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.
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.