Sean Khozin, MD, MPH

Yesterday President Obama revealed a plan, expected to cost $950 billion over 10 years, to renew the administrations push for healthcare reform.  The plan proposes to provide coverage to more than 31 million uninsured Americans.

More details:

• The plan includes a measure designed to close the Medicare “donut-hole” gap for prescription drug coverage, which leaves seniors paying the full cost of medicines during a certain stage of the programme due to coverage limits.
• Obama proposes increasing fees paid by the pharmaceutical industry $10 billion over 10 years and above the $23-billion increase proposed under the Senate bill. Obama’s plan also delays implementation of these fees by one year to 2011.
• Obama’s plan includes provisions designed to increase access to generic drugs by giving the Federal Trade Commission the authority to address the practice of “pay for delay” agreements between brand name and generic drug manufacturers. The plan suggests prohibiting generic drug manufacturers from accepting “anything of value from a brand-name manufacturer that contains a provision in which the generic drug manufacturer agrees to limit or forgo research, development, marketing, manufacturing or sales of the generic drug.” Such deals could only be reached if the parties “demonstrate by clear and convincing evidence that the pro-competitive benefits of the agreement outweigh the anti-competitive effects of the agreement.”

The plan will be debated this week at a bipartisan healthcare summit.

Source: FirstWord

On Monday, doctors from around the country will join the President at the White House to show their support for passing health insurance reform legislation this year. These doctors were invited for many reasons: Many are leaders in their communities. Others belong to one of the many physician organizations in this country. All are supporters of health insurance reform. Senior administration official: “We are reaching the end of the Senate Finance Committee process in Washington, so now is a good time to bring the discussion back to Americans who are struggling with rising costs and growing insecurity in the health insurance market in their home towns. Their local doctors see these struggles every day and know more than anyone how cruel and arbitrary the health care system can be. Doctors all around America believe that we need health insurance reform this year. They agree with the President that inaction is not an option, and they are offering their help and support.” Politico

We all know we need health insurance reform but is what the administration proposing the best way to go?

Last month, I talked to three European journalists about the healthcare system in the U.S. and opportunities to improve the care delivery system through a combination of  bottom-up innovation and top-down reform. Above is an article that appeared in an Italian magazine a couple of days ago, outlining the debate on healthcare reform in the U.S. and my thoughts on the issue.

Despite the fact that we spend more per capita on healthcare services, the problems that we have are very similar to those encountered in Europe. We’re all facing a growing demand for healthcare services due to an aging population that continues to acquire more complex, mostly age- and lifestyle-related, diseases.

In his address to Congress last night, President Obama touched on medical liability reform. I wish he had devoted more time and attention to this issue. Clearly it is an important concern of not only physicians but, as a new poll conducted by the Clarus Research Group and commissioned by Common Good and the Committee for Economic Development has found, “83% of American voters want Congress to address medical liability reform as part of any health care reform package – and 67% support the creation of special health courts.”

“The American people want the system of medical justice to change,” states Common Good Chair Philip K. Howard in a press release announcing the poll’s results.  “They are saying it in very large numbers, and they want it to change as part of health care reform.”

I find the results of this poll very promising as I’m doubtful that we can control healthcare costs in a meaningful way without comprehensive reform of our medical liability system.

President Obama will deliver a much anticipated address on healthcare reform tonight. There are lots of eyes and ears on this event. A reporter called me today to see if I would watch the address with her so that she could write about my reaction (I declined due to a scheduling conflict). I’m sure a great variety of secondary reactions and opinions will surface soon after his speech.

So here are seven things to watch for during Obama’s address tonight: (POLITICO)

1. Can he keep it simple? Can the President spark enough interest to successfully compete with the season premiere of “So You Think You Can Dance” on FOX?
2. Who is his bad guy? Every good story needs a villain.
3. Where’s that old campaign magic? Can Obama connect with the American people the way he did during the campaign?
4. Does he win the spin? To help Obama’s message go viral, White House Communications Director Anita Dunn will be on whitehouse.gov for a live video chat and will respond to questions coming from Facebook and Twitter
5. Public option or no public option? That is the question.
6. What’s the bite of the night? Expect to hear a lot of sound bites.
7. Can he get Republicans to cheer? It’s important for Republicans to show that they favor reform without endorsing Obama’s controversial ideas.

There are indications that President Obama will mention malpractice reform in his speech. I really hope so, because as you can see here it’s a critical issue that’s been largely left out of the debate.

