Raymond J. Zastrow
QuadMed President

Raymond J. Zastrow

Raymond J. Zastrow, M.D. is the president of QuadMed, which helps companies develop on-site health care for its employees.

The Benefit of the Doubt

As I listened to President Obama's speech as he went before the American Medical Association House of Delegates on Monday, I sensed that the tone of the event was one of mutual respect. While not a campaign trail love-fest by any stretch of the imagination, the event could have been much more contentious for Obama. He asked for and received the benefit of the doubt from these representatives of the nation's doctors. The President acknowledged their fear of change and emphasized his desire to fix what's wrong while building upon what works, such as electronic health records, prevention, wellness incentives and evidence-based medicine. Proposed changes to physician compensation, such as bundled payments and pay-for-performance, were politely received. Less well-received was the president's insistence there not be caps for medical malpractice awards, a long-sought goal of the AMA.

The President spent much energy driving home the argument for a public insurance option and reassurances that such an option was not a single-payer "Trojan Horse." He is asking for the benefit of the doubt.

Conspicuously absent was any discussion of taxing employer-sponsored health-care benefits. And the issue of individual or employer mandates was hardly touched upon. How, then, to pay for this anticipated 10-year, one trillion dollar investment in re-shaping the U.S. health-care system? A return to more modest Reagan-era tax deductions for the nation's wealthiest citizens coupled with a reduction in Medicare payments. He is asking for the benefit of the doubt.

It was a long speech that required a lot of active listening to appreciate fully. Toward the end it struck me: re-shaping health care is a BIG JOB. Health care, after all, has a lot of moving parts. What's broken about health care is that the parts aren't moving in sync. The worst thing we can do is to pay more for the same disjointed services we are buying now. Conceptually, I like to point out to folks that what we need to be driving toward is health care payment reform separate from, but enmeshed with, health-care delivery transformation. Even after we shrink it to 10 percent of the GDP, health care will remain an enormous, vibrant sector of the economy. To the extent that they keep working toward this end-state, the President and Congress deserve the benefit of the doubt.

Those of us working in the private sector to improve health and health-care delivery, control costs and improve the experience of care ask for the benefit of the doubt in return: Allow us to continue to expand our successful efforts to transform health care without changing the playing field so much that we are unable to continue.

Now repeat after me, "The public option is my friend..."

By Raymond J. Zastrow  |  June 16, 2009; 4:36 PM ET  | Category:  Health Care Reform Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
Previous: Fix What Is Broken, Build on What Works | Next: Message to Obama from Small Businesses


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The President says we have to take incremental steps. Medicare for All IS an incremental step. Step one was Medicare for the highest risk pool, old fogies like me. Step 2 is Medicare for everybody else which is actually easier because it does not cost any more (see below). Step 3 would be more efficient medical practice.

The main reason that it is far better to extend Medicare to everyone is cost. Private insurance companies waste about $400 Billion each year in high overhead and unnecessary requirements on physicians. There is another $100 Billion wasted on high drug prices to companies that spend 3 times as much on "marketing" as on R & D. This $500 Billion each year can be used to pay for the extension of Medicare to everyone.If you simply add a public plan, you are leaving the $500 Billion on the table. You are simply adding cost. This is just stupid.

In addition, there are technical reasons just adding a public plan is foolish. If it has to take everyone while private companies can pick and choose , it will wind up with another high risk pool--the sick and the poor. While the idea of creating another pool is bad enough, if it is a high risk pool, it will be very expensive. The Republicans will seize on this and progress will halt. Also if it covers preexisting conditions, then it will greatly expand the pool of the self insured which is terrible from an efficiency point of view. After all, why pay premiums when you are well?

Finally as to the attitudes of the public, Representative Anthony Weiner recently held a telephonic town meeting with 4,700 members of the public. He asked who preferred the public plan option and who preferred Medicare for All. Two thirds preferred Medicare for All. Then the Representative said the private insurance industry would never permit that option.

Who is running this country?

Posted by: lensch | June 19, 2009 4:42 PM
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