Dear Patients - From Joel Ciarochi, M.D.

Dear Patients,

I am a physician. I am a business owner. I am not a politician. I am not a republican. I am not a democrat. I care about the potential for Americans to get the best healthcare possible and I want to utilize our precious resources as if they were my own.

The voices of physicians are not being heard. The media has not given us the opportunity to speak or participate in the greatest challenge of healthcare. I am one of many clinical practicing physicians that will be required to participate in a national healthcare system and make it function. I am an expert in healthcare quality, its delivery system, and its economics, but I am not being included in the debate. I want healthcare reform, but the plans proposed in Washington will not resolve any of our healthcare issues and they will raise the cost for everyone. Physicians are not being consulted in this matter and it will be to the detriment of our quality of life. Most physicians expect that if they do their job well, the rest will take care of itself. This perception has prevented physicians from becoming involved in the formation and maintenance of our healthcare system.

Healthcare is a quality issue. Canada, the United Kingdom, Germany, and France are all countries with national healthcare systems. No single country has a healthcare system that is close in comparison to US quality healthcare. Why do foreign emissaries and nobility come to the US for treatment? Why do Canadians come to the United States for elective surgery? It is simple, our system is the best. We have the best doctors. All of these countries have dealt with healthcare at the national level and what has emerged is a two tier system: a private system for the wealthy, and a public system for the rest of the population. Does this sound familiar to the recent cry from Washington? A public system will become the option for the economically disadvantaged in our country. One look at the Veteran Affairs system and numerous quality scandals over the years can show us that a public option will be a VERY low quality system. Any doctor that is of high quality will not participate in the public system and over time, the gap in quality will increase between the private and the public systems. This plan will only widen the gap between the rich and poor in the United States, and ultimately will leave the uninsured with a far worse option for healthcare than they have today. Washington has already created a top-tier healthcare system for itself that provides a premium level of care to Federal employees, Congress, and the President. If this public option is going to be so viable and great, why not make it mandatory for all of Congress, and the President to be participants in the public option? This will never happen.

The second issue is cost. The current proposals in Washington are exceeding 1.5 trillion dollars over 10 years, about 150 billion dollars per year. As a simple comparison, the purchase of premium private insurance for all of the uninsured patients in the United States should cost less than 125 billion dollars per year. This price tag would only apply if they were so foolish to pay full retail price! If the government had any ability to negotiate prices with such a large pool of individuals (which they do) the price tag would be even smaller. So, why are we talking about huge expenditures for healthcare? It is because the government is not capable of providing a benefit at a reasonable cost. Before involving a public plan or a government run system, why not allow the major carriers an opportunity to bid the plan?

The second aspect of cost is the source of the funding. Who is going to pay for it? Healthcare costs continue to rise. Is an increasing level of cost part of the legislation? Why would we increase our debt in a major recession and further delay economic recovery? Why would we increase taxation in a recession? History repeats itself and if one raises the cost of goods and increases taxes in a recession, it will become a full depression.

The third issue is benefits. What level of benefits is going to be offered in the public plan? In Washington, they are telling us that people will be able to see the same doctor and have similar benefits. This is untrue. It is not possible. The same level of benefits cannot be provided at a fraction of the price. Look at the other national health systems as examples. In Canada, dialysis is not offered past a certain age. If you need dialysis and live in Canada, you either die or cross the border to the United States to receive your dialysis, and the American taxpayer pays the bill. In the United Kingdom, patients with heart disease over a certain age are not offered surgical intervention. They only get medicine for the treatment of heart disease. Do you want to be placed on a waiting list to get cataracts removed? How many years do you want to wait to have hip surgery? Do you want a lottery system to determine who gets care and who does not? In Germany, a recent study showed that the rate of decubitus ulcers (bed sores) in elderly patients was more than six times (600 percent) higher than in the United States. This is a result of neglect. The plan in Washington is promising great benefits, and it will deliver far less. It has been said that if something is too good to be true, it is certainly false.

The fourth issue is physician reimbursement. I, like my colleagues, expect to take care of patients without getting paid. It is part of the job description, and we are willing to care for people that are unable to pay for their healthcare. It is our responsibility to care for all patients. However, we cannot care for an entire nation without reasonable reimbursement. We must be able to see enough patients that are able to pay their bills in order to offset the ones that cannot or will not. Most doctors spend a minimum of eleven years after high school to become physicians. It is a long and difficult path and it leads to large educational debts and a significant delay until a salary can be earned. We sacrifice our families and choose a lifestyle that means we work at night and we work at other very inconvenient times, because our patients need us. The plan in Washington uses medicare rates as its reimbursement basis. These rates are one third to two thirds of commercial rates and most doctors are forced to limit the number of medicare patients that they treat. This limiting of care to medicare patients is not to increase profit, but simply rather to cover overhead costs. How many physicians do you think are going to participate in the public plan? Do you really think that your excellent doctor is going to work for half price? The plan in Washington is proposing some rates that are one third of commercial rates. Would you do your same job for thirty cents on the dollar? This does not make sense.

The fifth issue is limiting malpractice awards. President Obama made it very clear when he addressed the American Medical Association that he had no intention of controlling costs by implementing limits on lawsuits. Do lawsuits improve the quality of medicine? Does patient care improve when lawsuits are settled? The answer is no, but many people gain a large financial benefit in the process. Ultimately the patient gains only a fraction of the monetary award and never sees an improvement in health. Malpractice insurance can cost up to twenty percent of a physician’s overhead in order to practice medicine. Effective TORT reform can reduce these costs and the savings can be used to help cover the uninsured. This is not on the table as a cost reduction strategy. Why?

The final issue is sustainability. Let us assume that we can pay for the proposed changes without bankrupting our great nation. Who is going to be willing to go through the rigorous training, offer the personal commitment, and make the sacrifices required to become an excellent physician? How many medical schools will have to close their doors, due to a lack of people unwilling to forgo their youth for a dead end career? How many physicians will decide to participate in a poorly reimbursed health plan? One thing is certain; at least twenty percent of current physicians have already declared that they would opt for early retirement instead of being part of a low quality healthcare system. As these experienced physicians leave medicine, who is going to train the new group of future physicians? What will our system become in a few years? The vision is a system with too few physicians, too many patients, and long delays in medical care. If you want to see this future, look at the other countries that have this type of system, and you will see our future.

We assumed that we could control costs initially. Let us be realistic now. Healthcare costs have risen every year. The plan in Washington has minimal provisions to limit costs. The new technologies and treatments are more and more expensive. It is the price that must be paid for new research and development in any field, whether it is in computers, communications, or medicine. The advancement of science requires large sums of money, and Washington is not prepared for this increase in cost.

In summary, I am a patient advocate and I am an advocate for high quality medical care. I would like to participate in healthcare reform, but I am not invited. There are solutions to the problems in medicine, but the plan proposed in Washington will not meet the needs of its patients, will not be within any reasonable budget, and will not be served by the best quality physicians. Washington is chasing a dream, and they do not have a realistic solution. These proposed changes are being forced to occur in a very rapid fashion without allowing sufficient time for discussion. In my mind, a political agenda should never take precedence over patient care.

Sincerely,


Joel Ciarochi, M.D.