Bitter Reform Pill to Swallow

A doctor writes about five critical and central healthcare reforms.

Dr. Marc Siegel writes: "Based on my experience, I believe there are at least five central reforms that President Obama has yet to consider - and will likely not grapple with in tonight's speech to Congress - because of a narrow world-view and pressures from special interests."

1. Extend high-deductible insurance to the uninsured;

2. Demand real tort reform;

3. Extend liability to the government as well private insurers;

4. Increase rather than decrease reimbursements to doctors and hospitals;

5. Subsidize primary care education.

. - By Dr. Marc Siegel New York Daily News September 9, 2009

5 pills for Obama to swallow: A medical doctor gives his Rx for health care reform

Dr. Siegel is an Associate Professor of Medicine and the Medical Director of Doctor Radio at NYU Langone Medical Center. He and his wife have very active and sizable patient care loads.

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Let me respond. . . . .

From: Fredrick H (MD, PhD, JD)

To: Gilbert R (Large Med. Grp Exec Dir)

>>Extend high-deductible insurance to the uninsured.

Medical care is so expensive today, that many WITH insurance go bankrupt just from the deductibles and co-pays. People who can't afford the initial testing end up waiting till the disease becomes a disaster. This guy talks from the perspective of a rich practicing internist, who has no problem meeting a high deductible.

>>Demand real tort reform.

I just lost a dear friend of 45 years to a complete medical screw-up. More people die of medical screwups than of auto accidents. Instead of giving providers a license to kill with impunity by removing their liability for their screw-ups, we need laws that require more oversight, mandatory safety procedures, and severer penalties for preventable errors.

>>Extend liability to the government as well private insurers.

This is a red herring! Give me one example of a doctor who has been held liable for failing to do a procedure when an insurer refused to allow it. That said, I'm all in favor of heightened liability for ALL insurers and HMOs, not just government ones, for actions which unreasonably lead to harm to patients. That said, I see such actions far more with private insurers than with Medicare.

>>Increase rather than decrease reimbursements to doctors and hospitals.

Yes, every pig wants his place at the trough! We should pay reasonable costs for medical services, but we have no obligation to make every doctor a multimillionaire and every hospital exec a multihectamillionaire.

>>Subsidize primary care education.

I agree that we should encourage doctors to go into primary care. One way is to pay for their medical education in return for service in primary care. Another is to divert some of the money going to specialists to primary care doctors. Another is to allow more well-trained well-spoken foreign doctors into practice if they agree to do primary care.