Financial crisis may make comprehensive healthcare reform more politically feasible, physician contends

In a commentary in the Chicago Tribune (10/12), Dr. Ezekiel J. Emanuel, chair of the department of bioethics at The Clinical Center of the National Institutes of Health, wrote that not only does the current financial crisis “actually make healthcare reform more pressing, it makes comprehensive reform – change in the way healthcare is paid for and how care is organized and delivered – more realistic and feasible.” Furthermore, because Americans are now facing “the prospect of losing their homes and jobs,” they “may be more willing to forgo gold-plated comprehensive insurance that covers everything with few restrictions.” Dr. Emanuel noted that “this should enhance the chances for a bipartisan deal on healthcare,” especially since “the huge increase in the federal debt that [the] bailouts will entail intensifies the pressure to rein in healthcare costs,” which “favors comprehensive rather than incremental reform.” Dr. Emanuel concludes that, “while the financial crisis has appeared to knock healthcare off the national agenda…it may in fact make comprehensive healthcare reform more politically feasible.”

Experts warn financial crisis will impact healthcare, medical communities. MedPage Today (10/10, Walker) reported, “The worldwide financial crisis and credit crunch will not spare the healthcare and medical communities, and they should brace for some major upheavals, warn economists, executives, and physicians.” According to a series of interviews by MedPage Today, physicians will face workforce issues and changes at group practices and hospitals in light of the current economic downturn. William Jessee, M.D., president and CEO of the Medical Group Management Association, noted that “one of the most immediate changes in medicine that the financial crisis may herald is that older physicians are likely to delay retirement.” The “silver lining,” however, may be a delay in the expected physician shortage, Jessee added. He also predicted that “credit lines on which” physician group practices “previously relied to run their business” may dry up, forcing them to “lay-off employees or to shut down altogether.” Furthermore, although it is currently unclear “whether the federal government’s $750 billion Wall Street rescue strengthens or diminishes the chances of” healthcare reform by the new administration, “some say reform is now more important than ever.”

Economic downturn may delay healthcare reform, analysts say. In the Chicago Tribune’s (10/10) Triage blog, Judith Graham wrote, “The financial crisis roiling Wall Street and Main Street will make wide-ranging health reform all but impossible next year and perhaps for years to come,” according to “a growing number of policy analysts.” Joseph Antos, the Wilson H. Taylor scholar in healthcare and retirement policy at the American Enterprise Institute, said that, although “we still need to do something about healthcare,” Sen. Barack Obama’s (D-Ill.) “vision of getting everyone insurance [and] everyone getting coverage as good as [their] congressman’s – that’s not possible right now.” Antos noted that Sen. John McCain’s (R-Ariz.) “health plan would be extremely expensive to implement – almost as costly as the Obama plan – and that it, too probably isn’t affordable during an economic downturn.” He added that “the healthcare cost containment strategies” proposed by the candidates “will require significant upfront investments before they begin to yield significant savings.”

We are not going to beg for better and fair health care,we are going to demand it. Health& education are basic life support.

I know you are right, we need to demand it, however, some days (like today) this whole thing just makes me so sad.

Maybe I just need to rest, too late to see things clearly.

With less money to go around, we can expect to see further hospital closures, and more people going without routine maintenance health care (unless their employment-based coverage encourages routine doctor visits with low co-pays and high coverage of office-run tests). This will put an increasing burden on already crowded emergency rooms. In addition, expect people to postpone or forego elective surgery – with the result of higher casualty and complication rates when these surgeries are performed on an emergency basis.

On the plus side, this economization may result in the reduction in number of medically-unnecessary procedures, and further moves towards generic drugs over designer drugs. And maybe less overdrugging of the US population in general.

If we socialize medical care, we will all end up with the worst of the Medicaid/Medicare boondoggle, with rationed service at ridiculously low levels (one blood test every OTHER day for T2D?), and proportionally higher rates of complications and early deaths.

Any way I slice it, it looks like a lose-lose proposition.

