Monday, September 14, 2009

Dr. Tyler Taylor delivers a physician's view of the Public Option.

Good afternoon, and thank you for coming out today. I appreciate the dedication of the organizers and all of you attending.

Just this year, I had my 30th anniversary as a family physician. During all that time, I have worked in small towns, and cared for patients in offices, hospitals, ERs, nursing homes, and in their homes. The last 9 years I have been in Los Alamos. My career has given me quite an opportunity to observe our health care system where the rubber meets the road. Sadly, I have come to the conclusion, as have many others, that we are witnessing a relentless implosion of that health care system.

I don't want to bore you or depress you, but it's important, as a starting point, for me to share the kinds of problems that I see getting steadily worse over the years:
-Increasing insurance company intrusion into patient care.
-Steadily more arrogance and deceitfulness on the part of insurers.
-Incomes of specialists rising much faster than those of PCPs.
-Fewer young physicians choosing to do primary care, and PCPs getting more scarce.
-Drs. saying they “have to” see more patients per day, to make the income they feel they deserve.
-More tests being ordered because doctors are rushing through visits and are afraid of malpractice suits.
-Hugely expensive diagnostic equipment and treatments being overused.
-Inner city hospitals going under, while their ERs are swamped with uninsured patients, or those on Medicaid.
-Increasing numbers of elderly, and of middle class folks, who can’t afford important medicines.
-Rising confusion and anger among patients about how complex and unfair their health coverage has become.
-Worsening problems in finding affordable mental health care for my patients.
-Medical software at times being used in ways that are meaningless, and that obscure the truth,
-Increasing number of doctors no longer willing to take patients with Medicare or Medicaid,
-Billing functions in offices and hospitals getting to be huge and complex, as payers create ever more complex games to avoid paying for services. In a 2009 survey, the cost of dealing with these insurers was found to be $68,000/per doctor/per year.
-Having a flood of reliable and unreliable healthcare information coming at physicians each month, making it very hard to know what are truly the “best practices” we’re supposed to follow
-Seeing our healthcare system waste so much money, while our country acts like we can’t afford to provide basic quality care to the 15% of our population who are uninsured.

So, most primary care physicians are clearly aware that we are working within a marketplace, and not a true healthcare system. We find these problems with payers, including both insurance companies and Federal payers, infuriating. These hurdles too often seem more about their profit margin or budget than good patient care, or creating a better healthcare system. What is especially disturbing is that profit-driven business ethics have permeated the once-honorable professional ethics of Medicine, and patients suffer most of the consequences. It often feels to me like an era of devoted, super-responsible primary care physicians is closing. Morale among my colleagues is low, with apathy, burnout and cynicism rampant. A large national survey of physicians last year showed that 30% of them plan to leave patient care within the next 3 years. One third of them describe their morale as "low" or "very poor".

So, to have major health care reform seem like a very real possibility in 2009, is almost beyond my comprehension. This new reality, though, has certainly been noted and embraced by the large national
primary care organizations. Seven of them, representing over 450,000 family physicians, internists,
pediatricians and medical students have put out a joint letter this summer. It clearly says that we are very supportive of the healthcare efforts currently in Congress, and believe that moving forward in 2009 is urgent. I’ve brought copies of that joint letter, if anyone would like a copy after today's program.

We all know that there are two quite frustrated groups currently in the U. S., those that want much less healthcare change than is being proposed, and those that want much more. To the latter group, I suggest that 4 huge sea changes are happening here, if Congress passes some version of the bills currently before the 2 chambers. First, the principal of regulating insurance companies for the good of the public will be established. Secondly, the right to healthcare for all will no longer be in debate. Thirdly, health insurance companies will no longer have such enormous profits to use for stymieing future reforms, nor will they seem invincible. And lastly, a fundamental recognition of the need to change the incentives in healthcare will have occurred.

It is amazing to me that the current efforts at health care reform have been portrayed as somewhat radical. To me, the two public option plans in Congress are middle of the road compromises, which balance compassion for people and competition for profit. They combine commonsense and decades of healthcare research. They have not been cooked up in a hurry, since people in several think tanks and agencies have been developing these ideas for years. And our legislators are mostly doing what we pay them to do, putting together various promising ideas in the most practical and affordable way. So I would say it is a typically American solution, merging our compassion for our neighbors, our tradition of capitalism, and our problem-solving abilities. I believe that we can be proud we are hammering out a middle path, as ugly as it may sometimes get at the moment.

I am convinced that more than 80% of the healthcare reforms before Congress will become law this year – an incredible historic achievement. But what about the Public Option? It is a hugely important component that would begin to slow down healthcare inflation, saving Americans $1-3 trillion over the next 11 years, according to the Commonwealth Fund. A Public Option plan would also offer 3 other things: planning and procedures not distorted by fickle Wall Street pressures, a great chance to improve the incentives for providers of healthcare, and a new standard for insurance company business transparency. These 4 features make it a dynamo of positive change among health insurers.

But if it doesn’t pass in 2009, I say “Don’t despair”. Having lived in Alabama in the 1950’s, ‘60s and ‘70s,
I’m keenly aware that making America more just is a slow, steady process. For African-Americans, it took 25 years to go from integrating the military to opening to all the buses, restaurants, schools, voting booths, housing and job opportunities. 25 years of battles, and step-by-step recognitions that everyone in the U.S. deserves basic civil rights.

Today we are rallying for the right to be free of excessive and unjust fear: Fear of getting sick, or having sick children, or dying, for lack of health insurance. Fear of going bankrupt, of losing one’s employer-based insurance, or having to choose between buying medicine and paying rent.  But when universal coverage with much fairer insurance has a strong likelihood of becoming law before Christmas, we are living in an exciting time! We must keep pushing for it, to make sure the scales tip in our favor. But remember that greater justice in any social sphere takes years, maybe decades. If there is no Public Option this year, the continued skyrocketing of insurance premiums means it will be back on the table soon. And we’ll be ready for fight for it again then.

Thank you for all you are doing to make sure America takes the biggest possible stride for healthcare sanity and justice in 2009.