Physicians Practice - July/August 2008 - (Page 38)

HEALTHCARE REFORM plans that cover people just get in the way of good healthcare. But what’s so good about a healthcare system, Walker argues, where so many people can’t gain access to it? Glad we could settle that. Hotze and Walker represent opposite ends of the political spectrum but most of the debate over healthcare reform is taking place on ground between these views. Mainstream Republican politicians are not advocating a purely fee-for-service marketdriven healthcare system that would, if taken to its logical conclusion, spell the end of Medicare, Medicaid, and even private third-party payment schemes, all of which, in the view of Hotze and many others, simply obstruct the doctor-patient relationpayers. Most instead propose making it more affordable for patients to get into managed-care plans. HOPELESS ABOUT MEDICARE Medicare is the biggest problem in healthcare for a psychiatrist we spoke to in Philadelphia. He, too, thinks the political discussion misses the point. “Medicare is actuarially unsustainable,” he argues. “Just on a mathematical basis, it can’t keep going at the [present] rate of growth, and the problem is that there is absolutely nothing which is being put in process now that is addressing this issue at all. I don’t think that anybody — McCain maybe a little bit — is even looking at [it].” “Basically, patients still believe that after 40 years of largely free healthcare they … should be able to get what they want and pay nothing.” FREE LUNCH A Philadelphia psychiatrist ship. Most conservative reform ideas would, instead, simply tweak the current healthcare system to make it more responsive to market forces without being at their mercy. Nor are many Democrats talking about truly socialized medicine, if that’s deﬁned as a system in which everyone is forced into government healthcare with all the bills paid by tax- Medicare’s ﬁscal picture can only improve if the government addresses either cost or access to care, says the psychiatrist. The former would reduce what physicians and hospitals are paid. The latter would reduce the number of people covered, or the number or things for which they are covered, or would increase the amount that beneﬁciaries pay out of their own pockets. Dropping reimbursement would be devastating to physicians, especially those in primary care. “I still don’t think anybody has any idea of how fragile the primary-care delivery system is and how close we are to imminent collapse,” says the psychiatrist, who asked his name be withheld because he was speaking without his employer’s authorization. “The marginal revenue per patient is rapidly reaching the marginal cost.” The psychiatrist’s wife is a primarycare physician who plans to quit soon and probably won’t practice medicine anymore. Though young, she is exhausted by the churn of high volume and low pay. “They are trying to get every last nickel out of it,” says her husband. “Doctors are well-educated enough to know they can do other things. They just can’t survive in this economic model.” Reducing access through rationing or waiting lists isn’t really an option, either, he feels. “I don’t think we’re anywhere near where people are ready to do that. Basically, patients still believe that after 40 years of largely free healthcare they … should be able to get what they want and pay nothing.” The only possible solution, he concludes, is for each individual physician to look out for himself within the current environment. Forget about waiting for politicians to ﬁx “the system.” Instead, says this psychiatrist, who also has an MBA from the Wharton School of Business, stay focused on your piece of it, and keep an open mind: “There are different ways to make this succeed. Because so few people are thinking creatively, the people who do think in creative ways have the option to really succeed and succeed big.” REINVENTING THE ROCKET? When NASA’s scientists want to send a spacecraft farther than is ordinarily possible on one tank of fuel, they don’t waste time redesigning a whole new engine. Instead, they bounce it off the gravitational pull of a nearby planet to “slingshot” the craft into deep space. Great idea, but signiﬁcant time must pass to reap the beneﬁt. Consider that Galileo took ﬁve years to reach Jupiter, even with multiple gravity assists. So it may be with healthcare reform. Some experts say we should keep on with good things that are already afoot, that wholesale reconstruction may in fact hinder as much as help us. WWW.PHYSICIANSPRACTICE.COM 38 | PHYSICIANS PRACTICE | JULY/AUGUST 2008 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - July/August 2008

Physicians Practice - July/August 2008 Contents The Bigger Picture: Battle Royale in the EMR Market Letters Physicians Practice Pearls: Hire Right Noteworthy Cover Story: Healthcare Reform: Voting for Change Patient Relations: Dealing with Problem Patients The tech Doctor: Is Self-Service Medicine Inevitable? Technology: Do EMRs Make You a Better Doctor? The Guide Idealab: Cash-Only Care Still Works The Administrators Desk: Who’s in Charge? Ask The Experts What Went Wrong: ‘Why Our Great Idea Didn’t Work’ Coding Start It Up: How to Launch a Practice: Operations Partnership: Don't Let Partner Conflict Destroy Your Practice Appraisals: What’s Your Practice Worth? Getting Advice: How to Hire a Consultant Classifieds Advertiser Index

Physicians Practice - July/August 2008

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