Wednesday, September 09, 2009

On the President's Health Care Address

I just finished watching the well-delivered, but frankly heavily partisan, health care reform speech by President Obama. After seeing it, I did not think it was a game changer, but no doubt others will be wooed by the authoritative tone set by the President. The speech was clearly not aimed toward the Republicans in the Congress but rather appeared, in my view, to be a warning shot and "call to action" to the conservative and moderate Blue Dog Democrats as the President struggles to win their support of the Public Option and his plan for health care reform. Hard to see the Republicans nuzzling up to the President at this point and the strategy seems to have shifted to getting a bill through by reconciliation.

There were good points made early and late in the speech, like the need for reform and the need to provide insurance options to those who cannot afford it, making the denial of pre-existing conditions illegal, and even the requirement that insurers can't cancel coverage mid-way. But these reforms were no-brainers. And while there was no question that the best part of the speech was the heartfelt memory of Ted Kennedy through a letter he wanted opened after his death that reinforced his desire to define the "character" of the country through this initiative, there were some glaring problems with the speech as well.

First, I thought the President did a poor job as he spoke "directly" to seniors, convincing them how the hundreds of billions of cost savings he proposed to discover in Medicare and Medicaid would not affect their benefits in the program. Simply put, our seniors are smarter than that. This remains a major problem for the President and the reform efforts underway.

More importantly for doctors, there was the issue of medical malpractice reform. It was interesting to review what the President actually said:
Now finally, many in this chamber, particularly those of the Republican side of the aisle, have insisted that reforming medical malpractice laws will bring down the cost of health care. (Republican side of the aisle finally applauds, to which the President points out: "There you go. There you go." and then continues.)

Malpractice law is not a silver bullet. I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.

So... so, I am proposing that we move forward on a range of ideas to put patient safety first and let doctors focus on practicing medicine. I know that the Bush administration authorized demonstration projects in individual states to test these ideas. I think that is a good idea and I am directing my Secretary of Health and Human Services to move forward in this initiative today.
That was it. Medical malpractice reform by putting patient safety first. You could see the members of Congress sitting there somewhat stunned and with puzzled looks on their faces. They weren't sure if they should clap or not.

But a quick check on what the President was referring to can be found in the medical literature. In 2006, Hilary Clinton and Barack Obama co-authored a "perspective" piece published in the New England Journal of Medicine entitled "Making Patient Safety the Centerpiece of Medical Liability Reform." (Note: I have discussed my concern regarding the use of medical journals for political commentary previously). In this article, Clinton and Obama stated:
Instead of focusing on the few areas of intense disagreement, such as the possibility of mandating caps on the financial damages awarded to patients, we believe that the discussion should center on a more fundamental issue: the need to improve patient safety.
So there you have it. It will be medical liability reform through more safety supervisors, hand soap dispensers, operative "time outs" and hall monitors. No unseemly caps on financial damages. Boy, the Bar Association members must be giving each other "high fives" for how well the President handled that part of his speech, don't you think?

But despite all this, an even more surprising and memorable moment came when the President promised not to pay for coverage of illegal aliens in any government health care reform bill and a Republican Congressman blurted out so all could hear, "You lie!" The Democratic side of the aisle immediately booed the vocal Republican Congressman. The look on Nancy Pelosi's face as she sat befuddled behind the President following the outburst was, as they say, priceless. And while this was a tense moment that passed quickly, it reinforced the passionate nature of the debate for all Americans and served as a reminder of how hard it will be to pass any bill of this scope and magnitude.


Photo credit:


Anonymous said...

Some feed on the drama while others call it distraction.

In the end, Americans - doctors, policymakers, supporters and opponents alike - for better or worse (wise or foolish) will decide the fate of the reform.


"After the speech, Rahm Emanuel, the White House chief of staff who sat a few rows in front of Mr. Wilson, said he immediately approached senior Republican lawmakers to encourage them to identify the heckler and urge him to issue an apology quickly.

“No president has ever been treated like that. Ever,” Mr. Emanuel said."

Chuck Thompson said...

The future is in the builtinout. When he stated that no one here illegally would benefit from his plan, he was giving us a hint of what is to come - "immigration reform". And if he grants legal status in some form to all the illegals here now, then they would qualify for free healthcare wouldn't they?

Anonymous said...

Our seniors are neither so smart nor knowledgeable as you might think; and perhaps you shouldn't "pass by" political articles in medical publications like NEJM.

The issue I find compelling is the June 10th Perspective entitled: Finding Money for Health Care Reform — Rooting Out Waste, Fraud, and Abuse.

This article shows the enormous amounts of fraud in healthcare. That is fraud, not to be confused with waste and abuse which further eat up diminishing amounts which could be the main reason why our GDP is 7% more than the average of the other industrialized nations.

