Colleen Conway-Welch
Nursing professor

Colleen Conway-Welch

Colleen Conway-Welch, RN, is the dean of Vanderbilt University’s School of Nursing.

The Short Answer Is No

The short answer is no, not until transformational change occurs in the infrastructure of health care delivery. The system today is so broken that, if the infrastructure is fixed and incentives re-aligned, we could deliver twice the health care to twice the people at half the cost but we won't achieve this by simply throwing money at it.

A combination of past-World War II policies is largely responsible for today's insanity that has resulted in the variety of different health care finance schemes:
• Medicaid and State Children's Health Insurance Program (SCHIP)
• Medicare
• Commercial Insurance
• "Self pay"
• No pay!

In order to address the problems of the infrastructure and rein in costs, we first need to:
• Fix the Employee Retirement Income Security Act of 1974 (which covers 75 percent of under 65 lives), including COBRA and HIPPA
• Address malpractice issues and tort reform
• Equalize the tax treatment relative to health insurance of individuals vs. business
• Allow consumers to shop for health insurance across state lines
• Permit small businesses to form insurance pools
• Remove regulatory barriers so that all health care providers can practice to the full, legal scope of their training, including nurse practitioners, physician assistants and certified nurse midwives
• Become "wired" so that technology can be better used to track patient care and so that patients can track their own health care metrics.
• Identify, standardize and reimburse "best practices" while leaving room for individual patient variation
• Remove state obstacles to allow retail clinics to offer routine health care and provide incentives for them to allay themselves with a local hospital so that electronic patient records reflect care in the retail clinics as well.

All the current bills in the House and Senate are only trying to reduce costs; until we take waste, over-use, misuse, and non-incentives out of our non-system (such as paying providers piecemeal as if they were selling doughnuts) re-arranging the expensive deck chairs on the Titanic won't work.

By Colleen Conway-Welch  |  July 24, 2009; 9:58 AM ET  | Category:  Health Care Reform , Health costs Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati  
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There is simply no need for litigation in malpractice cases. A panel of legal and medical experts or even arbitration can do the job just as well and just as fair. And this would save plenty of money in the long haul. Jury trial ? Where is jury trial when most of the cases are settled out of court.
No other country in the world has this kind of system of litigation. It is a pure waste of money.

Posted by: emerywood2004 | July 25, 2009 11:13 PM
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PDMMD - Are you saying that physicians are paranoid? Are you saying that any accountability for doctors leads to irrational behavior on their part? If what you say is true, there is no solution other than to change the culture of physicians which which seems as difficult in this matter as in others.

Posted by: lensch | July 25, 2009 5:20 PM
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The question of how malpractice affects the cost of care is not nearly as simple as looking at states where there are caps. The problem is that physicians trained in the US are taught from the very beginning of their education to keep liability at the forefront of clinical decisions. It is an integral part of how one interacts with patients and resultant decisions. It will take years if not generations to change practice patterns which have been established under a system where one unintentional error can ruin a career.

Posted by: PDMMD | July 25, 2009 1:33 PM
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" the expensive deck chairs on the Titanic won't work."

My daughter prefers to say we are rearranging the band aids on the TB patient while the rest of the world is using antibiotics.

In you list you omit one of what should be the easiest and most effective ways to get quality health care to all. A well run for profit corporation has one and only one goal--to make money for share holders. In the case of health insurers this conflicts with the goal of quality effective health care. They waste $400 Billion each and every year on high overhead and compliance costs designed to raise their stock price by lowering their medical cost ratios.

The reason we have so many different and complicated proposals is because the first principle of all of these proposals is to preserve the riches going to insurance company executive and shareholders. These proposals run 1,000 pages. HR676, Medicare for All, is 70 pages long. It gives quality health care to everyone. It solves problems like pre-existing condition and like lose job=>lose insurance and since it picks up the $400 Billion mentioned above, it will cost no more than we are now spending, probably less.

Can we get your support?

Posted by: lensch | July 24, 2009 2:14 PM
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" Address malpractice issues and tort reform"

But first get the facts:

1. The total of all malpractice insurance premiums amounts to 0.56% of health care costs.
2. The CBO has examined the idea of defensive medicine. They found no difference in practice between states with limits on tort settlements and those with no limits.
3. There is no correlation between the price of malpractice premiums and the amount given out in malpractice settlements.
4. The price of premiums does (anti) correlate with interests rates.
5. If you take all the money given out in malpractice settlements over $250,000 in NJ ( a state without caps) in a year and give it to physicians, each doctor would get $15.

These come from the book The Malpractice Myth by Peter Baker (U of Chicago Press)

Thus the doctors are wrong on almost every count. Malpractice premiums are not a significant factor in health costs. Physicians order unnecessary tests and treatments even when there are draconian limits on lawsuits as in Texas. Caps would save us nothing. The price they pay for insurance has nothing to do with the large settlements given out, and the total amount of money involved in these settlements is trivial. What they believe is a fantasy.

Posted by: lensch | July 24, 2009 2:02 PM
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