On Aug 28, the Obama Administration hosted a nationwide call-in for physicians, in which more than 1,900 physicians participated. It was said to be “closed to the press” so that a “conversation” could occur.
Much of the call was taken up by a primary care internist, now in the Office of Public Engagement, telling about her frustrations during her brief time in practice: a “treadmill,” phoning for preauthorizations, paperwork, no time to talk to patients, doing “the same thing over and over again.”
Because of this experience, she decided to go into health policy work. She says that “health care reform” is vitally important, “especially for the profession of medicine.” She claims that 12 million people are being denied necessary care, or losing their insurance, and that “we can’t wait any longer.”
Doctors were urged to visit www.healthreform.gov, to “resonate with the message,” and to correct the “myths that have been spread out there.” They should “talk about why this means so much to you” and about “taking back our profession.”
More than 400 questions were said to have been turned in, and diligent White House staff pored over them and sorted them into various categories.
A member of the White House Office of Communications warned of “misinformation” and “negative messages.” He thought that this call was like “preaching to the converted.” It’s all about healing and “making sure our health care system works.” But the past month of town halls has reflected “how emotional the issue is.” There’s “tremendous fear” resulting from “misinformation.” The Administration needs doctors to gain trust and credibility for its Plan. The “status quo” is what is driving the call for reform. Americans are receiving the best care, he said, whether they have insurance or not, but they have problems navigating the system. Out-of-pocket costs are more than they can bear, and they are omitting preventive care because of cost.
The essential consumer protections that he promised everyone will have after reform are: (1) No one denied coverage because of a pre-existing condition; (2) no one loses insurance because of illness; (3) everyone gets preventive care, such as an annual examination, without charge (“barriers”); (4) limits on out-of-pocket costs; (5) no lifetime caps on coverage.
Once “we pass it,” Americans will have security, stability, and peace of mind. We are “further along than we ever have been” toward “transformational reform.”
The communicators then considered the three most frequent questions culled from the 400 submitted.
Q: Once everybody gets disease care, what about improving prevention? A: We’ll eliminate copays. Prevention is the right thing to do, and there are some examples of cost savings. If all diabetics got the best care, we could prevent 40,000 hospital admissions per year.
Q: What about the SGR? A: Congress has fixed it yearly, “to be sure physicians are appropriately compensated.” A fix is “baked into the cake,” having already been factored into Obama’s baseline budget. But more basic change is in the works. Since fee for service “misaligns incentives,” we need to go beyond pay for performance and align incentives to put quality over quantity.
Q: How do we get young doctors to go into primary care? A: We’re already “investing” $0.5 billion through the Stimulus, even before health care reform. We’re expanding the National Health Service Corps, allocating $250 million for training nurses and physician extenders, and expanding scholarship and loan-repayment programs.
Doctors were invited to submit additional questions through public@who.eop.gov.
A few doctors were permitted to ask questions live. One concerned the Medicare Advantage program. Why were taxpayers supporting private insurers when the money could be better spent on the children? “Spot on” was the brief answer.
Another noted that Massachusetts was thinking of changing from fee for service to a global payment system. The answer was that a shift from FFS was in all the reform bills being considered, not just to save money but to enhance care.
A third asked about liability reform, and about the President’s statement that doctors got paid $50,000 for doing an amputation when Medicare only reimbursed less than $1,000. The response from the former internist was to express sympathy and to assure the caller that Congress was working very hard to assure that doctors could do what they were trained to do. We need best practices and better quality and error prevention. The President has listened to doctors and is sure we can find a fair and equitable solution if we work together. He has shown his consistent willingness to dig down and see what the drivers and stressors are. He is not in favor of caps, as he thinks these would be inequitable to some people. We should not misinterpret the President’s statement about the amputation; he meant system cost.
A fourth caller suggested a White House conference about end-of-life care in which stakeholders could reach a consensus. “It really riles me up to see the coverage of the death panels,” responded the former internist. Something that makes perfect sense to all the doctors she knows—just having a conversation with the patient before he gets into one of those situations—has been twisted and turned around, she said. The issue has come up time and time again in conferences with the White House.
A family physician from Wisconsin asked whether the value of preventive care would be recognized with health care reform. The answer is that it would be covered in all plans, Medicare, public, and private.
This call was one small part of the intense public outreach strategy of the Obama Administration. The intensity of protests at town-hall meetings was not foreseen. Despite years of polling and focus groups to find words that win over voters, “Obama allies find that words fail them,” writes Jonathan Weisman (Wall St J 8/25/09).
In particular, concerns about euthanasia and death panels were not anticipated.
Additional information:
The question is simple: Shall we abandon the best (though imperfect) system in the world for one proven totally unacceptable? Shall we drop the system most people like for a disastrously expensive universal Medicaid?
