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July 26, 2009

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Sofia Fernandez, MD

We can all agree that health care reform is needed. There are several good plans out there, however, none are getting their "just desserts" due to the agendas of congretional leadership. It took us several decades to get into this mess, who honestly believe we can solve it in 2 weeks!

Let us be pragmatic, we need to focus on basic principles...freedom of choice being the first. Patients should be able to choose who they want to see, period, regardless of plan.

Physicians needs to be freed of the administration yolk and the burden of torts. This new found freedom can come with transparency of pricing. I can be up front with you as my patient about my fees, once the insurance companies are up front about how much they pay me vs. how much they pay my competitor down the street. This tranparency can be applied to radiology centers and hospitals. Patient can CHOOSE where they want to go. This empowers the patient.

I know that we as physicians want to not only treat the sick but prevent the illness. Quite frankly, the Medical Home is good conceptually, but in reality, it is another example of bean counting and an administrative nightmare. Enough! I do not need more work to justify my value as a physician! My patients will be the ones to decide MY VALUE.

We can achieve revolution in the system if we focus on the reality. If you cannot afford healthcare, how about a healthcare fund that will replace a portion of what would have been Medicaid or Medicare that you can tap into that will help you make the best decision for your family? What about changing insurance policy regulation and helping create a system based on regular preventative care and catastrophic policy choices? Let them compete like car or home owner's insurance. Employers who choose to provide this as a benefit would love the competition, helping to drive down prices. Common sense. Let us be able to keep our insurance after we leave our employer and transport it across state lines. Reform COBRA.

We need to fix the physician shortage. Tax incentives to reduce debt. Tort reform. You will not attract the best and the brightest if they cannot make a decent living. I am sorry, but $70k is not going to cut it. If we can reduce our administrative overhead, reduce malpractice payments, we can increase the amount of time with the patient. We can appropriately coordinate care and provide better services including electronic prescribing, emails and virtual visist. We can provide services that the patients, THE CONSUMERS, want! Right now, we cannot afford to provide these services...no payment.

I agree we need reform. I agree that the politicians have their own agenda. I agree that physicians are benevolent and we need to be ethical. However, if the system does not change for the good of ALL, then I can no longer afford to be benevolent. I might as well join the convent and take an oath of poverty-I'm already half way there!

John Brady

What is the definition of a "contributing member of society?" Who makes the distinction over who is contributing and who is just taking up space? Is an individual in a coma worth less than a CEO and therefore should be forced to go without care? If you believe health care is a privilege, then you must think some should be denied care. Who should be denied care and who should make that decision?
But my letter was mainly directed at doctors. Even if society deems health care to be a privilege, as physicians we have an ethical obligation to look beyond our own individual needs to that of our society (social justice). If we know that 20,000 people die annually of a disease, is it ethical to let the disease fester? I believe that the pillar of social justice requires us to act to try and to prevent it. If there were hope that an alternative piece of legislation would be put forth by doctors (or any other group) to address the needs of these individuals, then voting the current legislation down is perfectly legitimate. But, with no alternative legislation in site, we are dooming 20,000 people to die annually of a preventable illness and dooming untolded thousands to poverty due to their medical costs. As physicians bound to the basic ethical principle of social justice, we should be outraged at that thought and called into action.
So regardless of whether society believes health care should be a right or a privilege (and I do believe it should be a right), physicians have a higher calling and should work to eliminate pain and suffering both for the individual patient and for society as a whole.

Gordon Moore

John - someone sent me an email saying the premise of your post founders on the notion that health care is a right. He suggests that it is not a right, but a privilege one accrues as a contributing member of society.

What say you to that?
Gordon

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