The results of yesterday's election were stunning. Regardless of who you supported, most should be able to appreciate the historic moment that just occurred. President Obama will have many daunting challenges ahead, including fixing our broken health care system. Not only will this not be a difficult task, but it will also not occur overnight. However, doctors and patients are struggling now. With changes in the make up of congress and the momentum from the election, here are three things that President Obama could do immediately after January's Inauguration to make some substantial changes right now.
1. Pay physicians for talking to patients. Our study which looked at factors associated with medical students career choices showed that only 2% wanted to go into primary care internal medicine. Though huge student debt and lucrative salaries in fields like dermatology and radiology may contribute, most students who applied to medical school did not do so in order to drive a Mercedes or live in a mansion. One of the main reasons that students shy away from primary care has to do with the burdens of practice, which is largely due to the way in which primary care is reimbursed. The medical home has been proposed as one method to deliver coordinated care, improve quality as well as change the way primary care services are reimbursed. However, agreeing on exactly what this will look like and how it will become mainstay practice may take some time. In the mean time, how about some immediate legislation that increased the amount of money physicians get for the time time they spend with patients, without ridiculous codes and other documentation requirements to get reimbursed. This should also apply for non-visit related time such as emails, phone calls, and filling out forms/paper work. This is not a solution for solving our delivery system crisis, but would have an immediate impact.
2. Tort reform. There is agreement on both sides of the aisle on this issue, so let's pass something quickly. The main problem is that bad outcomes do not generally result from malpractice, but patients need some kind of compensation when things do go wrong. Doctors order more tests because of malpractice fears. Not only does this increase the cost health care, but probably results in more harm to patients, since added testing (especially in patients who don't really need it) usually leads to complications from further testing and treatment. No-fault insurance and/or an impartial hearing before a case goes forward have been proposed solutions. Even if a long term solution takes some time, immediate caps on pain and suffering could help now.
3. National formulary. Whether you favor universal health care, or fear "government run" health care, negotiating drug prices with the pharmaceutical industry is a no brainer. Medicare, Medicaid and the VA get the best deals on drug prices because they have the volume of patients that the government can use in their negotiations with the drug companies. You could even keep your private, for-profit health insurance, but have your drug benefits "carved out." Allowing the government to negotiate drug prices on your behalf could immediately cut the price we spend on pharmaceuticals. We could create a sliding scale based on income regarding what an individual would pay for generic and brand named drugs. Even if it takes some time to cover the 47 million Americans without health care, we should be able to get them prescriptions pretty quickly.