Th requirements proposed for private health insurance companies would put them out of business in a month. Ask anybody who has ever run a lemonade stand.
The internist representing Obama did not know how to do the business of medicine–at least according to her sound bites—hers was a wasted medical education–those of us who want to practice medicine find a way through the forest of finance and are reasonably happy in our profession–the idea of comparative effectiveness is only applicable to machine functions and not to genetic specfic individuals—
I was one of the few (400) physicians who submitted questions. Not one of my questions was asked or answered.
This was a propaganda exercise. I note that the “conversation” (one-way) was on an AT&T conference line.
Who paid for this propaganda? We did. With taxpayers money.
I found the “conversation” to be a one-way street and the physician policy-maker to be a misguided soul.
As always, the Obama Administration gives vague statements that can later be re-interpreted to the President’s advantage. Here’s an idea about Pay For Performance. Have the President sign a legally enforceable affidavit stating that, if passed, his legislation will effect these specific and desirable results by a clearly stated deadline–or he resigns and has to give back all his pay to the federal government. No, Mr. President? You won’t do that? Hmm. Maybe Pay For Performance isn’t such a good idea after all.
The hidden tax of cost-shifting and unequal reimbursements for the same work and uncompensated care in hospitals is never mentioned. Neither is the uninsurability of events certain to occur. We didn’t get into medical school because we were stupid.
This effort by our government is a good attempt to sell a bad product. It won’t work.
Commonsense rule:
Never try to change big, complex social systems through all-at-once, Big Bang, starry-eyed social re-engineering efforts, as the risk of adverse consequences is exceptionally high.
This is especially true when the changes are written by those with agendas and vested interests and are not vetted by those who actually understand and care about the above…
This whole healthcare “reform” effort reminds me of the inflexible, traditional IT development methodology and “big bang” rollout that attempts to change the entire culture of a healthcare organization [or country] in one fell swoop. These HIT efforts represent a microcosm of the problems of the larger effort at systemic reform now underway. Problem is, the “big bang” approach creates huge problems — as does anything that goes “boom.” Note what has occurred in the UK with their national IT program (summary at http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm ).
“Iterative and incremental development” is a term that holds the key to success in both the microcosm of Health IT and the macrocosm of healthcare “reform.”
Instead, we have a herd of raging bulls in the ancient dishware section of the Met.
Bookies should start taking bets now on the debacles this ill conceived, bull in a china shop, mass reform effort will create.
The Office of Public Engagement internist/shill gave the nonproductive, insane excesses of the managerial bureaucracy as her reason for wanting to support this “reform”. What she fails to mention, or perhaps see, is that the waste, fraud, inconvenience, misdirection and lousy service to both providers and patients that we see in the private insurance world is a result of the corporate world both imitating and being forced to follow the directives of government bureaucracy.
It would be a fatal error to to give a patient live, intravenous MRSA to cure a MRSA skin abscess, but what what this reform plan is, is a massive overdose of the disease we all are trying to cure. What we need is for government to pare back it’s bureaucratic leviathan to one vulnerable to MEANINGFUL feedback from the outside, and to have that government mandate the same changes to the private insurance industry. That will be a reform bill; this isn’t.
Excuse me, but we ARE PROFESSIONALS (although the Federal Trade Commission seem to think we are tradesmen subject to their control). Professionals are by definition paid a fee for their service to their clients (also known as patients, when the professional is a physician).
THERE IS NO OTHER ACCEPTABLE, ETHICAL SYSTEM.
Capitation (disguised as bundling of fees) is inherently unethical and can NOT BE ACCEPTED by physicians.
Why is anyone letting this concept go unchallenged?
HR 3400 (Patient Power, Republican bill) has Medicare & Medicaid option for $~2,000 deductible (1/3 cost) with deductible prepaid for the needy,
(if I heard rep. Dr Tom Price right, Thurs eve).
Let’s promote HR 3400, not just oppose HR 3200!
Cardiac surgeon John Garrett (C Span today) says his Virginia Med. Center gets 20% less than COST for Medicare and Medicaid patients, so
hosp practice as well as my family practice- happier with patient choice
How does Obama respond to Dick Morris’ comprehensive analysis of the health care plan-that there are not early sufficient number os doctors to care for an additional 47 million people, 25% of whom are illegal aliens?
How does he respond to Morris’ analysis that therefore there will have to be rationed care?
How about the fact that there will be significant decreases in reimbursements for physicians, and particularly for specialists, so that the high quality of specialized medicine in America will be destroyed because no one with any intelligence will pursue a course of medical studies for 5 years of residency and another at least 5 years of specialty fellowship training beyond 4 years of medical school with those hundreds of thousands of dollars of debts only to find that they cannot make sufficient monies as to cover debts and costs of practice?
