White House Healthcare Summit, March 5, 2009

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SELECTED PARTICIPANT COMMENTS & AAPS NOTES

(Please leave your comments at bottom of this page.)

 

Stakeholders included advocates for psychologists and dentists, drug companies, large employers, AARP, AMA, labor unions, single-payer advocates, National Federation of Independent Businesses, school-based clinics, Indian tribes, AIDs patients, cardiologists, family practitioners, community health centers, chronic disease programs and long term care.

 

NOTE: The White House did NOT release an advance the list of participants, so we cannot yet attribute some of the comments. 

 

Nancy Nielsen, AMA president:

“We’re here to be partners.”

“Doctors resist being told what to do…what they resist is government control, and this is not government control.”

 

Q. What is organized med going to do this time to make things work?

R:Nielsen: “Docs not happy, pts not happy, what is different from before is that we’ve been included, and if we have constructive suggestions, we’ll be heard – we’re here to head off unexpected consequences.”

 

W. Douglas Weaver, American College of Cardiology:

We want imaging in an electronic form.  “College is willing to commit we could decrease inappropriate tests by 15% within one year – by using point of care decision-making tools.”

 

Sen. Robert Bennett (R-UT):

“Republicans need to get over their opposition to universal coverage. They are distrustful because they equate it with single payer.”

 

Rep. Henry Waxman (D-CA):

“We can’t control costs unless everybody’s covered.”

 

A Congressional Republican:

“I want to compliment the President on the process…if it’s real…if it’s a real process, then we’ll participate…

 

“…Medicare Part D, which I was skeptical, I was the last vote in house to pass, has worked to create transparency and competition for participants to choose best plans for them…

 

“…Don’t try to micromanage doctors practice, but I’m with Sen. Baucus on the need for accountability and performance review…

 

…Sen. Baucus and I have been working with AMA to get some quality measures.  This legislature ought to move us in that direction, or set a deadline for moving in that direction.

 

OTHER NOTES:

 

One claimed: 250,000 are dead because we didn’t act in 1993! It’s a violation of respect for human life to have access to care depend on ability to pay (as opposed, presumably, because of a political decision to ration care).

 

Transparency a big thing. Also data, lots of data needed. Zeke Emanuel: How do we get it collected? Should government pay for collection? Somebody noted that government makes lots of people collect data without getting paid for it.

 

Somebody who represents 10,000 companies commented on success record of HSAs. John Deere got rid of an HMO, allowed HSAs, significant numbers of employees chose it, 2/3 of those with moderate or high risk; avg $1900 in accounts at end of first year; 100% coverage for preventive services. He also said defending ERISA very important to protect against vulnerability to “add-ons” (insurance mandates?).

 

Disparity (racial and ethnic) a big problem, need more representation of minorities at all levels.


A number commented on how much money could be saved by eliminating medical errors.

 

In Massachusetts, 75% of businesses are happy; consensus is that it’s “not too bad.”

 

Drug companies “prepared to compromise.” Love comparative effectiveness research.

 

Medicare Part D is wonderful, costs 40% less than lowest estimate because it has a competitive market. Zeke said for first time government just organized something without running it.

 

Zeke Emanuel: we need to make health care services more efficient. How do we make doctors, hospitals, etc. deliver care more efficiently? Some suggested just getting information, as on quality, out would work magic.

 

It was noted that hospitals may bill uninsured 10 to 20 times as much as government or insured patients. It’s that uncompensated care that’s the problem! To stop indirect subsidization we need universal coverage.

 

Incentives to doctors—perhaps collective incentive to groups who get to share in dollar savings.

 

Malpractice costs: perhaps put doctors under Federal Tort Claims Act for Medicare patient, like federally qualified health centers? Some doctors might do Medicare exclusively!

 

End of life costs: allow doctors to charge for educating patients about advance directives during the Welcome to Medicare physical, and perhaps reduce premiums for patients who go to an educational seminar on advance directives.

 

“We need better coordinated, team-based care.”

American Academy of Family Physicians made it clear that they were ready to provide ‘Medical Homes.’ [Re-invent managed care?]

