The Health Care Blog has an excellent article written by Dr. Rob Lamberts about his views on the recently-passed health care reform bill. I’d say that his middle-of-the-road views are pretty realistic, and a lot more rational than many of the opinions that have been floating around the internet for the last year or so regarding health care reform.
I especially agree with Dr. Lamberts that the legislative process over the last year regarding health care reform was a national embarrassment. Our political system is so intertwined with for-profit businesses that it’s virtually impossible to carry on any sort of genuine legislative process anymore without catering to special interests. But the health care reform debate was particularly bad. Now that the vote is over, Colorado Senator Mark Udall is claiming that the Republicans are blocking a hearing to discuss the bark beetle problem we’ve been dealing with for the last few years (bark beetles are killing vast quantities of Colorado’s lodge pole pine trees, to the point where some mountain slopes resemble areas that have been burned by fire, without a single live tree in sight). Udall claims that the Republicans have invoked an obscure rule that allows them to halt the hearing because of its timing, and he says that this is being done in retaliation for the passing of the health care bill by Democrats. Whatever is going on, it sounds like a continuation of that national embarrassment that Dr. Lamberts described.
One thing that Dr. Lamberts pointed out is that “Doctors control a huge percentage of HC costs…” I think that for this reason, doctors could be particularly effective in terms of controlling costs, although there are plenty of roadblocks standing in their way. There is no way that we’re going to bring down health care costs without denying some care, but perhaps it will all end up being care that is ineffective and/or dangerous in the first place. Maybe denying care will come in the form of eliminating redundant tests or opting for lower-tech but highly effective care when the alternative exists. Denying care doesn’t have to be a bad thing for patients. But the concept needs a better PR team. Right now, people are used to denials from health insurance companies, who get to be the “bad cops” in the patient care equation. But what if that denial came directly from the doctors instead? What if doctors refused MRIs for patients with back pain that was two days old? What if they systematically refused to prescribe antibiotics for viral infections? Would patients be more accepting of denials if the denial didn’t come from a faceless organization, but instead came from the doctors themselves? Maybe, maybe not. It’s far easier to change doctors than to change health insurance carriers, and pre-existing conditions aren’t usually an obstacle when one wants to find a new doctor. So unless rationing (explained in a positive light) becomes the industry standard for doctors, I doubt that any one doctor could make much of a difference, since people who are used to getting what they want from their doctors might just seek out another doctor. Hopefully as time goes by and more people understand the lack of sustainability with regards to health care costs, more people will be willing to consider the possibility that some forms of rationing in health care might be a good thing after all.
Dr. Lamberts’ article was included in the Cavalcade Of Risk this week, hosted by Andrew at Oz Risk.