I had the pleasure of being in the East Wing of the White House on Wednesday, one of about 160 people in the audience as President Obama appeared on national television, fielding questions about health care.
It was my first look at the President at close quarters. I came away with the impression that the President was possibly the most knowledgeable person in the room when it came to the current health care crisis. That's no small thing given the people who were there. We have had Presidents whose understanding of issues seemed confined to the precise talking points prepared by aides in briefings. This President knew his material well and was improvising as smartly as a jazz pianist, in response to questions.
The other thing I sensed was the President's tremendous passion for this cause. If there is something more important on his agenda, I don't know what it is. What also came across is that compared to everyone else who was there (physicians like me, the CEO of Aetna, the head of the AMA), the President was probably the only one whose interests in the health care debate were not self serving. His sole motivation seems to be to head off disaster, which seems inevitable if reform does not take place.
An important moment for me personally came when a young woman asked the President the very question that I had been prepared to ask. She wanted to know why we could not emulate the example of other advanced democracies that manage to cover all their citizens for about half what it seems to cost us. The President's answer was revealing; he pointed out that most of those countries had a one-payer system whereas we in America, "...have an employer based system that has grown up over decades. For us to completely change our system, root and branch, would be hugely disruptive and I think would end up resulting in people having to completely change their doctors, their health care providers in a way that I'm not prepared to go. This is one-sixth of our economy. I think that we can build on what works, fix what's broken, and still have some substantial money."
The obstacles in the President's way are considerable: 1) people and businesses who are profiting hugely from the status quo; 2) a general fear of government interference; 3) fear in Congress about the amount of money to be spent on health care reform and finally, 4) the fact that legislators who have to make change happen often serve the interests of the people who gave them the most campaign money--pharma, insurers, organized medicine. These contributions are what taint our political process--call it first world corruption.
I got back to my hotel room at 10pm, just as the session (which had been recorded "live to tape") was finally being aired. I was surprised to see that one commercial shown during the health care debate was on behalf of "Patients United Now"--a group I know little about. The ad was sowing seeds of fear by having a Canadian patient talk about the difficulties of that system. They couldn't wait to hear what the President had to say it seems.
Oh yes, and the other thing on television competing on the other channels was the news of Governor Sanford's whereabouts. As to that . . . less is more.
Comments (7)
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Abraham Verghese
Whoa, very cool -- it must have been amazing to see Obama in person and hear him talk. I've been very impressed by Obama's competence, and am quite pleased to have such a knowledgeable and articulate president.
However, I'm curious if Obama plans on capping malpractice jury awards or addressing concerns about physician liability. In contrast to your statement that "the President was probably the only one whose interests in the health care debate were not self serving", I believe that the president has a robust interest in protecting the scope of practice of trial lawyers. Although Obama has discussed medical malpractice before (i.e. during his speech to the AMA), I haven't seen any specific proposals to address or reduce medical malpractice lawsuits.
Probably because it has shown to have little (2%) to no effect on health care costs. Its like screaming for band-aid when you have severed leg.
Why waste time working on a symptom of our health care crisis in America, as opposed to taking on the fundamental problems. Texas has implemented tort reform yet still has some of the highest health care costs. Lawyers are an effective straw man, the bogey man of someone getting millions for spilled coffee.
Atul Gawande has an excellent article where he explores the health care systems in McAllen and El Paso Texas, and contrasted why health care costs are so disproportionate in towns with similar demographics. I'll give you a hint about his conclusion....Its not the fault of lawyers.
Thanks Gailin for the citation to the Northwestern U. white paper on tort reform -- it was quite an enjoyable read, and very eye-opening. I quite agree that broad health-care reforms are needed and that overutilization of resources is problematic (as noted by Atul Gawande's article).
However, I think it's inappropriate to trivialize the value of medical malpractice reforms in fixing the US healthcare systems. From a quantitative point of view, the 2% statistic cited in Avraham & Schanzenbach's article is quite conservative -- an earlier, better-cited publication by Kessler and McClellan states that malpractice reforms could reduce medical expenditures by 5 to 9 percent. Furthermore, speaking from personal experience as a medical student, the one thing that tips my hand to 'chase a zebra' or practice defensive medicine -- to order that spiral CT or HIDA scan -- is the worry of a lawsuit, not some desire to get 'kickbacks' or alternative financial compensation. In my opinion, medical malpractice is not merely a 'straw man', and needs to be addressed in order to reduce medical expenditures.
