What Will Healthcare Reform Look Like?... the size of Medicare and Medicaid, driving us more toward bankruptcy.” He predicts that physicians will answer to the government under this legislation. “What smart 22-year-old person would choose to spend an additional 8 to 10 years in school and accrue $300,000 in student loans to become a de facto employee of the federal government?” he questioned. “Bureaucracies will be set in place to determine reimbursements,” Rep Ryan says, suggesting that new mandates will raise the price of insurance, while government subsidies will take up the slack “at a time when government is going bankrupt.” The ultimate consequence will be a focus on cost rather than on quality of care, he insisted. Paying for reform is another big concern, says Congressman Ryan. “This bill has 10 years of tax increases and Medicare cuts to pay for years of spending,” he says. “We cannot put more money back into the same system.” The determination and achievement of value must include consumer involvement, and the emerging healthcare system must have at its “nucleus” the doctor–patient relationship. “Help patients understand what treatments cost, and see their success and failures.” Whereas the current system “rewards consumption,” reforms that alter volume can achieve savings, he predicts. Physician involvement and investment in these changes are critical, Congressman Ryan points. “The public will not trust reforms without you, and the policies will be poorly made in your absence.” No Government Takeover in Sight Mr Jennings countered these concerns, noting that far too often critics fight healthcare reform out of fear, “as though our current system is nirvana.”
“The United States spends 2.5 times more per person on healthcare than other industrialized countries, but we still have problems, and costs are going through the roof.”—Rep Paul Ryan
But “no one is talking about a government takeover,” he assured ACC attendees. “What is scary is the future without reform.” He said that the recently enacted healthcare reform bill not only contains bipartisan ideas but addresses “real issues of cost and coverage,” which are inseparable concepts.
Legal reform is the only reform that increases access to care, while decreasing cost. “On this basis alone, everyone, liberal and conservatives, should embrace it.” —Richard E. Anderson, MD, FACP Cost reforms cannot be achieved without meaningful insurance reform, he asserted. “And we cannot have meaningful insurance reform without covering every individual; otherwise people will wait until they are sick to buy insurance.” Better management of chronic illness will reduce costs, but this cannot happen with intermittent and sporadic coverage, he suggests, pointing out that >90% of dollars spent as a result of healthcare reform will “go back to private insurers.” Mr Jennings maintains that the polarizing debate about healthcare
Atrial Fibrillation... Continued from page 4 focus on the treatment of AF and nonAF CV conditions to lower total healthcare costs, Dr Kim suggests. Hospitalization Primary Cost Driver During the 12-month postindex period, twice as many patients with AF than the control patients were hospitalized for any reason (37.5% vs 17.5%, respectively; P <.001), and patients with AF had a 3-fold increased rate of multiple admissions compared with the control group (11.1% vs 3.3%, respectively; P <.001). The
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proportion of patients with AF who died during hospitalization for any cause was about 20-fold greater than in the controls (2.1% vs 0.1%, respectively; P <.001), the study showed. “Less than one quarter of AF-related incremental costs were attributable primarily to AF care,” Dr Kim noted. “Hospitalization continues to be the major cost driver in AF-related disease, so, all things being equal, management interventions that might prevent readmissions probably offer the best hope for reducing the cost burden of AF,” he suggested.—CH ■
reform is a metaphor for the larger concern about the nation’s mounting debt, and that rhetoric has bypassed reasoning. When a bipartisan compromise could not be obtained, “people went back to their talking points, and I’m tired of talking points after 25 years,” he said. “It is time we all worked together. The current situation is unsustainable.” New models of healthcare delivery are emerging that offer “value over volume,” and these should contain cost, Mr Jennings predicts. “The encouraging thing is that there is a tendency to start to embrace and move toward these.” Cardiologists Applaud Tort Reform To audience applause, Richard E. Anderson, MD, FACP, Chairman and CEO of the Doctors Company, the nation’s largest physician liability insurance company, insisted that tort reform is an integral component of any healthcare reform. “I submit to you that all healthcare in the United
nomic damages, according to Dr Anderson. States that have such caps have had a stable medical malpractice marketplace for 30 years, he noted. In California, for example, the cost of medical liability insurance is half of what it was in 1976 in inflationadjusted dollars, he says, and the cost of premiums has risen <2% in absolute dollars. “Fees that are not going to plaintiffs and attorneys stay inside the healthcare system to provide care,” he pointed out. Dr Anderson told cardiologists that he is encouraged by the Obama administration’s willingness to discuss tort reform, because “there was zero progress in this over the 8 years of the past administration.” Mayo Clinic Health Policy Recommendations Cardiologist Douglas Wood, MD, FACC, described the following principles for optimal healthcare delivery and cost-containment set by the Mayo Clinic Health Policy Center: • Physicians need to create value and strive for better outcomes at a lower overall cost • New methods of healthcare delivery should be explored that will enhance value • Medical care should be coordinated • The government must find a way to pay for value that does not center around cost control alone
“No one is talking about a government takeover….What is scary is the future without reform.”—Chris Jennings
States is, in fact, a form of defensive medicine,” he said. “No healthcare decisions are made without consideration of the legal or liability ramifications, and this makes the current medical liability system enormously wasteful and destructive.” The current system devalues physician judgment and undermines the doctor–patient relationship, “which is hanging on by a thread,” according to Dr Anderson, because there is “virtually no institutional support for it.” He added that legal reform is also the only reform that increases access to care, while decreasing cost. “On this basis alone, everyone, liberal and conservatives, should embrace it,” he told the audience. The single most effective component of tort reform is a cap on noneco-
• All Americans should have health insurance, and subsidies should be provided for those who cannot afford it or who are not provided insurance by their employers. The Health Policy Center used this framework for evaluating the legislation, and concluded that the Senate bill was largely in line with its guiding principles. “I am optimistic about what we can do,” Dr Wood said, “but it will take a lot of hard work.” ■
SEE ALSO articles on cost-effective analyses and cost outcomes on pages 6 and 11, including economic analyses of ACTIVE-A and JUPITER trials.
American College of Cardiology ACC 2010: Payer's Perspectives