I [recently] gave a speech at the Midwest Business Group on Health’s (MBGH) 30th Annual Conference. The MBGH is one of the country’s leading organizations on healthcare, and its members include the leading innovators and thought leaders on healthcare in America. It was a privilege to present to them.
I spoke about why healthcare just isn’t a consumer business in spite of all of the effort to turn people into healthcare “consumers.”
At Best Doctors, we have a closeup view of what happens to people when they try to find their way through the healthcare system. It’s not a pleasant picture. Healthcare consumers –- if you can call them that –- are often lost, confused, frustrated, alone. Read more »
Doubled over in pain, you stagger into the emergency room and are diagnosed with acute appendicitis. A surgeon leans over your stretcher:
Surgeon: You need an appendectomy.
You: What are my options?
Surgeon: Either I take out your appendix or you die.
Now that’s a conversation people can understand. But what if, instead of whisking you up to the operating room, the surgeon kept talking and invited a few other people into the discussion?
Surgeon: Do you think I should take it out by an open operation or laparoscopically?
Laparoscopy equipment salesman: You know, cutting you open the old-fashioned way and leaving a big scar or having a tiny incision. Laparoscopy is much better than the open procedure.
Guy who sells scar-removal cream: Wait a minute. Better for whom? Laparoscopy takes fourteen minutes longer.
Hospital administrator: But hospital stay is reduced by 0.7 days on average, patients have less pain, and you can return to work sooner.
Surgeon: Laparoscopy costs more than an open operation while you’re hospitalized but less once you’re home. What’s your co-pay?
You: Doc, my belly’s hurting a lot more now.
Guy who owns shares in a drug company: What if we just treat him with antibiotics?
Surgeon: Don’t be silly. His appendix could burst.
Funeral director: What about doing nothing?
Very smart people are zoning out of the health care reform debate because they think it’s just too complicated.
The latest poll out today from the Kaiser Family Foundation, a nonpartisan health-care-policy research organization unaffiliated with Kaiser Permanente, says only 27 percent of the public has been following the health reform debate closely. Despite this, more than half (56 percent) of Americans think health reform is more important than ever.
Simply put, there are four main goals of the legislation:
Coverage expansion and subsidies. This is where most of the estimated trillion dollar price tag over ten years would go – to expanding Medicaid for uninsured and lower income people and to help people who can’t afford it pay on a sliding scale for insurance through new health insurance exchanges.
Insurance market reforms. This is about fair play in the insurance industry. Advocates want to eliminate practices such as refusing to cover people with pre-existing conditions and jacking up premiums if they’re sick. The most controversial proposal is the establishment of a “public option” – a government insurance plan that would compete against private ones.
Delivery and payment reforms. This is about delivering more effective care at a lower cost.
About 20 percent of the 2.5 trillion dollar annual health care price tag does not contribute to better health.
Prevention. This has been long overlooked in America. Spend a few dollars on foot care for a diabetic and you may prevent a foot amputation and thousands of dollars in expenses.Defining the goals is relatively easy to understand. Implementing them is tough and that’s where people are made to feel stupid – partly by special interest groups who intentionally or unintentionally confuse the debate. Drew Altman, Ph. D., the President and CEO of Kaiser Family Foundation, told me there’s “all kinds of spin, mis-statement of fact and plain old mis-truths being bandied about and the debate is getting nastier and nastier.” He added that people are becoming confused and “it’s beginning to make the public more anxious and antsier.”
Half-truths feed on fear. People are afraid of losing or compromising what coverage they already have. They’re afraid of higher taxes and lower quality of care. Who has the time or patience to read the 1,000-page bill proposed by the House of Representatives? So we rely on summaries and are susceptible to all sorts of misrepresentation. And nobody wants a plan with major faults rammed down their throat in the name of political expediency.
Today’s Kaiser Family Foundation report suggests that the tactics of special interest groups are working. Sixty percent of adults surveyed support a public option. But “(w)hen those who initially support the public plan are told that this could give the government an unfair advantage over private companies, overall support drops to 35 percent. Conversely, when opponents are told that public plans would give people more choice or help drive down costs through competition, overall support jumps to roughly seven in ten.”
It’s in the interest of those who oppose health care reform to make us feel that it’s just too hard to understand. I have certainly felt that way at times over the past year. But the stakes are too high for Americans to bale out on the discussion. Our common sense and sense of fair play are crucial to the national conversation. We should hear out the special interest groups; they often have legitimate concerns and thoughtful analysis. But we need to remember where they are coming from. And we must seek out information from sources that try to be nonpartisan, such as the
Kaiser Family Foundation.
No, you’re not stupid if you’re confused about health care reform. But you may be psyched out. You probably know a lot more than you think – but you may need to do some homework in order to participate in this extraordinarily important national debate. The national debate needs you.
For this week’s CBS Doc Dot Com, I moderate a debate about the public option between Wendell Potter, former head of public relations for Cigna and Rob Schlossberg, Executive Sales Director for BenefitMall. Mr. Schlossberg opposes it and Mr. Potter favors it.
To view the debate on a public option, click here.
To view a brief discussion of for-profit vs. not-for-profit health insurance organizations, click here.
For Janet Adamy’s excellent summary, “Ten Questions on the Health-Care Overhaul,” in the July 21st issue of the The Wall Street Journal, click here.
The patient sits across the exam room and looks at me with a combination of surprise and hurt. He had answered all of my questions to the best of his abilities, hoping that I would figure out what was causing the symptoms and fix his problem. A bit of doubt shows on his brow as he goes over what he feels and what happened in the past. Did he say things wrong? Did he mistake the way it felt? Is he just bad at explaining things?
“I am not accusing you of being untruthful. Your symptoms are your symptoms, and you felt what you felt. Unfortunately they don’t always read the medical textbooks and so make me earn my keep. I believe your symptoms are real; I just don’t understand how they fit together. It’s confusing.” I say this as reassuringly as possible. He relaxes visibly as I speak.
But that doesn’t change the fact that the symptoms defy logic. It’s my job to figure things out and fix things, right? Isn’t this an admission of defeat? Isn’t it a confession of my inadequacy? Won’t this undermine the thing that I have said is the cornerstone of a doctor/patient relationship: trust?
Some people seem impatient for an answer, but most are OK with me not knowing for a while. The thing that makes it acceptable for me to be confused is the longstanding nature of the relationship of a patient with their PCP. This is one page in the book, not the whole story. This concept – of the patient’s “story” – is one I actually use in this situation. I say:
You know when you see a movie that is really confusing in the start? You don’t know who is who, or why one person was mad at the other, etc. It is just hard to figure out what is going on. But later on in the movie things become clear. You say “Oh, so that’s who that guy was! That’s why she was so mad at him.” It all clears up over time. With your illness, we may just be at that confusion part of the movie. It may just take time for us to be able to make sense of what is going on.
I have to say that I actually am glad for those cases where things are confusing at the start. No, I am not happy for the patients, but the hard stuff is what separates the good docs from the bad ones. If I can sort through things and come up with an answer when one wasn’t apparent, I am showing the merit of all of my hard work. I justify my salary. I go home feeling like I am more than just a bunch of algorythms.
I don’t want everyone to be confusing, but just because things seem to not add up it doesn’t mean we won’t come to a good answer eventually.
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