After Princess Diana’s horrific accident in 1997, it took the ambulance 110 minutes to arrive at the hospital, which was only minutes away. This was not faulty behavior on part of the first responders. They were simply following the protocol of the French emergency medical system dubbed “stay and play,” where a well equipped medical ambulance with a team that usually includes an ER doctor treats the patient before taking them to the hospital.

The French system is in sharp contrast to the American “scoop and run” strategy, where trauma victims are rushed to the hospital while standard techniques are applied by paramedics to stabalize the patient. The US system is based on studies showing that “trauma victim’s best chance for survival is reaching the operating room within 10 minutes.”

As NBC News reports, the French system’s handling of the accident is raising questions on whether Princess Diana would’ve survived had the accident occurred in the US.

I suppose in every healthcare system, there are those who fall through the cracks.

In the past few weeks, CNN has done a great job presenting the real views of physicians about the healthcare system. In fact, today I was on CNN with Heidi Collins speaking about my medical practice and healthcare reform (will post the video when it’s up).

One of the recent commentaries on CNN is an interesting account of Dr. Vance Harris’s frustrations as a primary care physician. I had published an earlier piece by Dr. Harris on my blog last year called “Not in a Million Years.”

After venting out a bit, Dr. Harris ends his commentary with:

Good luck recruiting primary care specialists when we are projected to be short 39,000 by 2020, according to the American Academy of Family Physicians. And nearly half of all doctors surveyed by the Physicians’ Foundation have said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.

I know this is true because I am struggling to find a primary care doctor to take care of my wife and myself. Now that is ironic. Anyone know who is taking new patients in California?

Dr. Harris initially posted his commentary on Sermo and was met with great words of moral support from his colleagues.

As the health reform fight shifts this month from a vacationing Washington to congressional districts and local airwaves around the country, much more of the battle than most people realize is already over. The likely victors are insurance giants such as UnitedHealth Group, Aetna, and WellPoint. The carriers have succeeded in redefining the terms of the reform debate to such a degree that no matter what specifics emerge in the voluminous bill Congress may send to President Obama this fall, the insurance industry will emerge more profitable. Health reform could come with a $1 trillion price tag over the next decade, and it may complicate matters for some large employers. But insurance CEOs ought to be smiling. BUSINESS WEEK

It’s a shame that the voice of patients and physicians has been largely absent from the dialogue on healthcare reform. The vacuum created by the lack of appropriate representation on behalf of the public and the physician community is being filled by special interests. The AMA may want to be more aggressive in voicing the concerns of practicing physician in the trenches who have a deep understanding of the deficits of the current system and can be the best patient advocates.

Is is time for a new organization to represent physicians in the U.S.? Looking at this may suggest the answer.

A recent survey of 367 healthcare executives–representing payers, providers, and pharmaceutical companies–suggests that most of them are not prepared for the changing economic conditions and the evolving prospects for reform:

Only 30 percent of executives representing the health care industry in the United States say their companies are ready for reform and changing economic conditions… 76 percent say the impact of reform on the industry will be significant, and 54 percent say the same about the effects of the current economic crisis.

This report also found that those who feel prepared are the ones  that “drive innovation in a wider range of areas, including product design, customer service, and IT.”

Innovation and controlled experimentation are now necessary ingredients for healthcare organizations if they wish to survive, adapt, and truly prosper.

As America struggles to extend health-care coverage while curbing health-care costs, we face a decision that is more important than whether we have a public-insurance option, more important than whether we will have a single-payer system in the long run or a mixture of public and private insurance, as we do now. Atul Gawande

As Gawande puts it, we are now witnessing a “battle for the soul of American Medicine.” There is a lot of blame going around but there is a trend that is starting to emerge: we need a redesign how care is delivered. Gawande likes the idea of having integrated healthcare delivery systems, like the Mayo Clinic, where salaried physicians work in multidisciplinary teams and there is a fair amount of collective thinking. As the CEO of the Mayo Clinic told him, “When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing.”

If we conclude that the Mayo Clinic model is applicable to other parts of the country, replicating it requires reforming the system in such a way that it does not financially threaten physicians (less than 10% of healthcare dollars go to physicians) but changes the incentives from doing more to thinking more. Most physicians would find getting paid for their time this way more fulfilling but are currently burdened by a payment and malpractice environment that promotes doing more that’s needed and disregards the cognitive aspects of medicine (Although the issue of malpractice is downplayed by some, physicians of all specialties and creed practice defensively).

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.