A recent New York Times/CBS Poll found that a large majority of Americans support a government run insurance plan. Politicians not supporting a public-health insurance option, are truly out of touch with their constituents. The current draft in the senate promoting co-ops is frankly a bad idea and won’t really do anything to keep insurance companies in check, improve quality, and bring down costs. We need to demand from our congressmen and women to support a real and robust public health insurance option.  I’m not surprised by the results, we all have so many patients who are disgruntled with private insurance companies. Everyone, please call your congressmen and women and demand real reform which includes a public health insurance option and nothing less!

In Poll, Wide Support for Government-Run Health
By KEVIN SACK and MARJORIE CONNELLY

Americans favor a plan for government-run insurance to compete with private insurers, a Times/CBS poll found.

Generally, I lack the time to follow much TV, so it’s been a while that I watched Lost, but I thought the show’s basic and primordial premise – being lost on an island, where no one really knows how they got there, or how to get away (ok, for those who are up to date on this, people seems to have gotten off the island in Season 4) – seems so befitting our current economic situation. Now, I am a physician and not a economist, but most analysts seems to agree with me that the current world economic situation is quite similar to the TV series: we seem utterly lost, every day brings a new turn (together with a 500 up or down in the Dow), no one fully undertsands how we got here (some of the villans, subprimes, clearly not being everything), no one really knows how to get out of the hole.

But that is not the only thing lost. Although I just learned that Ed Kennedy is working on comprehensive heallth care reform (bless him, I wish him well but this may be his parting gift to Congress and the American People), I think that people like Bean, Gingrich and Kerry, who just out forward a suggestions to run medicine like baseball, should do a reality check. Here are some things they wrote that bug me:

Studies have shown that most health care is not based on clinical studies of what works best and what does not, be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition (…)  We can do better if doctors have better access to concise, evidence-based medical information (…)  Evidence-based health care would not strip doctors of their decision-making authority nor replace their expertise. Instead, data and evidence should complement a lifetime of experience, so that doctors can deliver the best quality care at the lowest possible cost.

First, apart from the fact that a baseball player can hardly be compared with a doctor, it is not like Evidence Based Medicine is a new concept. It has been around for decades. And the barrier to findings new evidence is not primarlily the lack of will of doctors to accept it, it’s the lack of evidence, caused by a lack of studies, especially unbiased studies. The US government and public have sat back, NIH funding has been insufficient, and we have left it to the drug industry to go and find the evidence. Thus there is a lot of (often biased) evidence of the most lucrative conditions (although the FDA’s orphan drug program has made some difference), like the new diseases everybody seems to have (restless legs, social anxiety, ADHD). Meanwhile, it has become more and more expensive to get a medical education, there is a shortage of physcians, particularly in primary care, the doctors that do work often have no time, and sometimes no funds, for continuing education. Furthremore,  the number of un- and underinsured people is at an alltime high. Although I think it is a great idea, adequately funding the NIH, or some new institution, to run large unbiased clinical trials will have no immediate impact on clinical care: evidence will take years to accumulate and be transplated into practice and it will cost billions that Americans unfortunately are not willing  to pay (more taxes, anyone?).

Everyday I deal with the checkbox mentality of doctors: patient has condition X, so I must check Y and order Z. If I don’t, my hospital gets poor marks on the statistics used to judge their performance, and soon will determine their reimbursement. Furthermore, doctors are trained to think that if they do yet another test, they will not get sued and risk their livelihood and job as a result. Meanwhile, they have not time to talk to the patient, take a good history and review the chart. There is little, if any, evidence that increaseing the ‘batting average” of a doctor to run test Z does anything to make a patient better.  What we need NOW (notn in 5 to 10 years), is to get off the island. Not mb checking boxes, or more tax breaks, but by comprehensive health care reform. Let’s get Un-Lost!

On some level, I pity politicians for the way they have to straddle two vastly different worlds.

They spend part of their time in DC, working with highly functional, intelligent, motivated people with agendas (usually hidden). And then they go back to their districts and meet with “the people”. And I don’t mean the average people. I mean the kind of people who come to local political events.

Yesterday I gave a 20 minute presentation about Single Payer to about 20 people as part of a local county DFL series on health care reform. (DFL is Democratic Farm Labor party — Minnesota’s Democrats.) The other speaker was from the Minnesota Medical Association, giving the AMA’s plan for universal coverage.

I was the youngest person in the room by at least a decade. The other presenter just retired as a general surgeon, and was the past-president of the MMA. The moderator was an ED physician from the county medical center (there *is* another health care facility in Rochester).

The audience was mostly Medicare-age folks. As they asked questions in the Q&A time, we learned that one was retired from IBM, another from the state Medicaid office, a third had worked for Mayo in their development office.

And then there was the guy in the back wearing the Star Trek communicator.

His first comment was to point out how the underlying issue was actually ideology about private industry vs government.

Okay, so he has a very insightful comment to make. Despite the Star Trek paraphernalia.

I gave a broad overview of single payer, and didn’t dive into the nitty details (source of tax funds, how it is decided what is covered, etc). The other presenter did give more details, but he had to because the individual mandate with insurance reform is complicated.

When the issue of waiting lines in Canada came up, someone else in the audience pointed out that it was likely propaganda rather than factual. Several other times, members of the audience piped up to answer questions with very knowledgeable statements.

Yes, a crowd in Rochester is not a typical crowd of people. This is one of the most over-educated populations in the country thanks to Mayo and IBM.

Overall, I probably didn’t sell single payer to anyone who didn’t already believe in it. But I did get to use two of my favorite arguments. When someone brought up the “fact” that the government is inefficient, I was ready with both the reality of Medicare vs insurance as well as the student loan industry (where Direct Loans are 10x more efficient than private, government-guaranteed loans).

And I got the biggest laugh out of the audience during a discussion about concerns for underfunding the system. The other presenter said that a single payer system would automatically result in underfunding. I rejoined with “the military has a single-payer, and it does not seem to have any problems with being underfunded.” That line really works in a room full of Democrats.

After hearing the MMA/AMA proposal, it does seem that all of the ideas health care reform are merely different ways to go in the same direction. The AMA plan would require immense amounts of government regulation to ensure that community pricing is fair, that no one is priced out of the market, that the level of benefits is appropriate, that low-income patients aren’t sold high-deductable insurance (essentially relegating them back to being uninsured), etc.

With those kinds of regulations, how long will insurance companies play along until they pull out because the market isn’t profitable? And once you have only two (or one) private insurer left in a market that is heavily regulated, how is that not like a de facto government-run single-payer system?

On the flip side, a single-payer system would in reality be implemented through private insurance companies who are selected by a bidding process. I guess the only difference is whether individuals “choose” their insurance provider, or allow the government to select it for them.