Dear Hillary (or Rudy or Mitt or Barack):
I know you have a lot on your mind, what with not knowing whether you are in New Hampshire or South Carolina half the time during the campaign. But I wanted to drop you a note and let you know there is a big mess in healthcare.
Hospitalists are a growing army that can bring our country patient-centered care and measurable quality outcomes, all delivered by teams of health professionals—if you and Congress can give us some help.
In case you are not totally familiar with the concept, hospital medicine is the fastest-growing specialty in American medical history. We are more than 20,000 strong, and we treat more than 30% of medical inpatients in the country. Hospitalists are right where the action is in healthcare.
We know we can do our part to change our health communities, starting with our hospitals. But we need to improve the economics of healthcare—both what we pay for and what we reward—if we are to get the right physicians to go into hospital medicine and make this a sustainable career.
So here is our wish list.
Insure All Americans
There are about 50 million people without health insurance, give or take a million. Everyone knows these people are sicker and die quicker. I guess the good news is that when they eventually show up in distress at our hospitals, we hospitalists jump in and do the best we can—regardless of whether they can pay for their care or not.
The problem is these uninsured patients often should have seen us days or weeks earlier, which makes it harder for us to help them. If we are fortunate enough to get a handle on the crisis, too often lack of insurance makes it harder to find doctors in the community to follow up with these needy patients.
We are working with the American Cancer Society, which has recognized that even for those who think they have insurance coverage, many times it is inadequate. If you’re unlucky enough to get the “big C” you may end up with a choice between the best care and bankruptcy—or both.
I don’t know whether the solution is to:
- Expand the State Children’s Health Insurance Program to include all kids;
- Extend Medicare to people at age 55 (as Sen. Joe Biden, D-Del., has suggested); or
- Extend Medicare to those as young as 15 to get everybody covered.
I do know the time for talk is well past. It is time for leadership and action.
If you get a chance you might take a look at the November/December 2007 issue of Health Affairs. In it, experts like Victor Fuchs, Bill Roper, Bob Berenson, Len Schaeffer, and many others frame the issues of health reform in practical terms. At the very least direct your health staffer to get a copy.
People should expect value in healthcare, as we do in almost everything else we buy and need. We have an outmoded payment system that insists on rewarding the doing of anything. We have to start paying for what we want.