 

We need to “help the change,” and we all need to be “better than average.”

 

Patients need to be educated about the importance of change, the fact that more is not always better, and that we need to accept change. [Need to lower expectations.]

 

We must be bold, willing to overturn sacred cows.

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  • David Hubler MD

    Have the government show they know what they are doing. Let the government perfect the VA medical system to the point we all want to go there (even if we are not eligible) because it is the world’s best medical care. They have had complete control over that system for 80 years but 80% of the people eligible for it don’t go because it is not as good as the “poor” medical care they get elsewhere. Also it would give them a good cost estimate to treat people (The VA is now at $13,300 a year per person treated. Muliply that times the population of the US)
    The FDA requires medicines be tested in trials before approval, why not government programs?

  • doctorsh

    Our profession is too important to be devalued into a governemnt entitlement. Medicare and Medicaid are unsustainable. The VA is not an ideal program. If we let the govt takeover the system, and incrementally force everyone into govt insurance, then our healthcare system is doomed.

  • Lester FieldsMD

    The real truth nobody talks about. As a whole Physicians are powerless and generally spineless. They unfortunately are not used to real world politics, cost containment, and that no one cares about their patients except their family and hopefully their Physicians. we need more actual Physicians in Judiciary and political power, because good relationships with senators etc…. won’t cut it. It hasn’t yet and realistically never will.

    despite the enormous strides that have been met the battle has been lost a long long time.

    No need to give up but must be realistic and not live in a medical school world!!!!

    Wake up America

  • My father, a famous medical school professor and “social democrat” warned years ago not to go down the road of socialized medicine. He was concerned about the dangers of removing incentives for hard work and the rewards of innovation. Uwe Reinhardt, hardly a physician advocate, has warned that major reductions in physician pay and increases in regulation raise the danger of a “discouraged ” medical profession. Physicians are most energized when the fruits of their labor is realized, both in patient satisfaction and financially. We can not afford to remove control over health care from us, and we must contest the constant attacks on “medical errors”, poor longevity, and high infant mortality rates trumped up by poor data from other countries and one or two studies.
    The preventive care trumpeted by the administration to save billions a year is nonsense. Most patients who are obese,drink, smoke, forego colonoscopy, blood sugar and blood pressure testing, and pap smears will continue to do so with national coverage. That is suggested by the fact the intelligent people with money and insurance avoid seeking help.

    It is outrageous that anyone but those who have gone through the rigors of a medical eduction and years of clinical experience should relinquish their profession and it’s rewards to bureaucrats fed bits of dat a to support a power grab and the ruination of American style health care.

  • J. Rorig, MD.

    A mandatory, universal EMS, has only one purpose: to enable easy government snooping into private medical records under the guise of the “Patriot Act”.

    To save money, stop shoveling it into the Medical Supply, Home Health Care, and Hospice companies.

    Cut out the pharmaceutical middlemen insurance companies that constitute Part D. Compare drug prices on the internet.

    Stop over-rewarding early and overly frequent cataract extractions/lens implants, joint replacements, stents, and many pacer/AICD’s.

    The simplest way to control costs, is to revert to a complete free market. Given what primary care doctors and general surgeons actually get paid, and what Hospitals actually get paid, those prices are already competitive.

    People would wait longer to have their cataracts removed, and then there would be competition on the cost, much like what has happened with Lasix surgery or Cardiac CT because they weren’t insurance covered. Fewer joint replacements and fewer stents would be elected by patients, followed by lower prices. The demand for expensive imaging and other high tech stuff would plummet, followed by a tremendous drop in prices. Fewer scanners would be bought. Next the cost of the scanners would have to go down. The same applies to the cost of all the high end stuff. The Scooter Store would simply go out of business.

    A free market in medical care would cost all of us less than what we pay for insurance and Medicare. We could still buy policies to supplement extended hospital stays, disability insurance, and in-home non-skilled care to replace end of life nursing home stays.