The report of our fraud expert for the past two decades has been hidden since it first appeared on May 20th which was the same day the President signed into law more restrictive laws to "uncover fraud and recover stolen government healthcare funds, the leading cause of which comes from pharmaceutical manufactures, with whom our President has agreed to "work with to reduce costs". With $100 to $500 billion lost to fraud each year, while an average $1 billion is recovered, existing government entitlement plans will be bankrupt before this President is up for reelection!

Kate Burton said...

The fraud in Medicare is rampant, look at the state of Florida where millions in fraud is announced on a regular basis.

As for malpractice reform how much time would have been enough? This was a broad based policy speech about health care reform not about tort reform.

The Scribe said...

If hospitals offered money back guarantees, we wouldn't have a liability problem in health care! Even if they completely screw you up, they still keep the money. Lawsuits are the only way people can get justice.

Keith said...


I thought it was a wonderful speech and well articulated on all points. I will agree that the malpractice comments were vague and I find it puzzling, but politically clear, why malpractice reform is not on the table. It belies the political jibberish the administration has been offering that we need to have all the pieces of health reform in order to constrain costs (usually the comback to why we need to pass the public option now).

But what he did was put the extremes of both parties on notice that there needs to be a compromise and that they should resist digging in their heals. I thought it less of being directed at the blue dogs and more at the other extreme of the democratic party who have stated they will not vote for a plan without a public option (it was clear to me that he is willing to take a lesser option to get a bill, as he should, rather than sacrifice everything for a public plan). And he made it clear the the scare tactics that the the opposition, most of which you have to admit are just that, will not be tolerated and that he will be taking off the gloves.

He re-established his centrist position and stated he would not cut one benefit from Medicare very clearly. You and your cardilogy colleugues are confusing this with Medicares threat of payment decreases to some providers which does not represent any cut to beneficiaries unless specialists seek other carreers and frankly I don't see that happening soon (if it does, I have some exciting opportunities for you in primary care, albieit at a significant pay cut).

We internists/primary care docs have tolerated this for years. Believe me, you'll adapt but you won't be happy about it. Who is ever being happy being told your services are worth less than they were before. And when your ranks become less (as has happened to primary cae docs), the goverment will realize a shortage and increase the rates again. It is supply and demand as only it can occur under an skewed insurance system as exists now.

And to Ms Burton, look at who commits the biggest frauds on Medicare over the years; HCA, Tenant Health care, Pfizer, Lilly, etc, etc. Not to mention the unscupulous behavior of our financial services industries during the saving and loans crisis earlier and the more recent bad behavior of people who have apparently only one motivation in our capitilist system; to make more money at all costs. Thank God for the for profit model of health care we have!

Tom B said...

Cerberus -

If hospitals offered a money-back guarantee, what hospitals would take the difficult cases?

This reminds me of the hospitals with excellent health grades in say, cardiac care. Of course, the surgeons only take ideal cases.

Meanwhile, the university hospital across town takes the hard cases that other hospitals won't even try.

Do you suppose they should perform these procedures for free? Be grateful they'll operate on you when no one else will.

Don't forget to sue them when they're done.


Anonymous said...

"More importantly for doctors, there was the issue of medical malpractice reform"

That fact that you believe this was an "important" thing for doctors just shows how lost physicians are in this whole process.

Look, if it's not obvious by now that tort reform doesn't save a dime in healthcare dollars, then you're either being willfully blind or you're just dumb. It's no cheaper to get healthcare in California than it is in Tennessee (assuming they haven't adopted it too).

And, if Obama's reform passes, the people most hurt by tort reform, those without wages (kids, old people, etc) are no longer hurt nearly as bad because their medical bills are taken care of.

But do physicians really believe the govt. paying for this isn't going to punish them in some way for their malpractice? Really? Well, given their blind belief in damage caps, I guess it's possible they do.

DrWes said...

Anony 10:42PM-

I must be really dumb to think that 100,000 - $250,000 malpractice premiums for doctors who have never been sued don’t affect the cost of health care delivered to patients. Worse, 83% of doctors polled in Massachusetts must also be dumb when they admit they have ordered unnecessary tests to avoid liability concerns – certainly this doesn’t affect the cost of health care there. Further, one only has to look to Texas, where obstetrical doctors left the state in droves until malpractice reform was enacted there to see how dumb it is to have caps on liability enacted – certainly lack of liability reform caused no personal "cost" to patients, right? Finally, I’m sure that channeling the thoughts of an unborn fetus to get multimillion dollar judgments against doctors really doesn’t affect the health care delivery climate.

No, it sounds like you've got it all figured out.