Wednesday, February 25, 2009

Obama on Health Care

For starters, let me say I am a huge fan of our new President. I voted for him, donated to his campaign, and am a proud member of Doctors for Obama

I listened closely to his speech last night looking for signs of what is to come next in health care reform. Though his speech was historic, to my surprise it left me somewhat disappointed on the matter of health care. Below is what the President said:

Our recovery plan will invest in electronic health records and new technology
that will reduce errors, bring down costs, ensure privacy, and save lives. It
will launch a new effort to conquer a disease that has touched the life of
nearly every American by seeking a cure for cancer in our time. And it makes the
largest investment ever in preventive care, because that is one of the best ways
to keep our people healthy and our costs under control. This budget builds on
these reforms. It includes an historic commitment to comprehensive health care
reform - a down-payment on the principle that we must have quality, affordable
health care for every American. It's a commitment that's paid for in part by
efficiencies in our system that are long overdue. And it's a step we must take
if we hope to bring down our deficit in the years to come.

In summary: Electronic Medical Records, the cure for cancer, preventative care, and universal coverage. Though all of these things are important, I am not sure this is the right focus.

I am in favor of Electronic Medical Records, but we have to be careful how we invest in this. I have already commented that the almost $20 Billion dollars from the stimulus package may not be well spent. It goes primarily to hospitals, which probably already have their own systems. The key is interoperability, and I don't know if there are any provisions for this in the bill. Also, the VA system has an amazing electronic medical record. Why not adopt this system and use the money to give every health care provider (hospital, office, clinic) the ability to access this one shared system rather than just padding hospital's bottom lines?

I would love to see the cure for cancer, and we have made great strides. I support more research in this area. However, cancer is not one disease but many complex diseases. Though cancer research is certainly a worthwhile cause, money spent on it today and in the near future will do nothing to improve the health care crisis we face today. I am for spending money on cancer research, but if funds are limited, we need to first spend money on fixing the current system now.

As a primary care physician, prevention is what I do every day. Prevention is key and critical. One of the reasons we spend so much on health care is because as a nation we are not well. Prevention is a broad term, and it is not clear from the President's speech what his focus is on. However, part of prevention (and an important part in my biased opinion) is strong relationships with, quality care by and reasonable access to primary care physicians. I am extremely disappointed that there was no mention of improving our primary care infrastructure. I wish he would have said something like "we will invest in primary care, because this is key to comprehensive health care reform"

Similarly, universal coverage is great, but somewhat has to be there to see all these patients with health insurance. This is the lesson we can learn from the Massachusetts plan. No policy maker or pundit, including our President, should mention universal coverage without mentioning improving access to primary care providers. Fewer students are going into primary care, more and more primary docs have stopped accepting insurance or have gone concierge.

I continue to support our President, and believe he will lead us down the right path. He has a cadre of experts in health care policy that are phenomenal. In addition, his speech essentially mandated that health care reform will not wait, which I am thankful for. Perhaps I am reading too much into a political speech. However, the center of any health care reform must address improvement in primary care.

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