Doctors for America Resource Center - The Issues

Everyone agrees that our system is broken. 47 million Americans are uninsured. 14,000 lose their insurance every day. Those who are insured are facing rising premiums and the ever-present threat of having their care denied for pre-existing conditions. Only 2% of medical students choose to go into primary care. Physicians spend an average of 3 hours a week on paperwork instead of taking care of patients. Despite having some of the best hospitals in the world, our health care indices fall far behind that of other industrialized nations.

This year, in 2009, there has been a concerted effort by Congress, the administration, various stakeholders, and the public to get reform passed. As physicians, we are both stakeholders and community leaders in health care. This resource center has been compiled to help you understand the issues and solutions in health reform so that you can be an informed advocate for the reform that you and your patients need.

Got questions? Use our easy online tool to ask a doctor about Health Care Reform!

In August, we conducted a poll of the top priorities of physicians in reform. Here they are:

1. Guarantee Access to Insurance

Covering all Americans would ensure that the insurance market functions effectively. Insurance works because policyholders pay into their plans when healthy, and have their medical bills paid when they are sick. Additionally, covering all Americans is essential to effective prevention and wellness efforts and managing chronic illnesses. Efforts to guard against and better manage illness are an important tool to improve health and contain costs but, without every American in the system, those efforts will fall short of their full potential. Lastly, the U.S. is the only developed country that does not guarantee health coverage for all its citizens, with 47 million uninsured in 2008 and another 25 million underinsured.

2. Prevention and Wellness

Chronic diseases – such as heart disease, stroke, cancer, and diabetes – are the most prevalent and preventable of all health problems and also the most costly. Nearly half (45%) of Americans suffer from one or more chronic conditions. Chronic disease accounts for 70% of all deaths (more than 1.7 million people). An estimated 80% of heart disease, stroke, and type-2 diabetes, and 40% of cancers, could be prevented if Americans stopped smoking, adopted healthy diets, and became more physically active. Efforts to guard against and better manage illness are an effective tool to improve health and attempt to contain costs over the long term. A financial investment would be need to create a better infrastructure for prevention health services and the cost savings may only be realized over the long term.

3. Public Insurance Option

The public insurance option can provide guaranteed access to health insurance, especially in poorly-covered areas. It would provide competition for private insurance companies which are currently functioning in highly concentrated markets with little competitive pressure. It would also help implement many of the reform provisions contained in the health reform bill. Opponents of a public option fear it will drive private insurers out of business. Proponents fear that without it, insurance companies will continue to drive up costs, decrease access, and sacrifice patient care in the interest of stockholders. Increasing the ability and options for all Americans to have health insurance will also help end the shifting of costs of care from the uninsured to the insured.

Note: The public option was removed from current legislation and looks to be politically untenable given the environment in the Senate. The driving forces behind the public option such as insurance regulation, access to insurance, risk pooling and delivery system reform continue to be important goals.

Public Option Webcast: Dr. Jacob Hacker (May 18)

Overview


Recent articles and briefs

4. Primary Care

Primary care is the keystone of a high-performing health care system. Increasing the supply and availability of primary care practitioners by improving the value placed on their work is a necessary step toward meaningful reform. Primary care has been shown to improve quality and restrain costs in the health care system. However, primary care is in crisis – few doctors are entering the field. One reason is that primary care physicians earn approximately 55% of the average earnings of all other non-primary care specialties.

5. Payment Reform

Today's payment systems reward providers for delivering more care rather than better care. Under the current system, the more visits, tests, images and services providers deliver, the more they are paid — regardless of the quality or the health outcomes of the patient. The perverse incentives have driven medicine to a breaking point where many physicians can only spend a short time with a patient, just to keep their practices afloat. Additionally, much of the administrative, phone call/email follow-up, care coordination work done by physicians goes unreimbursed in the current payment system. In a fee-for-service payment system, as in the one used for Medicare, the more services you provide . . . the more you get paid. This does not incentivize innovative methods to care for patients.

Articles

  • Follow the Money: Payment Reform as the Key to Health Reform link
  • Better Ways to Pay for Health Care: A Primer on Healthcare Payment Reform link
  • The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way, Commonwealth Fund link
  • Sens. Baucus, Grassley Release Memo on Payment Reform, Improving Health Care Quality link

Payment Reform Blog: Share your opinions

House Meeting Report: Download Report
On June 1-4, 2009, members of Doctors for America hosted and attended house meetings across the country to discuss payment reform in response to questions raised by Senators Baucus and Bingaman to the group regarding physician opinions. The final report was presented to members of Congress, and its findings were raised at the White House Health Reform Meeting with Physicians.

Webcast: Dr. Ellen-Marie Whelan, NP PhD (July 1)

Webcast: Dr. Tom Lee (Tuesday, May 26)

6. Comparative Effectiveness

Comparative effectiveness research examines the relative merits of two active therapeutic approaches by direct comparison. Understanding the relative effectiveness of different treatments, procedures, and drugs allows for enhanced evidence-based clinical decision. Pharmaceutical and medical device industries do not typically conduct studies that compare two similar treatment modalities.

7. Sustainable Growth Rate (SGR) Formula

The sustainable growth rate was enacted by Congress to control growth in Medicare payments to physicians. When spending reaches a certain target amount, payments to physicians are reduced. Spending has grown every year beyond the SGR target but payment cuts to physicians have been prevented by annual short-term Congressional legislation to stop it. In the current SGR-based system, physician payments in 2010 would be reduced 20%.

8. Malpractice Reform

Careful reforms of medical malpractice laws can lower administrative costs and health spending throughout the system, while ensuring that injured patients are compensated fairly for their losses. Malpractice reform could address money and time spent on litigation as well as improve patient and provider satisfaction with the resolution of complaints or grievances.

9. Care Coordination

The Patient Centered Medical Home (PCMH) is model of care that is designed to improve quality and achieve efficiencies by recognizing and supporting the value of care that is provided to patients by primary care physicians, working in practices that have the information systems needed to achieve the best outcomes. The model is based on a large and growing body of evidence that shows that care delivered by primary care physicians, supported with information systems and with the appropriate reimbursement incentives, can improve the quality and efficiency of care provided to patients, especially for patients with multiple chronic illnesses. CMS has begun several demonstration programs to test the medical home model in fee-for-service Medicare.

10. Health Information Technology

Read the latest report: "Health System Modernization Will Reduce the Deficit" link
May 11, 2009, David Cutler, Center for American Progress

Webcast: We were unable to record our webcast with Dr. Ashish Jha. However, you may see Dr. Jha discussing health IT in this video.


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11. Rural Health