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A Voice for Private Physicians Since 1943

Obama Administration tries to mollify doctors by teleconference, accuse dissenters of spreading myths.

On Aug 28, the Obama Administration hosted a nationwide call-in for physicians, in which more than 1,900 physicians participated. It was said to be “closed to the press” so that a “conversation” could occur.

Much of the call was taken up by a primary care internist, now in the Office of Public Engagement, telling about her frustrations during her brief time in practice: a “treadmill,” phoning for preauthorizations, paperwork, no time to talk to patients, doing “the same thing over and over again.”

Because of this experience, she decided to go into health policy work. She says that “health care reform” is vitally important, “especially for the profession of medicine.” She claims that 12 million people are being denied necessary care, or losing their insurance, and that “we can’t wait any longer.”

Doctors were urged to visit www.healthreform.gov, to “resonate with the message,” and to correct the “myths that have been spread out there.” They should “talk about why this means so much to you” and about “taking back our profession.”

More than 400 questions were said to have been turned in, and diligent White House staff pored over them and sorted them into various categories.

A member of the White House Office of Communications warned of “misinformation” and “negative messages.” He thought that this call was like “preaching to the converted.” It’s all about healing and “making sure our health care system works.” But the past month of town halls has reflected “how emotional the issue is.” There’s “tremendous fear” resulting from “misinformation.” The Administration needs doctors to gain trust and credibility for its Plan. The “status quo” is what is driving the call for reform. Americans are receiving the best care, he said, whether they have insurance or not, but they have problems navigating the system. Out-of-pocket costs are more than they can bear, and they are omitting preventive care because of cost.

The essential consumer protections that he promised everyone will have after reform are: (1) No one denied coverage because of a pre-existing condition; (2) no one loses insurance because of illness; (3) everyone gets preventive care, such as an annual examination, without charge (“barriers”); (4) limits on out-of-pocket costs; (5) no lifetime caps on coverage.

Once “we pass it,” Americans will have security, stability, and peace of mind. We are “further along than we ever have been” toward “transformational reform.”

The communicators then considered the three most frequent questions culled from the 400 submitted.

Q: Once everybody gets disease care, what about improving prevention? A: We’ll eliminate copays. Prevention is the right thing to do, and there are some examples of cost savings. If all diabetics got the best care, we could prevent 40,000 hospital admissions per year.

Q: What about the SGR? A: Congress has fixed it yearly, “to be sure physicians are appropriately compensated.” A fix is “baked into the cake,” having already been factored into Obama’s baseline budget. But more basic change is in the works. Since fee for service “misaligns incentives,” we need to go beyond pay for performance and align incentives to put quality over quantity.

Q: How do we get young doctors to go into primary care? A: We’re already “investing” $0.5 billion through the Stimulus, even before health care reform. We’re expanding the National Health Service Corps, allocating $250 million for training nurses and physician extenders, and expanding scholarship and loan-repayment programs.

Doctors were invited to submit additional questions through [email protected].

A few doctors were permitted to ask questions live. One concerned the Medicare Advantage program. Why were taxpayers supporting private insurers when the money could be better spent on the children? “Spot on” was the brief answer.

Another noted that Massachusetts was thinking of changing from fee for service to a global payment system. The answer was that a shift from FFS was in all the reform bills being considered, not just to save money but to enhance care.

A third asked about liability reform, and about the President’s statement that doctors got paid $50,000 for doing an amputation when Medicare only reimbursed less than $1,000. The response from the former internist was to express sympathy and to assure the caller that Congress was working very hard to assure that doctors could do what they were trained to do. We need best practices and better quality and error prevention. The President has listened to doctors and is sure we can find a fair and equitable solution if we work together. He has shown his consistent willingness to dig down and see what the drivers and stressors are. He is not in favor of caps, as he thinks these would be inequitable to some people. We should not misinterpret the President’s statement about the amputation; he meant system cost.

A fourth caller suggested a White House conference about end-of-life care in which stakeholders could reach a consensus. “It really riles me up to see the coverage of the death panels,” responded the former internist. Something that makes perfect sense to all the doctors she knows—just having a conversation with the patient before he gets into one of those situations—has been twisted and turned around, she said. The issue has come up time and time again in conferences with the White House.

A family physician from Wisconsin asked whether the value of preventive care would be recognized with health care reform. The answer is that it would be covered in all plans, Medicare, public, and private.

This call was one small part of the intense public outreach strategy of the Obama Administration. The intensity of protests at town-hall meetings was not foreseen. Despite years of polling and focus groups to find words that win over voters, “Obama allies find that words fail them,” writes Jonathan Weisman (Wall St J 8/25/09).

In particular, concerns about euthanasia and death panels were not anticipated.

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