A town hall meeting was held about healthcare at the Albuquerque Art Museum, Albuquerque, New Mexico. The meeting had two parts.
• First, there was a screening of the film “Sick and Sicker,” written and produced by Logan Darrow Clemens. The film analyzes the Canadian healthcare system based on the assumption that full implementation of the PPAHC (Patient Protection and Affordable Health Care Act, also called “Obamacare”) in the USA will produce a system similar to Canada’s.
• After the film, there was an unstructured, free flow open discussion about healthcare among the 47 attendees, moderated by Deane Waldman, author of “Uproot U.S. Healthcare.”
QUESTIONS (ITALICS) AND RESPONSES
Doesn’t it make more economic sense to spend our limited healthcare money on the young and not on senior citizens who won’t live that long and will not be as productive as the young? [Note: The questioner appeared to be at least 65 years old.]
In a purely rational economic sense and speaking only for the nation not the individuals, the answer was yes: spend more on those who can contribute more.
Waldman the moderator then offered a different approach. He claimed that we had enough money to care for both young and old, but only if healthcare money actually went to health CARE. Forty percent of all our healthcare spending goes to the bureaucrats and insurance company CEOs rather than to doctors and nurses who serve We The Patients. In 2009, that was over $1 trillion “healthcare” dollars that produced no health “care.”
You talk about the need to balance demand with supply: unlimited demand with limited supply. Who should do the balancing?
There are only two choices for the “balancer” of supply and demand. It is either the government by decree who rations health care, or the individual through the market forces who balances his or her demands for care with his or her own healthcare dollars.
Insurance companies are bad: they totally get in the way between doctor and patient.
Several responders in the audience immediately agreed. Waldman agreed as a physician saying doctors frequently cannot do what the patient needs because of insurance companies, but also because of the government as an insurer (Medicare and Medicaid). However, he continued, it is fundamentally a system problem. We do not reward the outcomes that people want: good health and long life. The system rewards – with profit or power – those who give the least care.
In the flow of conversation, the moderator asked a question of his own. “Let me have a show of hands. If you could throw out all 535 members of Congress, no exceptions whatsoever, plus the occupant of the White House, would you do it?”
In response to that question, almost before the final words came out, the vast majority of the audience enthusiastically raised their hands.
While I agree that insurance companies are a cause of the rising costs, there is also the practice of defensive medicine.
There were many nodding heads and several mumbled about tort reform but no one responded aloud. So Waldman spoke up, saying that we do not need tort “reform.” We need tort replacement. We need to dismantle the adversarial malpractice system and create one that will do what we want: compensate the injured and improve outcomes. (He then made a plug for his book “Uproot U.S. Healthcare,” which describes how we might do that.)
We need to restore the [direct] doctor-patient connection.
Everyone agreed with this statement. The moderator then reminded the audience that part of such a connection was direct payment. The audience seemed to have no problem with doctors making money. It was the government taking and controlling their money that rankled them.
What is the next step if Obamacare is repealed (overturned by the Supreme Court)?
Again, there was silence, with the audience expecting Waldman to answer, so he (I) did. Repeal of PPAHCA or not, either way healthcare is terminally ill and needs radical treatment. We cannot keep tinkering with a system that does not work and can never work. We The Patients – homage to We The People – need to become doctors for sick healthcare. “Uproot U.S. Healthcare” shows us how – it gives us power.
What happens if the Supreme Court strikes down the financial requirements in Obamacare but the Federal Government keeps the mandate to provide care regardless of payment source?
This was addressed specifically to the moderator. Waldman said, “So what? Nothing changes.” Either way, hospitals and doctors are legally bound to provide care for people most of whom cannot pay. Though care is federally mandated, the government does not pay.
Waldman brought up the question of illegal residents and health care for them. Discussion followed including the history of numbers (of uninsured “Americans”) as well as how European healthcare systems handle illegals (they don’t). The audience then demanded that Waldman give his personal opinion on what should be done.
I answered as follows. We as a nation should decide this important question. We The People should not accept what the pundits say or the President (or I, Deane) think is right. WE as a People should have a national dialogue, and then we should decide what is right.
I am a veteran and was injured in Vietnam just as our soldiers are now coming back injured from the wars in Iraq and Afghanistan. What is going to happen to health care for Veterans?
Nothing good. As shown in the film Sick & Sicker, the Province of Quebec now spends over 40% of its entire budget on healthcare and yet people are dying waiting in line for services. When those in power, “the system,” must decide between paying the providers or paying itself, guess who gets the short end of the stick. With limited resources, care services (and patients whether veterans or not) suffer, while the bureaucracy survives and thrives.
