It’s Up To Us …

Levy A conversation with a reporter yesterday helped me clarify my thoughts about federal health care legislation. In my view, the most effective role of the federal government would be to provide national standards by which the health insurance companies operate (e.g., with regard to pre-existing conditions, rescission, and lifetime limits), require the existence of insurance exchanges, and establish the conditions under which universal access to insurance is made possible. Other items I would suggest for federal legislation are summarized below.

I am hoping the US government will not attempt to control the costs of health care by making legislative decisions with regard to clinical matters. Not because we should abandon cost control; but because federal efforts in this sphere are likely to be crude and not clinically appropriate. You just have to look at the process by which the USDA food pyramid is influenced by food product lobbyists to imagine how the government would attempt to regulate the design and provision of care among medical specialties, equipment and supply manufacturers, and pharmaceutical companies.

As should be evident to readers, I think it is possible for the participants in the health care system to accomplish major changes in the rate of medical cost inflation. Two articles have this theme. One is by Business Week’s Catherine Arnst. The other is by Lucien Leape, Don Berwick, and others in Quality and Safety in Health Care. Both are worth reading, and they overlap in recommending several areas — reducing infections and other preventable harm; empowering patients and families to participate in their care; and disclosing and apologizing for mistakes.

Beyond these articles, there is a remarkable consensus on these items, and yet hospitals and doctors often fail to implement them. Even hospitals that house some of the most accomplished authors in these fields often do not follow the advice of those colleagues when it comes to making improvements in the delivery of patient care.

It is not unusual for industries facing structural change to be slow to move. Why? Because the leaders of those industries were promoted based on their success in the past financial, political, and social environment. They were hired for their ability to maintain the status quo, rather than for their ability to make change. Eventually, though, societal forces make themselves felt. If an industry does not adapt, the government will step in. The medical profession has to decide whether it wants to take charge of this process or abdicate to Congress the right to act in its stead.

4 replies »

  1. “In my view, the most effective role of the federal government would be to provide national standards by which the health insurance companies operate (e.g., with regard to pre-existing conditions, rescission,”
    This is telling ideology, there are two ways to accomplish this, one is proven to work the other proven to fail.
    Do you outlaw pre-ex and recission, and ignore why they exist in the first place, ordo you address the actions that cause recission and pre-ex and thus make them unnecessary?
    The left and congress thinks you can outlaw them and suffer no consiquences. This has been proven wrong for decades. The right thinks if you actually prosecute people for lying on their insurance application you can prevent the lieing and then there would be no need for recission. Same with pre-ex, if people were prevented from waiting until they were sick to buy insurance then we wouldn’t have pre-ex clauses. Two foundations of truth those most aggresivly pushing reform refuse to discuss.
    “Congress has done something close to nothing to reform the broken health care system.”
    Davis you need to do some homework, start with;
    Medicare, Medicaid, COBRA, HIPAA, GINA, Medicare modernization then come back and tell us Congress has done nothing. It is the action of Congress and failed reform that created the current mess

  2. I agree with Dr. Lippin. It’s too late for gentle intervention. As a physician you should probably understand that when a condition goes untreated for this long and the disease has spread through every organ, only aggressive and invasive measures stand any chance of solving the problem.
    We are all at fault for failing to address this problem in a timely fashion, and when only desperate measures are available, we should be prepared to suffer the pain, or admit defeat and go the palliative route.
    That is why reform must be brutally intrusive and comprehensive. A step-by-step approach, that might have worked years ago, will not work today. It’s too late.

  3. Its up to us to create a new health care system. The current one is based on greed pride and sloth and Congress has done something close to nothing to reform the broken health care system. The public should vote ocngress out of office and vote for new Congress members who have some genuine solutions to health care problems. In addition the public should call for insurers and medical organizations to be less greedy and more concerned with serving the needs of the public.

  4. Sorry Dr Levy- You make some good points but we are WAY beyond your proposals at this juncture.
    When millions of citizens are sufferring (even dying) in a broken US health care system through no fault of their own it is time for government to intervene. The Republicans call it a “government takeover” of 1/6th of the US economy.
    I call it a fundamental obligation of any nation that professes to be civil or moral
    Dr. Rick Lippin