Published 1/1/2010

Two views on health care

A broken system shatters lives
By Alice Chen, MD
As a leader of Doctors for America, I cannot unilaterally speak for the entire physician community. To believe so would require more hubris than anyone ought to have.

Instead, our organization is founded on the principle that individual physicians each have the responsibility to speak out for their patients and for what we believe based on our everyday experiences. Our members include primary care physicians and specialists, including orthopaedic surgeons, people 10 years into their careers, and some who have retired after decades. We also have a number of medical students who already see that the system their professors work in is a far cry from the ideals of medicine.

Our members work in solo private practices, in community health centers, in academic centers, and in Veterans Administration (VA) hospitals. Many practice in large cities, but many also practice in rural areas. Many are Democrats; others are Republicans. A number believe deeply in a single-payor system and some believe that the free market is the best solution. But all have come together because they recognize that the common sense and experience of practicing physicians has to be a part of reform and that the best way to do that is to learn about the issues and speak up about them.

I have been a practicing physician for just over 4 years. But in that time, I have seen lives shattered because of our broken system. I have gazed into the eyes of a patient whom I’m sending home with crummy follow-up and no good way to pay for the prescriptions he needs to stay out of the hospital—and I have seen his fear and helplessness. It has been estimated that 18,000 of our patients die annually because they have no insurance and come to us too late.

The first time I watched a man die under those circumstances was one time too many. Yes, I will learn more with additional years of experience, but am I wrong not to want to watch one more person die that way? It’s not fair, and it’s not right. I have to believe that we can do better. And the oath I swore the day I graduated from medical school said plain and clear: “That above all else I will serve the highest interest of my patients … that I will be an advocate for patients in need and strive for justice in the care of the sick.” That’s why I volunteer 40, 50, 80, 100 hours a week to help bring the voices of physicians (and through us, our patients) to healthcare reform.

Our healthcare system is not serving us or our patients well. The only way for reform to work is if physicians speak up and get involved. One of the hallmarks of Doctors for America is that, unlike many other physician organizations, we do not seek to speak for our members. Instead, we give our members the resources to speak for themselves. Our Voices of Physicians project includes the uncensored opinions of more than 1,500 of our colleagues on healthcare reform. We have shared this site with members of Congress, the administration, and the media as simply a platform on which physicians speak.

Yes, our organization as a whole does support the President’s vision for healthcare reform. That position has been determined by the collective input of our diverse members, not by the whim of the leadership. Over the past many months, we have collected opinions, comments, and stories from thousands of our colleagues in all 50 states. And thousands have taken action whether that is responding to a poll, writing an op-ed, giving interviews on TV, visiting their members of Congress, or organizing physician town halls with the public.

Our 15,000 members are joined by organizations that represent the majority of physicians that are standing up in support of the current healthcare reform bills as the best way forward to help our patients. At the same time, we recognize that we have colleagues who care about patients just as we do but do not support this reform. Our job is to make sure their concerns are being listened to as well. So tell me, Dr. Lou, what are your main objections to reform? Are there issues specific to your practice and to the patients that you see that you feel are being ignored?

Let’s focus on root causes
By Eugene C. Lou, MD
I would be the first to admit that there are many flaws in our current healthcare system, and critical changes can be implemented to further aid in the delivery of quality care to our patients. Health care is a resource that is valuable and delivered well to the overwhelming majority of patients. Millions, however, either cannot or choose not to subscribe to private insurance or government plans. These millions have been the focus of the president’s initiative and I would not argue against it being a noble cause.

To successfully curb the skyrocketing costs and flaws in our system, we first need to diagnose and recognize the root causes. If you analyze the escalating costs in health care, the publicized areas of rapidly increasing costs are in administration, pharmaceuticals, and newer technology. Many of the root problems can be traced to government intervention and medical-legal issues.

Government implementation of Medicare guidelines and complicated coding requirements has led to an explosion in administrative costs for insurance carriers, physicians, and hospitals. A single practicing physician now needs to employ or contract multiple billing and collections agents to stay in business. Coders, billers, and insurance agents play games of chess constantly trying to outmaneuver each other under these complex rules. The Health Insurance Portability and Privacy Act and electronic medical records cost billions to implement and force providers and institutions alike to shift costs.

Pharmaceutical companies have to protect themselves from class action lawsuits—many frivolous—to bring products to market. This inflates the costs of drugs in our country, which has the highest per-capita number of trial attorneys in the world. Physicians can no longer count on their own ability to properly diagnose patients without the latest panel of diagnostic tests and scans to protect themselves from malpractice claims.

Malpractice reform is curiously omitted entirely from some bills. Is it any wonder when more than 90 percent of politicians and lobbyists are attorneys? In Texas, tort reform has reduced the number of new claim filings by more than 80 percent and the cost of malpractice insurance has dropped significantly in return. The greatest impact of national tort reform, however, would be to reduce defensive medicine and pharmaceutical inflation.

Illegal immigration, the unpublicized cause of escalating costs, is the elephant in the room. Try plotting the increase in the population of illegal aliens and the growth in healthcare costs; the graphs will almost overlay. As critical resources are shifted, hundreds of hospitals must close, and major cost-shifting occurs, leading to absurd billing to defray non-reimbursed losses. The fact that our system has been able to stay afloat so long is a testimony to the strength of a private healthcare system. No other country in the world would be able to absorb such a burden. Are these people more deserving than our own citizens?

Lastly, the public or single payor option is one that will certainly destroy any hopes for improvement in our system. If your training at county hospitals or in the VA system did not convince you that they have more inherent waste, delay, rationing, and inadequate care than at private hospitals, then we have no reason to continue our discussion. You are not the first physician to experience “lives shattered” and to see “fear and helplessness” in your patients’ eyes; I have had such experiences working in the busiest trauma center, the largest VA hospital, and the county hospital system with the largest indigent population in the United States.

That is precisely why I oppose the bloodletting “cure” that single payor represents. It will relegate every patient in this country to “crummy follow-up,” inoculating the existing healthy parts of our system with the apathetic wasteful virus that is inherent in government-run institutions. How can we believe that a national venture will succeed when Massachusetts, Tennessee, and Hawaii have already demonstrated the fatal flaws of opportunistic enrollment and hyperutilization?

Editor’s note: AAOS fellow Eugene C. Lou, MD, recently corresponded with Alice Chen, MD, vice president of Doctors for America, a group that supports President Obama’s vision for healthcare reform. They agreed to share their different viewpoints with AAOS Now in a point/counterpoint.