Healthcare reform is top of mind on the national agenda. Bills are being considered in both the House of Representatives (HR3200) and in the Senate (the Baucus bill). Our American Academy of Dermatology is following developments closely and has provided a good resource for interested dermatologists who want to know more (http://www.aad.org/gov/index.html).

AADA Letter to Senator Baucus

The American Academy of Dermatology Association (AADA) has written a letter (http://www.aad.org/gov/documents/AHFA_09_AADA_Response.pdf) to Senator Baucus concerning the legislation that has come out of the Senate Finance Committee. While the AADA supports the general goals of healthcare reform — specifically improving healthcare delivery and providing coverage for more Americans — several concerns about the proposed legislation were outlined in the letter. The AADA cited specific concerns regarding having an unaccountable, non-physician panel reviewing relative value units, an Independent Medicare Commission that would remove physicians from setting payment policies, penalties in Physician Quality Reporting, expansion of physician feedback efforts to reduce overutilization, the sustainable growth rate formula, and medical liability reform.

Points of Agreement

There is general agreement that our healthcare system is too costly, and for what we are paying, we ought to have broader coverage of all Americans. While people who are generally healthy or who have access to the best of American medicine may be very satisfied with the current system, there’s concern that not everyone has access to that great care, resulting in poor scores for U.S. healthcare relative to healthcare systems in other countries.

The Real Problem – Lack of Personal Accountability

The reforms proposed so far — those in the House and Senate and the tweaks to the provisions therein offered by the AADA — don’t address the fundamental underlying problem in healthcare: the lack of personal accountability for the cost of care. Unless and until patients have a greater role to play in facing the costs of their own medical care decisions, the market forces that work in the rest of the economy to control costs and utilization will be absent. Without personal responsibility, government and insurers are left to control costs, requiring forms of rationing and central decision-making that are unpalatable to many Americans, including doctors who want their patients to have the best possible care regardless of the cost.

The Answer

Giving patients access and responsibility are not mutually exclusive and can be achieved through high deductible/health care savings account (HD/HSA) plans. A public option where the people are in charge of and responsible for the costs of their own healthcare decision-making is possible if government were to use (in the “public option”) and promote (through the tax code) HD/HSA as a solution to our current healthcare cost problems.

Steven R. Feldman, MD, PhD
Chief Medical Editor

Dr. Feldman is the author of Compartments: How the Brightest, Best Trained, and Most Caring People Can Make Judgments That are Completely and Utterly Wrong. Xlibris, Philadelphia, PA, 2009. For information, visit www.compartmentsbook.com.