    And this argument that everyone isn’t covered is just so sketchy. What happens now? Don’t the uninsured still show up in the ER? If prices were lowered, more would show up in the office.

    Get rid of all these laws that divert doctors’ income to insurance companies, lawyers, and legislators. Let doctors charge for labs or whatever, within medical bounds, in their offices. Take away all abusive state board powers. Enact a simple federal licensure good in all states.

    This whole thing is really a no-brainer. So a bunch of insurance company and drug company people join the ranks of the unemployed. This is the best time to do it! Maybe they’ll figure out something useful to do.

  • Ralph C. Whaley MD

    The purpose of government was stated in the Declaration Of Independence “all men are endowed by their creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness, that to SECURE THESE RIGHTS governments are institiuted among men deriving their just powers from the consent of the governed” Mr President, the only purpose of government is protection of every individual’s right to his life, his liberty and his own individual pursuit of his own happiness not the provision of happiness to others. Get the government out of the way and allow men to pursue and acheive their own happiness. We are capable efficacious beings who do not need government agents telling us what or how to act in this pursuit. We do need government to protect us from those who would force us to act an anything but our own individual judgement in that pursuit.

  • Gale Oleson MD

    If Congress is really serious about saving money by “eliminating errors” there is a much greater pile of savings waiting in the actions and activities of congress than in the medical field. They have already made errors that created the sub-prime housing market problem and SEC incompetence resulting in the loss of trillions of dollars. (Congressman heal thyself!)

    If they thought medical care was expensive before, just wait until they see the cost that will be induced by the rampant inflation that will occur on the back side of the “Stimulus Plan”. The government’s desire to control all things in matters in which they have no expertise is the cause of the problems not the answer. Look at how well the projected and controlled the expected and final costs of the Medicare program. Is that an example of how well they will handle the rest of the healthcare costs. If I had an employee that performed as poorly as the government has in projecting and controlling Medicare costs I would have fired them a long time ago…NOT promoted them and give them INCREASED responsibility!!!! It would be like Barney Frank and Chris Dodd interfering with the Fannie May and Freddie Mac loan requirements, creating major banking and credit failures and then leaving them in charge of the finance and banking commitees (Oh wait I believe that is exactly what they did isn’t it!)

  • Kyle Ver Steeg, M.D.

    Most of the American economy has not been a free market and that includes health care. It has for almost 100-years a mixed economy with private ownership and government control. Look at our current health care system for the results.

    The sector of our economy that has been most free is the technology sector, where thousands of tech companies have been competing with one another [considered wasteful duplication in health care]. As a result the quartz watch originally priced at ~ $130 in the early 1960’s you now can find in a Cracker Jack box – and on and on.

    To free up health care would require abolishing state Certificate of Need laws to allow physicians to compete with hospitals, for example. Do you think for a moment that the hospital lobby would allow this?

    Physicians would have to compete much more with other health care providers that have demonstrated competency. For example, optometrists could become competent to perform cataract surgery. Would physicians be ready for this, or feel so threatened they would go wining to Uncle Sam for anti-competitive regulations?

    The insurance industry would require a complete overhaul to allow more competition amonst companies – careful deregulation would be needed. Do you think the powerful insurance lobby would allow this?

    Unfortunately, Americans have lost their “root hog or die” spirit and their insistence on self reliance and freedom. So, I doubt health care will go the way of the tech sector, but rather soon be socialized and costs will then be controlled with rationing thru waiting lines, etc.

  • T Rosenwasser MD

    Right up until Lyndon Johnson figured out how to buy votes by giving people access to others’ people money as Medicare, medical practice in the USA worked fine. In fact, American physicians are responsible for the lion’s share of all the advances that have EVER been made in medicine, and the same goes for American scientists and medical scientists in medical science, as well as other sciences.

    National Socialism, on the other hand, did not work, and survived only for the less than ten years of its existence because it robbed other people.

    The Union of Soviet Socialist Republics also fell, due to the fact that Socialism is a basically flawed system.

  • T Rosenwasser MD

    Continuing from above. Whatever government takes over, it wrecks. Government did not invent hospitals; the Catholic Church invented them in the Middle Ages.

