Comments on: Theory v. Practice in Health Reform http://www.healthpolcom.com/blog/2009/06/01/theory-v-practice-in-health-reform/ Health Policy Consulting and Writing to Improve Quality, Reduce Costs, and Increase Value in US Healthcare Wed, 04 Jan 2012 09:15:15 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: The Coalition for Patients' Rights http://www.healthpolcom.com/blog/2009/06/01/theory-v-practice-in-health-reform/#comment-18396 The Coalition for Patients' Rights Mon, 13 Jul 2009 21:51:26 +0000 http://www.healthpolcom.com/blog/2009/06/01/theory-v-practice-in-health-reform/#comment-18396 It is certainly true that physician shortages and lack of affordable care for all Americans are some of the greatest challenges our nation is currently facing and will continue to face in the coming years. Health reform will not happen overnight, but Americans need cost effective and reliable healthcare now. To achieve this goal of a “high performing health system” that Dr. Miller comments upon, it is important to realize that doctors are not the only ones who can help to fix the current system. Throughout the country, you’ll find a broad spectrum of healthcare professionals (who are not doctors of medicine or osteopathy) who are well-prepared to meet the growing healthcare needs of Americans. These providers, who range from certified nurse-midwives to natural medicine specialists to psychologists, provide a diverse array of safe, high-quality and affordable services. All providers, MDs and non-MDs, can and should contribute to health reform. And throughout the process, we should protect patients’ rights to see their provider of choice. For more information on how to protect patients’ rights, visit the Coalition for Patients’ Rights™ at www.patientsrightscoalition.org. -By The Coalition for Patients’ Rights™ It is certainly true that physician shortages and lack of affordable care for all Americans are some of the greatest challenges our nation is currently facing and will continue to face in the coming years. Health reform will not happen overnight, but Americans need cost effective and reliable healthcare now.

To achieve this goal of a “high performing health system” that Dr. Miller comments upon, it is important to realize that doctors are not the only ones who can help to fix the current system. Throughout the country, you’ll find a broad spectrum of healthcare professionals (who are not doctors of medicine or osteopathy) who are well-prepared to meet the growing healthcare needs of Americans. These providers, who range from certified nurse-midwives to natural medicine specialists to psychologists, provide a diverse array of safe, high-quality and affordable services. All providers, MDs and non-MDs, can and should contribute to health reform. And throughout the process, we should protect patients’ rights to see their provider of choice.

For more information on how to protect patients’ rights, visit the Coalition for Patients’ Rights™ at http://www.patientsrightscoalition.org.

-By The Coalition for Patients’ Rights™

]]> By: Rich Berning,MD http://www.healthpolcom.com/blog/2009/06/01/theory-v-practice-in-health-reform/#comment-16088 Rich Berning,MD Wed, 10 Jun 2009 02:17:10 +0000 http://www.healthpolcom.com/blog/2009/06/01/theory-v-practice-in-health-reform/#comment-16088 I hear Mr. Langston's argument and agree with Dr. Miller's response to it, that doctors at Mayo and elsewhere already figured out ways to deliver excellent care at reasonable prices. It is unfair to paint all physicians with a broad brush just because there are a few unscrupulous or even greedy doctors. It's also unfair to ask any doctor to work for free, or for less then their skills are worth to a society. There has to be a fair wage, and a commensurate salary for the years of training and deferred gratification that doctors invest for the privilege of providing care to their patients. Most doctors are fair and honest people, and these doctors want a fair system too. Doctors may be part of the problem, but they will be a big part of the solution when one is found. I hear Mr. Langston’s argument and agree with Dr. Miller’s response to it, that doctors at Mayo and elsewhere already figured out ways to deliver excellent care at reasonable prices. It is unfair to paint all physicians with a broad brush just because there are a few unscrupulous or even greedy doctors. It’s also unfair to ask any doctor to work for free, or for less then their skills are worth to a society. There has to be a fair wage, and a commensurate salary for the years of training and deferred gratification that doctors invest for the privilege of providing care to their patients. Most doctors are fair and honest people, and these doctors want a fair system too. Doctors may be part of the problem, but they will be a big part of the solution when one is found.

