The shape of future healthcare reform is uncertain, as there are many cooks in the legislative kitchen presently, in addition to the serious financial constraints at play.

 

What is universally accepted by all is our future inability to pay for health care as it is currently structured. We are paying for process rather than outcome in the context of a demographic change which represents a tsunami of new publicly financed health care recipients (Medicare patients). Cost is linked to quality of care, both of which are linked to access. Fewer Americans can afford access given co-pays, high premiums, deductibles, and less generous insurance coverage in general. This declining access will likely force a higher degree of efficiency by providers; this may not result in deterioration in the quality of services provided, however. Presently, much of what is referred to as "quality" is in fact quantity of medical care. Unfortunately, the cost of healthcare cannot be passed along to the ultimate consumer of goods and services, as the consumer will often not be willing to pay an inflated price. The inability to recoup one's input costs will result in economic decline, unemployment, and macro economic catastrophe, which the government will not permit (or otherwise risk severe recession-depression).

 

With healthcare presently consuming 17.5 percent of US GDP, cuts must be made. Physicians, insurers, hospitals, and pharmaceutical companies will all feel the pain, which will likely be severe. Whether a single payer or a so-called public option arises, we providers will survive and adapt to a changing world, or perish individually and collectively.

I have always enjoyed your publication but I sometimes worry about the misinformation that can result from some of the columns. The article on robotic colon surgery is very one-sided and amounts to an advertisement for the doctor.

 

I believe it would much more accurate and truly informative if more than one physician is interviewed in these types of articles so a true perspective is given to the readers. I performed the first laparoscopic colon resection in Memphis in the early 1990s and have performed hundreds of same since that time. Many good surgeons in Memphis do laparoscopic colon surgery. There is absolutely NO evidence that robotic-laparoscopic adds ANYTHING over laparoscopic surgery without the robot. In fact there have been multiple publications show that robotics adds nothing over laparoscopic surgery other than tremendous expense; not something you want in this day of healthcare reform.

 

Robotics is being shamelessly used as a marketing tool by all the hospitals and there is NO data to support its use in prostate, gynecologic or general surgery (colon etc.). In fact, most of the surgeons using robotics do not have good laparoscopic skills and are using the robot to develop their skill set. I encourage you to dig harder in the future when doing columns of this sort and seek out other opinions.

As a practicing physician, I am under no illusion that my opinion is as important in the debate as the collective opinions of trade organizations such as the AMA or AHA. As many note, the AMA has already shown support for HR3200. Yet, I also believe there is much to be reformed about the insuring, financing, and the misaligned incentives that impact all stakeholders. I could keep a daily list of things that my patients and I experience that adds to the cost of healthcare. But let me introduce you to the elephant occupying the health reform headquarters: The unaffordable long term cost of Medicare. We can deal with access for uninsured, the misplaced risk models of insurers and overutilization by some providers. Guess what? It won't solve the real financial problem which is how to pay for covering millions of Baby Boomers with enhanced Medicare benefits for longer than Medicare founders ever anticipated. These are the guys that taught Bernie Madoff his business. It is estimated that the largest PONZI scheme of all times could only be made solvent with about $66 trillion dollars, which is obviously not possible. Reform efforts will likely change our delivery of care and our business models. As Chairman of Metrocare Physicians I am proud that our Board is investing time in understanding and planning for reform on behalf of over 1500 area physicians.