    IT IS NOT A PROPER FUNCTION OF GOVERNMENT TO TRY TO SUNSTITUTE FOR FAMILY, CIVIL ORGANIZATIONS OR CHURCH. IT IS UNCONSTITUTIONAL FOR THE GOVERNMENT TO BE INVOLVED IN DICTATING MEDICAL PRACTICE OR ANYTHING ABOUT IT.

    IF GOVERNMENT TAKES OVER DIRECTION OF MEDICAL PRACTICE IN THIS COUNTRY, YOU WILL WISH YOU WERE A DOG, AND COULD GET MEDICAL CARE FROM A VETERINARIAN. THERE WILL BE RATIONING. SOMEONE ELSE WILL DECIDE HOW MUCH YOU, AND YOUR FAMILY’S LIVES ARE WORTH.

  • Our political “leaders” appear to have excluded ALL of the physcians/surgeons who sit as elected representatives in Congress. They have successfully kept those who truly represent patients and physicians from being part of this process. This is an outrage and yet I do not hear LOUD voices expressing that outrage. There cannot be an acceptable and workabel “solution” without physicians and patients since these are the two most important stakeholders.

    For those who have not as yet read “Who Killed Health Care?: America’s $2 Trillion Medical Problem – and the Consumer-Driven Cure”,
    by Regina Herzlinger, permit me to encourage you to do so NOW!

    Another one to get is:”Fixing American Healthcare: Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare” by Richard, N. Fogoros

    Both of these should be mandatory reading for any elected representative and certainly physicians.

    Complacency on the part of physcians will lead to a system that will fail eveyone. Get off your collective derrieres, write your elected representatives and make your voice heard in your professional organizations.

  • Gary Gillespie, M.D.

    The essence of any healthcare program is the doctor-patient relationship and the freedom it allows for decision-making in the patient’s interests. Much more constrictive than increasing regulation, gate-keeping, and practicing purely evidence-based medicine are the constraints of a socialized healthcare plan: advancing from Managed Care formularies and preferred providers, it creates a moral hazard in which a bureaucracy within a centralized government alleges to know best what represents the definition of good medicine for the greatest number of people; the doctor and patient often removed from the equation. In such a program, the needs of the state and social planning take precedence over accessibility and the choices of the individual patient, and has attached an implicit obligation to the state. Such a ‘change’ is really no change at all: but simply gives license for a ‘cradle to grave’ mentality which gives way to official sanctions over many of the freedoms our healthcare system provided prior to the institution of Medicare. Such are the characteristics of the healthcare system in the nation to our north. Restrictions on healtcare availabilityand decreased accessibility give way to lugubrious queues, in which some Canadians live out their final days. At present, some of them come to America to receive that which is denied them in their home country. In similar circumstances, to whom can Americans turn? Why can’t more doctors limn what is wrong with this picture?

  • Dan Eisenberg MD

    Government needs to get out of the way. Gov sets our prices as Medicare is lowest allowable and then complains of too high a cost. Give seniors an insurance allowance. Discontinue Medicare as an insurance completely. Let private companies compete for the seniors’ premiums and let seniors’ pay extra for better plans if desired. Discontinue mandated rates and allow doctors and hospitals etc to figure out ways to be more efficient and charge less. Enough of the discounted payment system. If the bill is $50 then the pay is $50, just like everything else. The free market works, no reason to invent another way.

  • 1. Irrespective of the plan adopted, why not give a tax credit now to doctors who give uncompensated care?

    This simple step offers immediate incentive with no administrative cost.

    2. Irrespective of the plan adopted, why not require due process in peer review as a condition of Medicare and insurance reimbursement to hospitals? There is a doctor shortage and the Health Care Quality Improvement Act of 1986 as amended fails to protect doctors: Under the law, U.S. medicine is unsafe for U.S. doctors.

  • Since Congress is trusted as much as the corporations which control it, why not end our ‘Enron medicine’ by insisting that the plan enjoyed by Members of Congress is extended to all citizens?

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