Last weekend at the Ohio Dental Association annual meeting one of the speakers was a lobbyist for the American Dental Association. During the Q&A period I posed this question, “Nearly 20% of the Gross National Product goes to health care, what percent goes to the law profession and legal services?
The lobbyist did not have the slightest idea. Legal expenses and possible reform are not even on the table for discussion.
I suspect taxpayers pay a lot more to lawyers than to doctors every year, and don’t get as much bang for the buck.
If you add up med school loans, a later start in life, health risk, higher tax rate when receiving pay, lack of a public pension (federal employees), tort liability, stress, call requirements, may be prosecuted for making a mistake in biling, and time value of money, why wouldn’t every doctor aspire to be a health care administrator for the federal government with the fine skill of determining how to ration care? The return on investment of being an administrator would pose a problem for those wanting to take care of people or having a conscience.
Just where is this country going if Personal injury attorneys who receive windfalls for people suffering have more political clout (and keep tort reform out of bills) than Doctors who save people?
Most thinking Doctors will not be swayed by another outpouring of white house malarky. Yes paperwork is overwhelming and its all Government driven. More Government plans make it worse…not better.Besides, this is NOT about improving health care,….its ALL about increasing Government Power and Control.
Forty years ago our hospital had one(1) hospital Administrator and one(1) secretary. Thirty years later with no increase in hospital size there was a;CEO,COO,CFO etc etc and 35 employees in Administration to do the same job. Go figure.
I sent the following in via the website: Dr. Thomas: I believe the best proposal in Congress is the Patients Choice Act sponsored by Senator (Dr.) Coburn and Congressman Paul Ryan. See http://www.house.gov/ryan/PCA/. This proposal maximizes physician and patient choices and keeps big govenment involvement to a minimum. It is budget neutral. In addition, it increases market forces which will drive costs down. It stands in stark contrast to HR 3200.
Why is it that as physicians (non surgical primarily) we need to prove that what we do works through “evidence” or randomized controlled trials but policy makers dismiss and ignore evidence. I have spoken with residents of of France, England and Canada. These discussions and reading have revealed that those countries have skyrocketing health care costs and bureaucrats making decisions for doctors and patients. What arrogance those politicians have to think that a similar program will not do the same here! And our very own Medicare is unsustainable. President Obama admits that. And yet they call for more of the same, on a grander scale. I
I am an AMA member and plan to not renew. The members of Sermo, a larger organization are far more representative of physician views than is the much smaller AMA that support Medicare in the ’60s.
Let’s come out in support of the Patients Choice Act. Read it and see why it makes sense for us all.
http://www.house.gov/ryan/PCA/.
Dan Weiss MD CDE FACP PNS CPI
These above responses are outstanding, well-stated and truly “Spot-on”. Not big lies from hubristic politicians. Check out the Patients’ Choice Act of Senator (Dr.) Coburn and Congressman Paul Ryan! And tell your patients about it.
The above comments are very clear and state things the way they are. What it all boils down to is the thirst for power by those who seek government positions, and to those in Congress, and the President, who are trying to foist this Orwellian nightmare upon us; to them, we and our patients are abstractions. To us physicians, our patients are real people.
We could run the government much better than these bozos, but they cannot practice medicine.
It is the height of hubris and arrogance for them to think their interference will in any way improve things, or that they can or should even try to direct medical care for 300 million people. Get government out of the clinics, offices and hospitals.
I except people like Ron Paul, Tom Coburn, Ryan, Tom Price, and about 30 others from the above. Those are true public servants and thinking people.
The following is my account of the teleconference:
An Evening Of Telephonic Hilarity At The Improv!
Subtitle: Wait! You Mean They Were Scripted? And Serious?
On August 25 I dialed into the White House’s conference call on health care reform for physicians.
After being disconnected twice (and the symbolism was not lost!) I was connected with approximately 2,600 other physicians and the event’s two co-hosts.
They were David Simas, a Taunton, Massachusetts City Councilor appointed aide to Governor Duval Patrick in 2008 and then assistant to President Obama in January. He has no clinical experience but likes to talk as if he knows all about the rigors and emotions of patient care. Kavita Patel, M.D., is a former oncologist from Houston, who, conversely, does not talk like a doctor at all, as she is now in public relations for the White House.
Their introductory remarks focused on problems with private health care insurance and emphasized, re-emphasized, re-stated, and re-iterated that anyone who disagrees with the President’s health care reform agenda is spreading “disinformation”.
This was followed by some boilerplate including that doctors are central to health care delivery, if you like your doctor you can keep your doctor, etc.
