In an op-ed in the Washington Post cardiologist Dr. Arthur Feldman lists ten things he hates about healthcare reform as it’s currently being presented:
- Private insurance companies escape real regulation
- We urgently need tort reform, but it’s nowhere to be seen.
- “Prevention” won’t magically make costs go down.
- Reform efforts don’t address our critical shortage of health-care workers.
- We need more primary-care physicians — but we also need specialists.
- We have to streamline drug development and shake up the Food and Drug Administration.
- We can’t fund health-care reform by cutting payments to doctors.
- We can’t forget about research.
- Cutting reimbursements could shut some hospitals down.
- We need to improve the quality of care.
I agree with a lot of what Dr. Feldman has to say. In particular I’m glad that he pays some attention to medical education. For example, most people here in the States don’t realize how greatly the government subsidizes medical education nor that in most of the world becoming a physician isn’t post-graduate education. The evidence that our system produces better doctors is meager, indeed, although the evidence that it produces more expensive doctors is a matter of simple arithmetic.
However, I think that he, like a lot of people inside and outside of healthcare, has yet to appreciate that the world of healthcare as he’s experienced it simply cannot continue. There just isn’t enough money to pay ever more for healthcare even as our incomes recede. Unless we can figure out how to deliver more while paying less, we’re going to need to come to terms with the idea that there will be less healthcare rather than more in the future. That is the necessary implication of an unsustainable systematic over-investment in healthcare over a period of decades and if that means the incomes of all of the players in the healthcare sector whether insurance companies, hospitals, or physicians must be restrained at the very least, so be it.
