Physicians, Begich, and Moving Forward

This morning I went to the town hall meeting that Senator Mark Begich held with health care providers. This is going to be a simple recap of what got discussed.

Tort Reform

This is clearly on the mind of physicians. It was brought up at least a half a dozen times. One physician pointed out they pay $60K in malpractice insurance. Another pointed out the cost of malpractice insurance to do obstetrics in New York keeps family medicine physicians away from the delivery room.

The case of a man who claimed to have a surgery done that was never performed by a surgeon who had never met him was discussed. The cost to all of us was $10K. I do not know who the lawyer was who filed that case and clogged the Alaska system with it but he should be disbarred.

It was pointed out to Begich that there are already places where tort reform has worked.

Begich mentioned that Obama has demonstration plans for tort reform. Obama actually said he was considering it but the bill is sorely lacking in any tort reform.

Begich also pointed out his problems with the tort system in the past as the mayor of Anchorage. If Begich is really that concerned maybe he could actually write the bill to do something about it. Fat chance, he gets money from lawyers like every other Democrat.

Medicare Reimbursement

None of these meetings ever makes it through without talking about this issue. There was the doctor who has opted out of Medicare, the one that may need to do it in a few years and the ones who have had to stop taking new Medicare patients.

Begich is right in that Alaska is the tip of the iceberg for the problem.

Alaska is a high expense environment. As Medicare reimbursement continues to lag behind inflation the rest of the country will follow. If the Congressional corrections to the Sustainable Growth Formula ever stop the problem would precipitate quickly.

Foreign Systems

One doctor who trained in Canada and another who has worked in Denmark spoke out about their experience.

The feeling of the physician who trained in Canada was that the US would have to change many other things to accommodate a similar system. One of those things is a way to make medical education affordable.

Denmark's system clearly has access issues when it comes to diabetes care. The speaker would know based on his specialty. The physician also pointed out to Begich that if we use Europe as our model for health care we need to also use Europe's system of dealing with medical malpractice as a model.

Primary Care Reimbursement

The money paid to primary care physicians was a hot topic for many speakers. It is difficult to want to stay in primary care and make less money when you are saddled with up to $300K in debt.

Begich believes that loan repayments might help. The problem is that unless you close the gap between primary care pay and specialty pay there will still be significant incentive to specialize. It is not particularly attractive to many people to be told where they have to practice to get the repayment.

Begich brought up the programs that produced more police officers. The problem pointed out to him is it takes 6 months to build a police officer and 11 years to build a physician.

Polls

Both the IBD and the Robert Wood Johnson poll were brought up.

Oddly enough, the public option did not get much discussion despite these polls being talked about. Begich indicated he is not a supporter of a public option.

One of the best points brought up with regards to the public option was the story of Tenncare. Tennessee found out what can happen with best of good intentions.

States like Massachusetts and Tennessee have already been guinea pigs for the nation and we should look long and hard at them as we drive down the road of reform.

It appears the public option is likely dead looking at where some Democrats are standing. People who support need to start looking at what else is there. If there is no compromise there may not be a bill.

Negotiating Drug Costs

Senator Begich repeatedly brought up how the VA is allowed to negotiate drug costs and Medicare should be allowed to do the same.

Begich is right but one must be careful. The VA has a limited amount of drugs available. Gastroenterologists find this out with proton pump inhibitors and inflammatory bowel disease drugs. The VA has been known to deny drugs because they are not available on formulary. The problem is they often do not have suitable alternatives.

Internists in private practice in Anchorage have complained about drug availability at medicine meetings over the years as well. The most common disease that has been the target of inadequate drug availability has been diabetes.

It sounds great to negotiate better deals on drugs but it can quickly turn into a process that gets in the way of patient care.

There is great difficulty assessing where a politician may actually come down on things. Mayor Begich and TheSdog went at it a number of times on the Alaska Politics blog. I still think he left the city in a mess and has issues with being straight despite how he portrays himself.

However, regardless of my distrust, he needs to follow through on a couple of things he said.

He argued that citizens should be allowed to buy into the same plan that insures him. I agree but let us take it a step further. Let small businesses come together and buy not only into that plan but any plan they choose as a group. More importantly, let them buy insurances across state lines. That is an idea killed by your party to protect mandates in the past.

Begich also argued that the plan has too many bits and pieces. He commented on 500 amendments being put on the latest bill in 48 hours. He seemed open to passing smaller pieces one at a time and this is the way to do it. This is something on which he and Senator Lisa Murkowski have agreement. Pass what can be agreed on and leave the rest for later. This also allows us to see the effects of some policy changes.

There were other things discussed but this shows you what health care providers in Alaska are thinking. There will be a meeting where the public can talk to physicians at the Loussac library at 7PM Monday. I will not be one of the physicians but I likely will be lurking in the shadows if I can get done with work.

As a final note, I have purposefully never used this space as a way to go after other posters. I will debate them in the comments but the pieces themselves are supposed to create discussion and move the debate forward.

I am suspending that rule for this post.

The use of a racial slur by Rudy Wittshirk in the first paragraph of his recent entry is not acceptable. He may want to do some research on the origin of the word he used and think about what he is actually saying.

I went to elementary school in Linda Vista which is a rough suburb of San Diego. I watched Filipino and Vietnamese youths verbally and physically attack each other because of their ethnic backgrounds. I heard words I would never repeat and saw things that make me sick to this day. I will never understand what guides such hatred. That is true racism Mr. Wittshirk, not the nonsense you are spinning.

This country needs to leave the false cries of racism behind. It clouds our ability to move forward. That was the point of my last piece. It is why I slammed Glenn Beck for playing the same game.

Real racism is out there and it is cheapened every time the left calls people like me a racist. That is exactly what you did Rudy. Shame on you.

Barak Obama figured the problem out with the Cambridge case. He is out telling the American public that opposition to the health care plan is not racism. 88% of the public agree with him. Like me, Obama is welcoming debate.

All of us should take the president at his word on this one.