On May 27, 2009 I gave a talk to a group of physicians in Bayonne, New Jersey. Bayonne is an interesting place since it is a microcosm of many of the issues that health care will face going forward. It was an old manufacturing town, clean and neat but showing its place in history. The presentation was based upon what I have been writing and speaking about for the past six months but it was highly interactive and the group gave me their ideas as to what is important. I thought it would be most useful to memorialize them.
Their suggestions are as follows:
1. Increase taxes on cigarettes, and in turn on carbs to the point where they truly suppress the consumption and change disease patterns.
2. Allow Medicare to negotiate on drugs. They all seem to feel that the previous Administration's plan was the wrong way to go.
3. Tort Reform was an issue which came up again and again. They clearly all practiced defensive medicine. They also were concerned that if a Comparative Clinical Effectiveness plan were started and they were required to follow its dictates that they needed some protection in a revised tort reform package. What if they were reimbursed only for the approved CCE procedures and tests and they patient died and they were sued for not taking extreme actions that generally were not accepted. This was a real issue.
4. Dismantle the VA system and allow patients to be treated in the existing system. Oh yes and many of these physicians served in the military. The VA seems to have a vary bad reputation.
5. The end of life issue is a real problem. It is cultural and legal in nature. Many physicians take extreme measures with patients for fear of being sued by relatives after the patients demise. Uncle Lou has terminal colon cancer and he died three days early, then you get sued for not saving his life! This is more common than thought. Thus the physician spends drastically more money than necessary. They recommend a revision of the Tort system in general. The cultural end of life issue is also a major factor. Many groups want Uncle Lou to last for as long as possible no matter how painful it may be. That becomes an educational issue.
6. The Immigration Problem! Wow, I really did not think this was as big as it was. It is not just the illegal immigrant laborers, it is also people with cancers, flying to New York-Newark, getting off the plane on a tourist visa and then going to a hospital with everything from pancreatic cancer, lung cancer, congestive heart failure and the like. If you cannot get care in your country then get a cheap ticket to the US and get it free! Try this in Russia and you will die quickly in Siberia!
Thus these six issue are interesting and should be included in the debate.
Their suggestions are as follows:
1. Increase taxes on cigarettes, and in turn on carbs to the point where they truly suppress the consumption and change disease patterns.
2. Allow Medicare to negotiate on drugs. They all seem to feel that the previous Administration's plan was the wrong way to go.
3. Tort Reform was an issue which came up again and again. They clearly all practiced defensive medicine. They also were concerned that if a Comparative Clinical Effectiveness plan were started and they were required to follow its dictates that they needed some protection in a revised tort reform package. What if they were reimbursed only for the approved CCE procedures and tests and they patient died and they were sued for not taking extreme actions that generally were not accepted. This was a real issue.
4. Dismantle the VA system and allow patients to be treated in the existing system. Oh yes and many of these physicians served in the military. The VA seems to have a vary bad reputation.
5. The end of life issue is a real problem. It is cultural and legal in nature. Many physicians take extreme measures with patients for fear of being sued by relatives after the patients demise. Uncle Lou has terminal colon cancer and he died three days early, then you get sued for not saving his life! This is more common than thought. Thus the physician spends drastically more money than necessary. They recommend a revision of the Tort system in general. The cultural end of life issue is also a major factor. Many groups want Uncle Lou to last for as long as possible no matter how painful it may be. That becomes an educational issue.
6. The Immigration Problem! Wow, I really did not think this was as big as it was. It is not just the illegal immigrant laborers, it is also people with cancers, flying to New York-Newark, getting off the plane on a tourist visa and then going to a hospital with everything from pancreatic cancer, lung cancer, congestive heart failure and the like. If you cannot get care in your country then get a cheap ticket to the US and get it free! Try this in Russia and you will die quickly in Siberia!
Thus these six issue are interesting and should be included in the debate.
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