September 5, 2011, Labor Day
First posted on MedInnovation Blog
Since my book The Health Reform Maze (Greenbranch Publishing) was published in August, I’ve been asked to write or speak about the present status of health reform and what lies ahead before three national audiences.
I puzzle how to do this.
Unpredictability of Health Reform
He who thinks he can predict health reform’s future has a fool for a prophet.
Current political and reform uncertainties make predictions foolhardy. Given the current climate of joblessness, hopelessness, and unhappiness, there’s a 50/50 chance President Obama will not be re-elected, a 50/50 chance the Supreme Court will declare Obamacare unconstitutional, and a 50/50 chance the present health law will not remain intact.
Two Physician Foundation Surveys
Whatever and however one thinks, the new health law and private reform pressures mean private practice will never be the same again. According to a Physicians Foundation October 2010 survey of 100,000 doctors, “Health Reform and the Decline of Private Practice,” the clear majority of physicians do not approve of the health reform law, believe reform will increase patient loads while decreasing financial viabilities of their practices, will reduce patient access to their practices , will cause doctors to retire, not accept third party payments, or work part-time, locum tenens, or in concierge practices, and will harm quality.
A subsequent survey June 2011 “A Roadmap for Physicians to Health Reform” was even more pessimistic, It forecast physicians would be forced to care for populations, not individuals; compelled to join networks, groups, or organizations; make them unable to carry on a “private” practice; require them to comply with a host of new rules and regulations , assume financial risks for outcomes beyond their control ; and end in a physician shortage, with older physicians retiring or cutting practices with other physicians seeking refuge in hospital employment with shorter hours.
Not a Pretty Picture
This is not a pretty picture. This demoralizes physician community. This portends more unwanted government intervention.
But this has not left us without options. We can still take a leadership role in shaping reform. No reform is possible without physicians to deliver care, no matter what the system.
In the course of writing 11 books and creating 1936 Medinnovation blogs on reform and innovation, I like to think I have done my homework and have something to offer physicians on how to right the reform ship.
But how? Health reform is devilishly complicated. Reform does not lend itself to simplistic solutions.
Then I thought of the 1969 book I’m OK, You’re OK by Thomas Harris, MD (1910-1995), a Sacramento and former U/S. Army psychiatrist who promoted the concept of I’m OK-You’re OK approach, a form of transactional analysis. He insisted this technique made feelings more accessible, guilt less oppressive, results more productive, and dealing with issues easier. The book is a perennial bestseller and is still in print.
Opening Closed Doors
That said, maybe I’m OK, You’re OK will help open the behind Closed Door Approach with questionable deals (Louisiana Purchase, Cornhuster Hussle, and UConn Conn) that rammed through Obamacare and poisoned the political process responsible for the bitter partnership we now see.
Here’s what I might say to physician audiences.
1) It’s OK for me and you to disapprove of Obamacare. So does the majority of the American public, who would like to see it repealed.
2) It’s OK for you and me to say: Yes, we need reform, but we prefer bottom-up to top-down reform, led by doctors and patients, not by government.
3) It’s OK to say we believe in patient, physician, and business friendly reform based on a American competitive model of free enterprise, free choice, tax credits for all, shopping across state lines, tort reform, and personal responsibility engendered by health savings accounts and private contracting between patients and doctors rather than a a quasi- European model based on conformity to government standards, micro-management of physician practices, and covert rationing.
4) It’s OK to object to backdoor government strategies for control of practices such as financial penalties for not installing EHRs or prescribing electronically, “Independent” unelected Payment Advisory Boards, and SGR formulas for controlling physician pay.
5) It’s OK for use to say repeatedly that the hidden costs of Obamacare and the uncertainties of meeting universal government health plan standards has caused businesses, large and small, to stop hiring until they see the final costs and consequences of the health reform act.
6) It’s OK to push ahead with disruptive practice innovations – such as telemedicine, Skype connections with patients, remote patient monitoring apps, and patient entered histories before seeing doctors in the exam room, and to promote innovations at the grassroots that make medicine more personal, more decentralized, and more responsive to the needs of individual patients rather to an overreaching government.
7) It’s OK to say we believe in the will of the people rather than the wisdom of government experts.
8) It’s OK to say that electronic medical records are not up to prime time, are too expensive, slow productivity, are often useless as communication tools, distract from the doctor-patient relationship, are designed by and for managerial and government nerds rather than physicians, and can be improved by introducing voice recognition apps that turn doctors into relevant story tellers and recorders rather than mindless data entry clerks.
) It’s OK to take every opportunity to remind the public, policy wonks, and politicians in private and public forums that the present health reform law has not and probably cannot deliver on its promises to cut costs, to salvage Medicare and Medicaid, to allow one to keep one’s health plan and one’s doctor, and to improve the quality of medicine. Meeting these goals will require persistent physician input and physician efforts to deliver patient-centered rather than government-dictated care. Take the lead, Open the doors wide.
Tweet: Physicians can take a leadership role in promoting grassroots reform changes by adopting I’m OK-You’re OK dialogue.
Richard Reece, MD is a pathologist and a longtime health care interviewer and commentator.