Medical school enrollment is down; people are leaving the healthcare profession. How common is this? How bad will this be for us?
As the film Sick & Sicker showed, the Canadian government aggressively pared down the number of physicians in its efforts to control costs. This resulted in millions who simply cannot find a doctor. From 1995 to 2006, applications to U.S. medical schools fell almost 20%. There are currently over 500,000 unfilled nursing positions in the U.S.
“How bad will it be for us?” The moderator had nothing optimistic to respond. He reiterated that We The Patients must become active in our own self-interest and fix healthcare.
What will I do if Medicare reimbursements fall below the doctor’s cost and the doctor won’t see me anymore?
Medicare reimbursements HAVE fallen to below financially survivable numbers for doctors, and doctors are refusing to see Medicare patients. The film showed what will happen: people will wait, people will suffer, and people will die.
At the back of the meeting room there was a poster advertising moderator Waldman’s book and asking people to post question to be answered on this website. One such posted question was the following. “What are the strategies for a successful medical model after we find Obamacare unconstitutional?”
The answer is, as emphasized in “Uproot U.S. Healthcare,” to practice good medicine on healthcare. That means We The People must agree on a set of principles that will govern healthcare and then demand a new system based on those principles. That model and only that model will work.
CONCLUSION
People with different views exchanged their opinions. There was difference. There was honest exchange of divergent ideas. People demanded evidence when other people spoke out.
This was quite different from the staged events in 2009 that called themselves town hall meetings. This town hall was a great success because it was real dialogue. It was a small (okay, a tiny) step in the right direction – the path toward consensus.
The Rio Grande Foundation plans to hold more such town hall meetings around New Mexico. We urge other think tanks throughout the nation of whatever persuasion to do the same.
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“Arm chair economists” vs MD/MBA and Expert in Health Care Economics
I have read with amusement the letters to the editor in today’s (12/17/2011) Albuquerque Journal criticizing Dr. J. Deane Waldman’s recent editorial (12/4/11) regarding out of control health care costs and the government’s role in regulating and/or contributing to those costs.
It is interesting that all three letters published were all critical of Dr. Waldman’s analysis with no counter opposing view(s) supporting his analysis. I don’t know if that means there were no letters to support Dr. Waldman or if the Journal simply chose not to include any letters that supported his views.
Regardless if there was any supportive letters sent to the editor, it is both interesting and amusing to see three non-medical (and assuming, non-health care economics) professionals—unless one counts “45 years experience as a health care advocate” as qualifying as a health care professional—trying to rebut the thoughtful analysis of not only a practicing physician who has practiced for more than 2 decades within our “sick system”, but is also an MBA who is a published author and expert in healthcare economics and reform.
It is obvious from the reading of all three letters that the basis of their rebuttal is not based on any real facts or data from scholarly journals in medicine or economics, but rather simply on personal political ideology and opinion. All three letter writers obviously espouse a more liberal “more government is better” philosophy towards healthcare—vis-à-vis “Obamacare”– and two of the letter writers ignominiously attempt to discredit Dr. Waldman’s analysis as merely the musings or political ranting of just another ill-informed or unenlightened “conservative”.
Regarding the first letter by Mr. Richard Valdez, he somehow manages to shift the argument that more government regulation is more or less cost efficient based on the merits—or lack of—of governmental bureaucratic efficiency , instead arguing for the benefits of more government regulation in healthcare in order to improve patient safety. In other words, he is trying to compare apples to apples, but using oranges as an example. On top of that, he insinuates that Dr. Waldman just magically pulls his data (of 40% of health care expenditures not going to pay for direct patient care) out of the air if not from a “conservative think tank” while offering his own simple statistic from the CDC and Institute of Medicine (which by the way is a liberal think tank) of “100,000 to 135,000 deaths annually due to doctor and/or hospital error”. Now, did I miss something? I thought we were discussing money and bureaucratic efficiency/inefficiency here and not the number of potentially preventable patient deaths per year attributable to medical errors. What does one have to do with the other? I’m deeply sorry that he has lost two sons, but his argument that more government spending or regulations would have saved them may or may not be true, but have absolutely nothing to do with the argument that the government can or cannot be more efficient in managing healthcare!
