit to all Americans.

 

The opinions expressed herein are my own and do not necessarily reflect or represent the policies or opinions of any medical organization or group.

Check out my web site at www.robertsewellmd.com

The Buck Stops Here

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Harry S. Truman, the 33rd President of the United States took office in 1945 following the death of Franklin D. Roosevelt. He is perhaps best known as the man who ordered the dropping of the only two atomic weapons ever used in warfare; “Little Boy” on Hiroshima August 6, 1945 and “fat man” on Nagisaki three days later. The use of these two bombs, the only ones in existence at the time, brought an end to World War II. But what I prefer to remember Truman for is the sign on his desk, which stated unequivocally “The Buck Stops Here.”

In the turbulent years immediately following the greatest conflict in the history of mankind, America needed strong leadership and they had it in Truman. One can certainly argue that his post-war Truman Doctrine of “containment” with respect to communism, along with the Marshall Plan, which rebuilt Europe, were in large part responsible for the nuclear arms race, the “Cold War” and ultimately the Korean conflict. However, no one can disagree that he consistently acted with conviction and determination. He had a plan, laid it out clearly and then took responsibility for whatever the results. Where is that leadership style today?

I’m reminded of the theme song of the 1970’s sit-com “All in the Family” titled “Those were the days.” The lyrics told of a simpler time with more traditional values:

Boy the way Glen Miller played,

Songs that made the hit parade.

Guys like us we had it made,

Those were the days.

And you knew who you were then,

Girls were girls and men were men,

Mister we could use a man

Like Herbert Hoover again.

Didn’t need no welfare state,

Everybody pulled his weight.

Gee our old LaSalle ran great.

Those were the days.

 

 Leadership is an art form that includes possessing a vision based on unwavering principles, an ability to inspire and support others along with the instinct to know when to step forward, seize the reigns and provide specific direction. One could argue that Barack Obama actually possesses these qualities and he used them to get elected President of the United States. However, his campaign was long on inspiration but short on direction. All he promised was to “fundamentally change America.” Many people were anxious for a new direction and got caught-up in the “Hope and Change” without understanding the implications of the word “fundamentally.” Now we recognize that Mr. Obama’s unwavering principles are clearly different than those of most Americans and his direction for the country is not where most of us want to go.

Perhaps the most accurate statement that this President has made been since being inaugurated was “elections have consequences.” With those three arrogant words he polarized his opponents and helped launch a grassroots campaign that promises to set our nation on a different course following the next election. But who will step forward with a new vision? What will his or her principles be and how will we know if they are indeed unwavering? What will be the new direction for the American Ship of State? These questions must be asked of every candidate and the American electorate deserve and must demand straight-forward answers.

One thing is certain; the opportunity for true leadership has never been more obvious, at least not in my lifetime. Over the next few months someone will surely seize this unprecedented opportunity and we can only pray that person will once again place a sign in the Oval Office stating simply “The Buck Stops Here.”

 

 

The opinions expressed herein are my own and do not necessarily reflect or represent the policies or opinions of any medical organization or group.

Check out my web site at www.robertsewellmd.com