Some Closing Thoughts…

The weekly preparation of The Washington Report has been an interesting exercise.  It takes a fair amount of work, and my goal is to present information in a non-partisan way on what’s going on in Washington, DC.  As is fairly clear for those who have been following me, my perspective tends to be in the middle.   So, I was a bit taken aback this past week when one of my best friends from college sent a rather vitriolic rant on the content of the report.  I re-read the report several times in an effort to understand his position.  It seems that I have become personally responsible – in his mind – for the discussions, dialogue, and debates occurring on Capitol Hill.  However, I am simply trying to make sense of it all, or that is my intent.  But, I should probably be clear.  Like most Americans, I do have a point of view.  Where it’s relevant to the discussion, I’ll share it.  Where my point of view is irrelevant, I’ll try to stay away from engaging in the scrum. 

I do believe we need to reform the healthcare system.  I think the incentives of the current system are perverse and contribute to our problems.  We don’t pay for quality or outcomes.  We pay for procedures and doing things to people.  When a 58-year-old woman comes in to see her family physician about next steps in her treatment for pancreatic cancer, the incentives for the physician are to meet the Relative Value Unit measures set by the practice – not to spend an hour talking about options.  In fact, I frequently tell people that the US healthcare system is performing exactly the way the incentives are telling it to perform! 

We are currently spending just over 17 percent of Gross Domestic Product on healthcare in the United States.  It is projected to go over 20 percent in the coming decade.  Without changing our approach to healthcare and simply adopting the reform package under debate on Capitol Hill, we will reach 20 percent before the end of a decade.  I don’t think it is bad to include everyone under the health insurance tent, in some fashion.  In fact, I’m in favor of it.  But, if we’re going to include everyone – which seems to me to be what just societies should do – then we need to be responsible for creating proper incentives for healthcare delivery. 

However, I do not believe our country can afford an increasingly larger percentage of the economic pie going to healthcare to the exclusion of investments in public education, which is the cornerstone for creating our nation’s future wealth, or reinvesting in our withering infrastructure of roads, bridges and water supply systems, or [insert your favorite area here].  We, as a society, place a host of demands and expectations on our governments – both state and federal – where we expect good solutions and effective resolutions.  Healthcare is one of the many demands in an era of increasing constraints.

So, that is my counter rant!  If you think I’m biased, let me know.  I’m learning to not take these things personally although that’s hard at times.  I hope you’ll all engage in the debate, share your perspectives with your representatives, and try to bend the system.  Just remember, I do have one firm belief: change happens from the middle, not the extremes. 

Finally, I encourage you to go and buy Chaos and Organization in Health Care by Tom Lee, MD and Jim Mongan, MD (MIT Press, 278 pages, $29.95).  They provide a good overview of what’s wrong and what’s right in American medicine.  In particular, they provide a compelling argument for a new approach to American healthcare that does not rely upon the individual physician but upon a team approach to solving problems.  Their perspective resonates with a lot of us from all sorts of different political persuasions.  Now is the time to figure out a new way for increasing quality, reducing costs, and enhancing service.  We can do better.  Let’s perfect our healthcare system…

Kevin Fickenscher, MD

The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Perot Systems or its affiliates.