Senator Coburn Calls Health Bill “Malpractice”


Senator Tom Coburn weighed in on the health-care bill today, and he made some very good points.  As a disclaimer, I too am a physician and by definition can’t be unbiased.   Some comments on his points:

“The fundamental problem in health care is cost.” 
            He is absolutely correct.  Our system has very good quality, but access is a big problem.  Those without insurance, or with a form of underinsurance such as Medicaid, find it difficult or impossible to get access to care.  Care cannot even be guaranteed in emergency situations, since many emergency departments have experienced difficulty having adequate specialists on-call.
            Expanding Medicaid will increase costs but will not increase access, since reimbursement rates already are unrealistically low, and will have to be cut even further under this plan.  Fewer providers will accept Medicaid patients, leading to “coverage” but no access.   

“Supporters argue that the bill will save taxpayers $100 billion over 10 years, but this estimate is a sham.”
            Policymakers must have felt that it was essential to hide the true cost of the bill, in order to avoid widespread sticker shock.  I won’t go into the analysis of the financials, but it is a good question whether having more people insured will lead to lower future costs.  The idea is that having insurance leads to having routine care, and small inexpensive problems are treated before they become large and expensive ones.  Our current system doesn’t manage costs well with the exception of fully integrated systems such as Kaiser Permanente.  With or without reform, this problem will continue to grow.  With the aging of the Baby Boomer generation, costs are going to go up no matter what is done, and eventually we must face the reality of scarcity of healthcare resources.  Fortunately, there is a huge amount of “fat” in the system which can be excised without harming quality.  The difficult part is that the current incentive structure does not make this very likely to happen.

“…a recent poll by Sermo.com… found that only 1 in 10 physicians said Congress should push the current bills through, while nearly two-thirds of physicians said Congress should start over…”
            Forcing the current bills through will lead to a huge expansion of federal involvement in health care, and will have many unintended consequences.  The more that the system is entangled with regulations and interference, the more inefficient and snarled it will become.  This is because the various stakeholders will assess the terrain, and take action to obtain the most advantageous position.  This is what has already occurred over the last 45 or so years, so there is little reason to think that it will not continue.  An inefficient and snarled system does not serve patients in an effective manner.

If there were an easy answer to the problem, it would have been provided already.  It may be better to tackle this huge problem in small pieces, rather than attempting a sweeping overhaul.  There are many areas within health care that can be singled out, their problems analyzed and experimental reforms devised.  Successful efforts can be expanded to other areas, unsuccessful ones can be abandoned. 

 In surgery, this advice is given to new graduates: “Don’t try to hit home runs, try to hit singles”.

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