Therein lies the problem. You are advocating practicing defensive medicine out of fear of a problem that has been overblown for political and the financial self-interest of the companies who provide insurance.
In this study published in the New England Journal of Medicine, conducted by Harvard School of Public Health and the Harvard Risk Management Foundation, they reached the conclusion that, "Our findings suggest that moves to curb frivolous litigation, if successful, will have a relatively limited effect on the caseload and costs of litigation. The vast majority of resources go toward resolving and paying claims that involve errors. A higher-value target for reform than discouraging claims that do not belong in the system would be streamlining the processing of claims that do belong."
So while there are definite costs associated with malpractice suits, the reality is that most of the claims that are paid out are deserving of compensation. While most frivolous cases go no where. Which is pretty much how we should expect the system to work. I think we can definitely both agree with their statements regarding streamlining the process. If structured properly, it could be a great step in the right direction to reduce administrative costs.
If you want to lower malpractice insurance costs, then we should look at the root of the problem. Its the insurance industry that is profiting hand-over-fist from your fears, by lies and misinformation that they themselves spread. Be it through lobbyists or paid pundits, they have very clear interest in keeping you fearful, so that you will continue to pay overblown premiums.
Perhaps, instead of limiting a patients write to recourse in situations where damages are due, we could promote regulations or other measures that curb the ability to inflate insurance costs due to overblown fears and lies that the insurance companies perpetuate. Like most industries, where costs are commiserate with risk, and not like what you deal with today; an oligopoly that has little or no competition.
Follow that with sensible changes to the legal process that ensures a patients rights, and reduces a cumbersome system that can take an average of 5 years to reach a conclusion. These are all helpful measures to lower costs. But I again go back to the idea, that spending too much time on this now is picking around the edges of the problem.
I would rather have President Obama hit the big targets. A public option, ability to get coverage with a pre-existing condition that is reasonably priced and competitive. The items that will have the most impact. Once we get there, then we can start fine-tuning and honing the process.
I look at this an iterative process, and we have yet to get started on the first version.
Interesting article and I appreciate the very informative back and forth comments. Thank you for the intelligent discussion.
"What also came across is that compared to everyone else who was there (physicians like me, the CEO of Aetna, the head of the AMA), the President was probably the only one whose interests in the health care debate were not self serving. His sole motivation seems to be to head off disaster, which seems inevitable if reform does not take place."
With all due respect, I would recommend a little caution about so confidently believing in the purity of any politician's motivation. I don't doubt that President Obama sincerely cares about providing high-quality, affordable health care for as many Americans as possible. But his power and historical legacy would also greatly benefit from major legislative victory on healthcare reform. It seems naive to me to think that he doesn't also have a self-serving stake in this game.
This is probably one of the better debates on the impact of malpractice on the costs of health care. While it may be fear that causes physicians to practice defensively, I would argue that the fear is well placed. As a physician, I don't want to get sued, whether it's frivolous or not. And if I do, I need to have as much ammunition to defend myself as I can get. Let's put it in a real world perspective. If you're a busy physician, and it takes you 30 seconds to order a spiral CT, and 2 minutes to think about the result, it's preferable to spending hours in a deposition or even an hour writing out a thoughtful response.
We could argue back and forth about what the exact impact is, but that's not the point I want to make. Considering the plan under proposal is making broad, sweeping and disruptive changes (such as eliminating fraud and abuse which would save .... a whole 1%, or equalizing the pay for NPs, PAs and MDs who function as primary care practitioners), why wouldn't you include tort reform in this, even if the number is only 2%?
Two percent of $2.4 trillion is $48 billion. That is a lot of money to save.
So I do agree with original poster that it is very curious that there is no tort reform, which would save at least 2% according the first replier, when there are so many changes that are planned.
As Verghese has quoted, Obama says, to paraphrase, Let healers be healers. Tort reform would certainly allow physicians to stop practicing defensive medicine and focus more on their relationship with the patient.
I think the lack of tort reform is a glaring omission, and one that speaks loudly by its absence.