I always listen to what you say tmana,because you do reason well.May be in a large country like yours with many illegal immigrant,national health sevice will consume resources. In UK we saw the complaints about national health sevice standard but at least it does not leave any one without the basic care.There is private insurance in addition for those who want it ( though they pay taxes like others). In our part of the word it is another story …

What I’ve been reading about NHS is that it’s still somewhat spotty, depending on the area in which one lives, and again, without private insurance, care is rationed at ridiculously low levels. I’ve heard the same thing about the Canadian system. One of the issues is that the administrative costs of a government-run program (or even many private HMOs - Health Maintenance Organizations) are extremely high, as are the throughput expectations the system puts on the physicians and facilities. (Google “drive-through mastectomy”.)

I am curious what health-care delivery is like in the Middle East. We are told that most of the countries are rich, because of oil money, but that there are still very many poor people? And what are the implications of body modesty upon healthcare delivery?

In Saudi Arabia, the Ministry of Health runs primary care centers, run by GPs mostly, for general diseases, antnatal care and immunization. The doctors refer patients to hospitals for acute or chronic diseases that need subspecialty care. There are tertiary care hospitals for refereed cases. For those non Saudi who do not work in the government their firms have to pay for their health insurance, many small firms try to escape that. So most of type2 diabetics are cared by GPs, not to the optimal care as some are not trained or update their knowledge. That prompted the starting of a national program for training GPs and issuing guidlines&workshops for training them.
The diabetes supply is bought mostly by patients. Education & patient’s empowerment help a great deal to prompt people to take care of themselves
Type1 diabetics are cared by endocrinologists all their lives. Still the care is not optimal due to not enough awareness and education

Sounds a lot like private-medical diabetes care in the United States… except that for some of us, our insurance covers some or all of the cost of supplies. I find self-education and an open dialog with my GP to be essential in achieving optimal care. I will also pass along printouts of recent research of interest; it seems that GP’s schedules are so packed that many don’t have time to even peruse the tables of contents of the “standard” medical journals (The Lancet, New England Journal of Medicine, Journal of the American Medical Association, British Medical Journal, etc.) – much less some of the specialty journals such as Diabetes and BMC Endocrine Disorders.

National Program for diabetes care committee recommended a 3 yearly guidline depending o ADA recommendation for chronic diseases for GPs,backed by seminars and TV programms directed equally to GPs and the public.I am happy with the ongoing programs in Gulf state and Middle East as a whole.

I am still love to learn about the health care system in USA,and why many are against National Health Care system.Private insurance are profitable,with lots of beaurocracy spending your money to decide elegibility.Why it is sucessful in Canada,France and Japan,…,where is the percapita money spent on health care are high…

What we see in countries with National Health Care systems are (1) financial disincentives to enter the field of medicine (annual pay is capped and does not cover the cost of a medical education or the equipment and salaries needed to maintain a medical office); (2) bureaucratic increases in the price of delivery (consider the real cost to fill a prescription to Medicare versus the real cost of filling that same prescription through private insurance… Medicare may charge the patient the same, more, or less, but the government adds layers of highly-paid bureaucrats); (3) rationing of medical care – consider the increasing popularity of “medical tourism”, in which people cross travel from countries with socialized medicine to countries with free-market medical care, because it can take months to find a slot for a procedure that would entail serious complications if it were not performed within days to weeks. (This is often true even when the system allows private payment for additional service(s).); consider also that under rationed systmes, sometimes people are turned down for lifesaving care because the monetary cost of the equipment or the procedure is higher than a set average, and the system does not allow the wealthy person who is willing to pay for this care out-of-pocket to receive it; (4) inability to choose one’s clinicians – you get whoever the system throws you to. (Admittedly this exists under HMO programs, and gives one a direct financial incentive to stay in-network on PPO programs…) (5) A number of national-healthcare systems do not give people the option of either opting out (using private insurance instead) or opting for add-on coverage.

To bring this really close to home, consider that it’s barely three months since the Lancet published an NHS study suggesting that T2s should not EVER test their blood glucose levels, because it causes anxiety (nevermind that they were not told to test nearly often enough, or what to do with the numbers, or even what the numbers mean!)… Sorry, but I do NOT want to live under that sort of a system!!!

Thank you for your explanation Tmana,It is important for me to explore views to widen my knowledge.This community is great for exchanging views.