Thursday, January 22, 2009

Could President Obama be Serious about Cost?

In a press conference a few weeks ago when then President-Elect Obama was asked how he would be able to afford health care reform, I heard him say that cost would have to be reduced enough to pay for it. None of the commentators I heard picked up on that, but I thought the statement was very clear.

Day before yesterday, the mail included the January 19 issue of Modern Healthcare. It included comments about health care reform by five healthcare gurus. The references to cost consisted of suggestions of what somebody else should do, like living healthier lifestyles or funding more information technology or reducing the administrative overhead of insurance companies. Nobody mentioned the need for the delivery system to become more efficient.

Yesterday, I read the full text of President Obama’s inaugural address and found three statements relating to health care. They are:

1. Our health care is too costly.

2. We will….wield technology's wonders to raise health care's quality and lower its cost.

3. The question we ask today is….whether [government] helps families find care they can afford.

What I find noteworthy about this is that (a) he did not use the words “health care reform,” (b) he made no mention of the uninsured or of the payment system, and (c) all three references refer to cost and one to quality.

If President Obama is serious about tackling the cost issue he will eventually face the need for the providers of health care to get their costs under control. That will surprise a lot of people and dismay even more.

Thursday, January 08, 2009

A Reason for Slow Progress

“Myrtue Medical Center Board of Trustees voted unanimously on Tuesday, December 23 to deny Dr. Wing-Tai Fung’s application for reappointment to the Myrtue Medical Hospital’s medical staff.

The vote came following a 45-minute closed session. Dr. Fung, 76. has been a member of the medical staff since October 1, 1971.”

So opened an article in the December 29, 2008 issue of the local Harlan, Iowa twice-weekly newspaper serving Shelby County, of which it is the county seat.

The news apparently created something of a stir. Ten days later, the newspaper ran a long article reporting a meeting of a special committee formed to consider the matter and a subsequent additional meeting by the Trustees, both of which confirmed the December 23 action and expressed a desire that other roles be found “for Dr. Fung’s continued service to this community.” The article also recited Dr. Fung’s many accomplishments during his 35-plus years of practice.

The contents of the latter article were summarized daily as a news item on the local radio station for a few days thereafter.

Myrtue Medical Center is a quasi-public institution, owned by the county but run largely as a private entity under enabling Iowa legislation. Its Trustees are elected from the county and serve without pay.

The Dr. Fung episode illustrates one reason why the part of health care reform dealing with quality and safety is proceeding so slowly. When situations of this type arise, there remains a tendency on the part of the public to support the doctor(s). That seemed to be true in this case, even though all indications are that the Myrtue Board of Trustees acted in what it genuinely believed to be in the community’s best interest.

Small wonder, then, that Trustees want to avoid confrontations with physicians, even when the safety and quality of patient care are involved.

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