Monday, July 20, 2009

Doctors and Nurses Speak about Health Care Change

Great program on Kerri Miller's Midmorning show today. The show brought together dozens of doctors, nurses, and medical consumers to discuss health care reform.

They discussed:

  • overutilization -- the psychology of doctors being asked for tests, wanting to be liked, and also being "incentivized" to overuse tests because they get paid per procedure. Mayo Clinic doctors are salaried -- so there's not as much incentive to do tests that aren't needed.
  • lack of coordination of care, so that people end up on 30 medications that make them sicker instead of better.
  • the VA model, so often mentioned in health care reform discussions.
  • the ethics and values that need to be settled in terms of costs and access. (Ethicist Peter Singer recently posited a provocative question on this topic.)
  • a public option was generally thought to be needed to make the private insurance companies honest.
  • one nurse said she doesn't like to call what we have a health care system -- it's only a business. She sees people show up in her ICU because they couldn't afford a $15 copay. They get a cardiac stent put in, but then they can't afford the blood thinners to keep their blood from clotting around the stent.
An internist named Craig Bowron made this analogy: Our health care system is like a person with a meth problem, who thinks their only problem is that meth is too expensive. But if the person got off meth, all of their financial problems would clear up.

Doctors' medical school debt was raised as part of the problem. They spend seven to 13 years in medical school and residencies, ending up with $200,000 in debt. This affects decisions about going into specialties instead of family practice, internal medicine or pediatrics.

Measuring outcomes is always bandied about as a goal for medicine, but the audience repeatedly pointed out that it's not as easy as it might sound. It can take years, in many cases, to determine if one approach works better than another. So how do you "pay for performance" in medicine?

I don't think it was just self-congratulation, but the group seemed to be in agreement that Minnesota is doing more things right than most other states, and they wish a new system would learn from Minnesota.

And that states like Minnesota, with high-quality care at a reasonable cost, should not have their Medicare or other federally based compensation cut across the board, as is currently being considered.

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