While this letter is meant to offer a critique of the letters criticizing Dr. Waldman’s analysis and not a separate analysis of how we can best prevent medical errors in healthcare or what the government’s best role is in preventing medical errors, I do want to point out—using Mr. Valdez’ own statistics—how easy it is to pick and choose random statistics disingenuously to support one side or another of an argument. While Mr. Valdez correctly contends that there are anywhere from 100,000 to 135,000 (actual range is 85,000 to 195,000) deaths annually attributable to doctor and/or hospital errors, he conveniently fails to indicate that number one, these are classified as “potentially preventable deaths” and number two, that these potentially preventable deaths represent an extremely small fraction (0.00005%–using the higher number of 200,000) of the nearly 1 billion (995 million) doctors visits, outpatient clinic visits, ER visits, and hospitalizations (CDC data) seen each year! You don’t have to be a “Black Belt” in Six Sigma –an extremely rigorous business ideal advocating for near perfection or 99.99966% error free processes—to see that in medicine, we get pretty damn close! Now as a physician and a father– and a healthcare consumer– I understand that we are talking about human lives here and not the manufacturing of ball bearings and that even 1 preventable death due to medical error is tragic and regrettable, but from the dawn of civilization, we have never been, currently are not, and never will be perfect in medicine or in any other human endeavor!
Mr. Raymond Schall and Mr. Byers both just simply spout standard democratic party line demagoguery in their justification for and defense of “Obamacare” and increased government involvement in one of the most personal aspects of our lives without providing any real or objective data or logic to buttress their criticism of Dr. Waldmam’s analysis. Mr. Schall tries to also pick and choose some “statistics” to bolster his support of “Obamacare” by citing that the “Health and Human Services recently released their long awaited rules requiring insurance companies to spend at least 80 to 85 percent of their revenue on actual patient care. What he failed to mention is that in the United States, most private insurance companies spend about 6 to 11percent of revenues on “administrative costs” and 89 to 94% on “patient care costs” (multiple sources). He also did not mention that from at least 2000 to 2010, Medicare consistently has spent 19 to 31% more on true “administrative costs” than private insurance companies. He also tries to tout the benefits of “Obamacare” by stating that “more than 100,000” New Mexicans have “received free preventative health care” and “more than 18,000 students have received primary and behavioral healthcare” because of “Obamacare”.
Now Mr. Schall obviously has never heard of or does not believe in the 1st principle of economics which basically states “there is no such thing as a free lunch”. He uses the word “free” as if “the free market tooth fairy”—to borrow a trite little phrase from Mr. Byers (the 3rd letter writer)—suddenly dropped the money into the government coffers to pay for the “free care”! Excuse me, but just because the patients received “free” or discounted health care doesn’t at all mean that it was “free”—somebody (you and I—and not the tooth fairy) in the form of increased taxes and or both increased premiums has to pay for that “free health care”! Beyond that, the medical providers providing the “free care” do so at a deeply discounted government mandated rate that often is below the amount required to sustain a viable practice!
Finally, Mr. Doug Byer’s letter is nothing more than old and tired progressive-socialist and “new” OWS dogma lamenting the evils of capitalism and free markets thinly—as well as feebly–disguised as an attempt in intellectual discourse.
I conclude my critique of the letters to the editor with some rather interesting “statistics” to ponder:
1. There are approximately 1800 pages each in both Harrison’s textbook of Medicine and the American College of Surgeons textbook of Surgery which could be considered the “bibles” of Western Medicine and Surgery and which represent the collection of at least 3000 years of medical and surgical science and knowledge. This compares to 1000 pages in the Patient Protection and Affordable Act (aka “Obamacare”), 670 pages in the HIPPA regulations, and over 132, 000 pages of Medicare rules and regulations collected over the last few decades (this does not include the various state and local rules and regulations regarding the practice of medicine in States and local localities)!
2. There are approximately 650,000 practicing physicians and surgeons in the United States and it is estimated that for every physician, there is 2 to 5 or (1.2 to 3.25 million) “non-medical administrative” workers (most of them Federal and State employees) per doctor “administering healthcare”!
3. The Medicare Trustees have projected that Medicare (which administers to approximately 30.5 million Americans) will be bankrupt by 2024 at current spending projections and somehow we want to expand that government bureaucratic behemoth to cover 10 times that much? This is what a “real” doctor in health care economics has to say about that:
“Contrary to the claims of public plan advocates, moving millions of Americans from private insurance to a Medicare-like program will result in program administrative costs that are higher per person and higher, not lower, for the nation as a whole.”
Robert A. Book, Ph.D., is Senior Research Fellow in Health Economics in the Center for Data Analysis at The Heritage Foundation
Sincerely,
John R. Vigil, MD
Dr. Vigil has a blog titled “What’s Wrong With American Healthcare Today; The Musings of a Working Doc” and has been a practicing physician and surgeon for over 20 years. His interests in medicine are healthcare economics, improving healthcare delivery, and history of medicine and surgery. He has completed 1 year towards his Master’s degree in Business Administration at the Anderson School of Management, University of New Mexico.