Time for questions. We were told that questions were selected to be representative of those emailed by physicians before the meeting. I was surprised to learn that most physicians’ primary concern is preventive care. I’m still not sure I believe it. But at least this set up their platform to tell us that preventive care will be covered at 100%. (No co-insurance, no co-pays.) Does preventive care save money? Instead of answering, Dr. Patel took a sharp turn to remind us, “It is the right thing to do.”
A questioner challenged President Obama’s assertion that a surgeon makes $50,000 from an amputation. He said Medicare pays him about $1,000. Ah, but the President meant the TOTAL costs, including follow up care and lost wages, Dr. Patel asserted unconvincingly.
This led to a riff against fee-for-service reimbursement and in favor of the Sustainable Growth Rate, Pay-for-Performance, Global Payment Systems, and Accountable Care Organizations as appropriate vehicles for physician payment, “because they will save money”. Whoops! “Because they will enable doctors to practice medicine the way it should be practiced,” Dr. Patel hastily added. Then Mr. Simas assured us that reimbursement methods will continuously be looked at and changed with regard to Quality Improvement. That was not reassuring, especially for those of us caring for patients who are actually sick.
How will we find enough Primary Care Physicians to take care of those patients added to the government option? Dr. Patel reminded us that the Reinvestment and Recovery Act (the “stimulus bill”) provided approximately $750 million to the National Health Service Corps for training physicians and nurses. Are first year med students “shovel ready”? Do NHSC physicians stay in underserved areas after fulfilling their obligation?
Medicare has overhead of 4% whereas Medicare Advantage programs have overhead of 20%, an earnest pediatrician asserted. Couldn’t we take that excess 16% and devote it to child care? By way of answer, Medicare Advantage and profits were roundly attacked. Medicare’s immanent bankruptcy went unmentioned.
Why is there nothing about tort reform in any of the bills or the President’s speeches? (Whoa!!! Who chose this guy?) Dr. Patel assured us that Congress is working very hard to do everything possible to promote best practices so that medicine will be aligned with what we went into it for. The President has heard physicians’ complaints and would like a fair and equitable solution, but no caps. Patient safety must come first. You will be able to practice medicine as you were trained to do. Error disclosure will help. Safe harbor. Best practices. Mr. Simas added that we must see what the drivers are, what the stressors are, and have that discussion. Doctors are at the center of health care reform and if you like your doctor you can keep your doctor. (I cannot make this stuff up!!)
There was another question or two about preventive care, apparently the new obsession of most physicians.
Dr. Patel ended the teleconference with “The Takeaways”: The system is not working and we must change it. Preventive care will be offered without charge to the patient and no insurance company can refuse a willing customer due to a pre-existing condition.
(There was no mention of the ‘public option’, nor, under it, physician fees at Medicare + 5% and sanctions for off formulary prescribing.)
Reflecting on the experience of listening to all this, I couldn’t help realizing I would have rather been on call.
It seems we are led by Kinder kids up in Washington,DC,.:\
1)There is No real plan.
2) Everything exposed by the President is VAGUE at Best
3) How can you believe a President that lies CONSTANTLY.He well deserved..the expletive,(even it was not the right place for it)…”YOU LIE”.
It seems MrOBAMA has read Honest Abe in reverse !!…….”You may lie to the people most of the time,…but you…can not lie to the people …ALL THE TIME”!!!
4)These OLD ideas which have failed around THE WORLD are pushed to be accepted by the American people who in general believe the GOOD intentions of ANY President but are not capable of reading between the lines and The White House KNOWS it..!!!!
5)Even some dictators have decided to CUT DOWN the Government size and interference with MEDICAL PRACTICE because it was Counter Productive,fed a large Bureaucracy,was ineffective,of poor quality and took with it most of the Savings! that the system was supposed to obtain to begin with.
6)Are we not smart enough to create our OWN system rather COPYING THE BRITISH,CANADIANS OR ..RUSSIANS…CHINESES OR ANYBODY ELSE for that matter????
7)The principle here is…EASY…The White House WANTS TOTAL CONTROL OF THE PEOPLE and ALL Governments on this EARTH , at some point and time, have attempted TOTAL control of the population by means of “HEALTH CARE REFORM”..GOOD OR BAD.I call this POLITICAL DIVERSION to mislead the people, and in so doing,it will become our MASTER .
8)Wake up America,read between the lines and PROTECT YOUR RIGHTS AND FREEDOMS OR IT WILL BE TOO LATE !!!!!
GOD BLESS AMERICA AND HELP US !!
Jose G Monsalvez,MD
As a “Political Activist” for physicans and physican owns surgery centers and hospitals……….. it is quite a fight to protect patients rights. Obama DID LIE! If you review Obamacare it spells out exactly what he intends to do ……….point is “take over healthcare” including our liberties and freedom. I say fight and do not give up!
Janetta Florez Hansen
Political Activist
Member AAPS