]]> By: Michael D. Miller MD http://www.healthpolcom.com/blog/2009/06/01/theory-v-practice-in-health-reform/#comment-15658 Michael D. Miller MD Mon, 01 Jun 2009 18:06:20 +0000 http://www.healthpolcom.com/blog/2009/06/01/theory-v-practice-in-health-reform/#comment-15658 Christopher - Thanks for your great insights. I didn't mean to imply that all physicians are operating medical businesses with the goal of profit maximization. Atul's New Yorker article discusses several excellent examples of communities where physicians have been part of the leadership structure for creating local healthcare systems that operate with very high quality and below average costs. It is this type of physician leadership that is needed as part of an overall process where all stakeholders agree to the desired outcomes and objectives, and then jointly develop and implement plans to achieve those goals..... I hope this clarifies things a bit. Thanks, Mike Christopher – Thanks for your great insights. I didn’t mean to imply that all physicians are operating medical businesses with the goal of profit maximization. Atul’s New Yorker article discusses several excellent examples of communities where physicians have been part of the leadership structure for creating local healthcare systems that operate with very high quality and below average costs. It is this type of physician leadership that is needed as part of an overall process where all stakeholders agree to the desired outcomes and objectives, and then jointly develop and implement plans to achieve those goals….. I hope this clarifies things a bit. Thanks, Mike

]]> By: Christopher Langston http://www.healthpolcom.com/blog/2009/06/01/theory-v-practice-in-health-reform/#comment-15657 Christopher Langston Mon, 01 Jun 2009 17:15:59 +0000 http://www.healthpolcom.com/blog/2009/06/01/theory-v-practice-in-health-reform/#comment-15657 Dear Dr. Miller - Thank's for your interesting observations about the need to influence both health care systems at the macro level and physician practices at the ground level to create change. Also for your concern that the same profit incentives that have undermined the current system, be monitored carefully to be sure that patients are not denied access or other aspects of quality care. However, I wanted to raise a concern with your conclusion that because of their role in the problem, physician leaders need to be brought into the plans for reform. I believe the argument is that on the one hand they are potential opponents of change who must be propitiated and on the other they are potential local leaders for the more positive future we wish to have. While I don't oppose this in principle, the argument has the interesting structure that since the poor behavior of these actors has caused much of the problem (". . . physicians who have essentially shifted from practicing medicine in the interest of patients to running a business for the benefit of their bank accounts."), therefore they have to be part of the solution. It doesn't seem nessecerily "right" that those who have contributed to the problem be given great sway in determining its solution - this is certainly not an argument given much weight in other areas. Nor is it necessarily as practical as you are suggesting - what if the people who have benefited from the current system are essentially unwilling to change? Why give a veto to one particular group in the discussion? While it is challenging to many fundamental American assumptions, I think that much of the difficulty stems from the fact that physicians continue as individual piece-worker practitioners subject to the same incentives as any small business person, where take home pay is the difference between practice revenues and practice costs. Should teachers or police officers also be able to practice their craft under the same basis? We have fundamentally overestimated the protections to society of "professionalism" as the only real restraint on physicians. Wouldn't it be just as reasonable that physicians be employed professionals? Dear Dr. Miller – Thank’s for your interesting observations about the need to influence both health care systems at the macro level and physician practices at the ground level to create change. Also for your concern that the same profit incentives that have undermined the current system, be monitored carefully to be sure that patients are not denied access or other aspects of quality care.

However, I wanted to raise a concern with your conclusion that because of their role in the problem, physician leaders need to be brought into the plans for reform. I believe the argument is that on the one hand they are potential opponents of change who must be propitiated and on the other they are potential local leaders for the more positive future we wish to have.

While I don’t oppose this in principle, the argument has the interesting structure that since the poor behavior of these actors has caused much of the problem (“. . . physicians who have essentially shifted from practicing medicine in the interest of patients to running a business for the benefit of their bank accounts.”), therefore they have to be part of the solution.

It doesn’t seem nessecerily “right” that those who have contributed to the problem be given great sway in determining its solution – this is certainly not an argument given much weight in other areas. Nor is it necessarily as practical as you are suggesting – what if the people who have benefited from the current system are essentially unwilling to change? Why give a veto to one particular group in the discussion?

While it is challenging to many fundamental American assumptions, I think that much of the difficulty stems from the fact that physicians continue as individual piece-worker practitioners subject to the same incentives as any small business person, where take home pay is the difference between practice revenues and practice costs. Should teachers or police officers also be able to practice their craft under the same basis? We have fundamentally overestimated the protections to society of “professionalism” as the only real restraint on physicians. Wouldn’t it be just as reasonable that physicians be employed professionals?

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