Molly Cooke
With the country’s unemployment rate at a 14-year high and economists predicting a deep recession, President-elect Barack Obama and the new Congress are faced with the daunting task of getting the struggling economy back on track.
But health care advocates warn that there is an equally pressing — and longer-standing — national crisis that deserves just as much attention from Washington: health care.
“We have a new president and a new Congress who are obviously going to be preoccupied with the financial crisis,” said Jeffrey Harris, MD, president of the American College of Physicians (ACP), a national organization of 126,000 internists. “But that in no way lessens the fact that the health care system in the US is utterly unsustainable. It simply has to be changed, and at some point, this new president and new Congress are going to have to face that worrisome truth.”
At the annual meeting of the ACP’s Northern California Chapter in San Francisco on Nov. 22-23, Harris — along with Molly Cooke, MD, chapter governor and director of UCSF’s Haile T. Debas Academy of Medical Educators — will be discussing what he calls “the huge predicament of health care.”
“We need to change the system through which health care is delivered in this country,” Cooke said. “Physician engagement in the development, testing and implementation of solutions is essential.”
Currently, the United States has the most expensive health care system per capita in the industrialized world — gobbling up about 15 percent of the gross domestic product — and yet 46 million Americans remain uninsured, according to the US Census Bureau.
Reforming Health Care
Harris, Cooke and their fellow ACP leaders offer three basic recommendations for national health reform: offering universal health care, expanding primary care and overhauling the way physicians are compensated.
“In this country, only about 35 percent of our [medical] workforce is primary care,” Harris said. “When patients are followed by primary care physicians, there is a substantial reduction in emergency room visits, hospital stays, duplication of lab tests — all of which represent substantial savings to the system and better outcomes for patients.”
The ACP released a white paper on Nov. 8 that argues on behalf of expanded primary care by reviewing more than 100 studies over the past 20 years.
To rebuild the country’s primary care infrastructure, the ACP advocates establishing the so-called “patient-centered medical home,” an approach to health care that centers on a patient’s personal physician and also emphasizes lifestyle-friendly practices, such as flexible appointment scheduling and a heavy reliance on email and other information technology.
The personal physician would be the patient’s first point of contact in any health care scenario, and would be trained to provide continual, comprehensive care. When necessary, the physician would call in other medical professionals and specialists.
Demonstrations of the medical home approach will be starting up soon in eight states, with another 25 states considering a test of the approach among Medicaid recipients, Harris said.
“This approach appears to be the best available answer to our current needs — primary care — and the medical home is a sort of conduit for delivering it,” he said. “The patient would have a team of people helping him navigate through a thoroughly perplexing system.”
Cooke said she was “very excited about President-elect Obama’s vision for health care,” including his support for universal health care, decreasing administrative costs and investing in health information technology.
Of course, Cooke and Harris noted, the solution won’t come solely from Obama and Congress; the public must be vocal and persistent in its demand for change.
“During the Clinton administration, health care reform simply lost public support,” Harris said. “This, too, will become a sort of hearts-and-minds issue. We need to get people thinking beyond the financial crisis. There is a very real health care crisis, but there is a way, we think, to make it all better.”
