Under the guise of bipartisanship, President Obama will convene a January 25th summit of Democrat and Republican leaders in an attempt to rescue his troubled healthcare reform plan. Critics on the right are wary that this is a trap to embarrass the GOP; a publicity stunt meant to disguise the fact that the White House and Congressional Democrats have already made healthcare reform a fete accompli with a backroom deal. Critics on the left state that the GOP had ample opportunities to fix the healthcare problems that they are so earnestly concerned about now. The real question then is, “does either party really want healthcare reform?”
The answer to this question is complex, but the reality is that neither party seems serious about reform. The Obama administration has manufactured a crisis situation, envisioning an opportunity to nationalize 1/6 of our economy, with no clear solutions to the real problems confronting the healthcare system. The GOP has simply mounted a counter offensive, which has been weak and late coming. Although their ideas are closer to being workable solutions, the reality is that the Republicans lack the conviction to do what is necessary to shake things up and make the changes necessary to make a difference.
The danger of this summit is in trying to find common ground and in getting something done. What they will all agree on is how expensive healthcare is currently. Afraid to bite the hands that feed them, our Congressional leaders will avoid hurting their buddies in the insurance industry, the hospital lobby, and the unions. They will go after the “low hanging fruit” — the most visible and vulnerable player in this field: the doctors. This, in spite of the fact that only 12 cents out of every healthcare dollar spent goes to doctors.
There are already some “cost containing” measures being discussed in this bipartisan effort. Ideas such as “pay for performance” and episodic care make for great sound bites, but are terrible for patients and doctors. Pay for performance attempts to reimburse doctors on the basis of outcomes and while this sounds appealing, once doctors are penalized for bad outcomes, who will take care of the sickest patients? Who will be the arbiter of outcomes? This is not a cost containment plan; it is a potential public health disaster. Likewise, episodic care means paying a fixed price to a hospital for a patient’s problem. The hospital then divides the dollar, including the reimbursement to the doctor. The tremendous conflict here is obvious. It is yet another attempt to control doctors, just like the government and insurance companies have tried to do for years. The losers will be the patients, because as long as some group controls doctors, decisions affecting patients will be influenced by whoever controls the purse strings. Each of these groups is vying for the right to own doctors; to make them perform like circus animals for food.
Doctors long ago identified what the problems in the healthcare system were: too much government regulation, too much power by insurance companies, and unfair competition against doctors by hospitals. Patients’ concerns are unimportant to these entities although they would protest to the contrary. The government wants to control patients. The insurance companies and hospitals want to profit from them. Only doctors care for their patients as individuals and prove their devotion to them repeatedly on a daily basis.
The most glaring problem has been the conspicuous absence of doctors from this debate. Formulating a healthcare plan without doctors makes no sense. There are more good ideas coming out of a hospital doctor’s lounge than in an entire year on the floor of Congress. Doctors are the missing piece in this upcoming summit. Not the make believe, White House lawn, photo op doctors and not the AMA politicos, which represent just 17% of the US doctors. President Obama needs real doctors by his side. Instead of railing against doctors, he should embrace them, giving them the opportunity to succeed where his political minions have failed. This would demonstrate something far more impressive than bipartisanship.