A Chance to Fix the System?

We're living in a something-for-nothing society, in which consumers have been trained to expect high-quality goods and services for little to no money.

Americans expect top-notch care, physicians available 24/7, and any expensive test or procedure they might think they need. And who should pay for it all? Someone else, of course - the government, an employer, the physician. This mentality is one thing when shopping at Wal-Mart; when it comes to healthcare, it's dangerously unrealistic.

As a private-practice physician, you know that as well as anyone. The promise made to physicians is often based on a lie: healthcare "providers" will be paid for perfectly coded patient encounters. But you spend countless hours explaining medical conditions and treatments, prescription options, or simply reassuring patients, with little or no reimbursement.

Our politicians, meanwhile, are afraid to publicly state the obvious: this is not a sustainable model. That's why Congress created the Citizens' Healthcare Working Group, a panel of consumers, caregivers, business and hospital executives, healthcare economists, nurses and physicians charged with examining the healthcare system's problems and recommending solutions.

For scared politicians, the group provides cover to make unpopular change possible. That may seem a little wimpy, but sometimes it's the only way to get something done. Take military base closings, for instance. Few thought the government would ever shut a base when President John F. Kennedy, in the early 1960s, created the base-closure commission process. In the last two decades, 20 percent of the Defense Department's base capacity has been shuttered, with a savings of at least $17 billion, according to the department.

The Citizens' Healthcare Working Group is spending about a year and $6 million learning what type of healthcare service Americans want and how much they are willing to pay for it. Will it have the confidence to recommend radical changes?

Not on the group's agenda, unfortunately, is how to ensure the vibrancy of private physicians in the American healthcare system.

Maybe that will change. Among the members are three very different physicians:

Frank J. Baumeister, Jr., past president of the Oregon Medical Association, and a private-practice gastroenterologist in Portland;

Brent C. James, vice president of 200-hospital Intermountain Healthcare; and

Aaron Shirley, associate professor of pediatrics at the University of Mississippi, long active in studying problems of the uninsured.

Right now the group is traveling the country speaking with consumers, physicians, and others integral to the healthcare system. It is to report to the president and Congress by year's end.

The commissioners are trying to get citizens, as well as special interest groups who could ultimately support or kill any of their proposals, to come forward. They want to use the media to demonstrate the dysfunction of the current system. Their hope is that they can use horror stories to propose changes to it.

The group is spending a good deal of time briefing Congress and other heavy-hitters who could determine whether its report gets on the radar or is simply mothballed.

Our political system is resistant to change, but not impervious to it.

Let's see what happens with healthcare.

In the meantime, make sure the group hears from you: www.citizenshealthcare.gov.

Sign up to speak.

Tell them what you think.

And tell me what you think, too. Can an independent commission succeed in fixing American healthcare where Congress has failed? Write to me at kkarpay@physicianspractice.com. The views expressed here are my own, and do not necessarily reflect those of Physicians Practice.

This article originally appeared in the January 2006 issue of Physicians Practice.