An open letter to our leaders in Washington

President Barack Obama
Senator Kay Hagan
Senator Richard Burr
Congressman Howard Coble

As a practicing physician of 23 years who sees a number of Medicare patients, I am greatly interested in your proposals for healthcare reform. We are in need of reform, but reform that is nonpartisan and truly provides a viable long term solution, not something that is rushed and caters to special interests. No one understands the needs for reform better than one who sees patients day in and day out.  The number of factors contributing to the problem are myriad, and the long-term solutions are not easy.

With all due respect, I do not think that the members of the Senate and Congress  have the expertise or the knowledge to come up with a long-term solution.  The current system of Medicare financing and health care delivery is broken beyond repair. The VA medical system is not widely held up as a model of efficient healthcare delivery.  The private sector has its own set of problems. The problem when addressing healthcare reform is that everybody has his dog in the fight and thus what you see is the dogfight currently happening.

Recently we have witnessed much partisan bickering and a growing public mistrust as a complex bill is trying to be pushed rapidly through Congress despite uncertainty about financing and the long term implications.

In order to address this in a fair and meaningful way that will provide a long-term solution to the problem, I would suggest the following options.

1.       Why not appoint a bipartisan non-political commission with patients, industry, physicians, insurance companies, business leaders, government leaders, nursing, hospitals, pharmaceutical companies and medical supply companies and any other interested parties.  This commission would do an in-depth study and submit a proposed plan for comprehensive reform for public comment.  Following a period of public comment with subsequent revisions (with opportunity for final comment, and then the proposal would be submitted for an up or down vote without chance for modification in order to avoid protection of special interests.

2.        Why not then take the Federal Employees Healthcare insurance program and use it as a test model for healthcare reform?  That way the senators and Congress would be able to experience first-hand the healthcare reform that is proposed for the rest of the nation.  Because our tax dollars are already paying for this, this should result in significant savings at the Federal level.  One of President Obama’s campaign promises was that everybody should have the same healthcare benefits that the Federal employees have.  So I say, why don’t you go first and do healthcare reform on your insurance plan to see if it works.  That way once the bugs are worked out of it, then it could be rolled out to the rest of the country.

This model is done when bringing new treatments to the medical field.  They are tested on a small group before being rolled out to the folks at large.  In a way Medicare has done this for years with their demonstration projects.

3.       When Medicare was originally proposed in 1965, the average life expectancy was 67 years old.  Currently the average life expectancy is 78 years old.  The only way to make this work financially is to raise the age of eligibility. The current system of financing Medicare based upon workers subsidizing retirees is impossible to work given the current survival figures. Why not gradually increase the age of eligibility for those under 55 to at least 70 and perhaps older?

4.       Encourage greater patient responsibility.  The best example of this is the complicated Medicare drug prescription program that the members of Congress gave us. Prior to inception of this program, I was able to obtain free prescription medications donated by the pharmaceutical companies for indigent patients.  Once this program went into effect, the government mandate made it illegal for me to get these medications for my indigent patients.  Instead our tax dollars are paying for them. A simpler less complicated solution would have been either to give a direct $2000 allowance to cover the cost of drugs or a $2000 tax credit against the cost of their medications.  The current donut hole that the seniors experience is a perfect example of this.  The seniors are acutely interested in the price of their medications when they are in the doughnut hole but could care less otherwise at the beginning of the year when they do not understand the true cost. When patients are spending their own money rather than somebody else’s money, they make better choices in terms of cost and price.  I also would redo the current laws that make it illegal to provide free medications to indigent Medicare patients.  

A novel solution a least would be to do the donut hole upfront.  That way the patients would be pursuing the least costly medicine options and understand the true cost of the drugs.

5.       Encourage adoption of better lifestyles through the tax code. After spending 23 years trying to get patient to lose weight and have better health behaviors, I believe it would be more effective to have a tax surcharge for patients that do not make an effort to improve their health. (ie failure to begin losing meaningful weight after one year) The patients that do not pay that much taxes then would see their government benefits reduced by a similar amount for failure to undertake medical lifestyle interventions.

6.       One of the reasons that I hear for the high price of drugs is the need to do research and development for new drugs.  Why not review the patent laws and come up with a system that would allow for development of innovative new drug products.  That way, the pharmaceutical companies which continued to do innovative research rather than developing what we in the medical profession call “me too” drugs would be rewarded for research. 

 For example, a company that developed a new novel class of agents would receive lifetime royalties for this agent or an agent that was a cousin to it.  This would be similar to the way the music industry awards royalties.  That way other companies could produce the drug after limited patent protection for the developer which would then encourage price competition. A percentage of the revenues from the other companies would go back to the company that came up with the idea which would foster innovative research.  That would enable a very short period of time for patent protection for a drug and allow quicker entry of generic drugs into the market and encourage better price competition while encouraging research.

7.       Malpractice reform is vital and you have probably heard both sides of the story.  From the physician side, meaningful malpractice reform would reduce defensive medicine and lower cost without harming patients. Defensive medicine has been shown to be the major contributing factor to the rise in medical costs. 

WITHOUT TORT REFORM, HEALTHCARE REFORM IS DEAD.  The medical profession has been asking for tort reform for years while allowing protection of patients against harm.

8.       The importance of the right of conscience for the medical physician is paramount. A physician should not be forced to recommend a treatment or position that goes against his moral fabric.  Without protection of the right of conscience opt out of care that goes against a physician’s morals, many physicians and hospitals will stop practicing.  As I understand efforts to put right of conscience provisions in the current bill have been thwarted.  This is one item that needs to be included.

Without this, we are one step away from the horrors that happened in Nazi Germany and the Holocaust in their treatment of the elderly, and the disadvantaged.

The real problem is that we are living longer and longer with a greater rise in technology, with greater expectations, more expensive medicines and options, and a proliferation of information.  The people who are on the front lines to deliver healthcare understand what the issues are and will be able to speak articulately  to the process.  I would challenge you or any member of your staff to spend a week caring for these individuals and dealing with them first-hand.  You would then understand the issues involved.

The current Medicare program is bloated, abused, and extremely complex and difficult for the average physician to navigate.  I have reviewed the current documents and just see additional regulations that will only continue to drive physicians away from taking care of patients. Currently, they are projecting cuts of 20% for Cardiology for the next year according to a flawed payment formula. This will have dire consequences for access to care if they go through.  The laws and regulations are enormous.  Have you spoken with your constituents who are Medicare about finding a primary care doctor who is willing to take care of them?  How many doctors welcome Medicaid patients in their practice?

Each year due a flawed payment formula, there are threatened cuts which are patched up at the last minute or not at all. Most practices and hospitals are affected by the poor reimbursement of Medicare and Medicaid.

Most physicians I know deeply care about their patients, but are frustrated by the regulations, the lack of respect and poor reimbursement. It’s time to restore a level of civility about this debate and step back and let a non political solution come to surface. It is time to work together and not to serve special interest groups, political philosophies, and the agendas of some to the exclusion of others.



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