Speaking To Physicians

About Single Payer

Matt Hendrickson, MD MPHPNHP California

P-PACAPatient Protection and Affordability

Care Act

•President Obama set out 3 goals

•Universal

•Quality

•Affordable

•Let’s add one more goal

•Physician Quality of Life

UniversalUniversal Emergency

Care!

““I mean, people I mean, people have access to have access to health care health care in America.in America.

After all, you After all, you just go to an just go to an emergency emergency room.”room.”

This was the old paradigm for Universal care, it’s called Universal Emergency Care. Congress passed a law in 1997, EMTALA which stated their firm support of the principle of healthcare as a right of all Americans. The problem was they didn’t come up with a way to pay for it. Rather than implement fundamental reform by removing the 400 billion dollar surcharge that the private insurance industry imposes on our system which could pay for first dollar coverage for all Americans. Instead, congress passed a law which mandates emergency rooms and hospitals to care for all Americans without funding, you ER doctors and hospitalists figure out how to deal with it.

Once again Doctors getting stuck with the hot potato without the control to find a sustainable solution. We will return to this topic in the future!

Back to the question of why 1% of the uninsured die every year due to lack of insurance.

This was the old paradigm for Universal care, it’s called Universal Emergency Care. Congress passed a law in 1997, EMTALA which stated their firm support of the principle of healthcare as a right of all Americans. The problem was they didn’t come up with a way to pay for it. Rather than implement fundamental reform by removing the 400 billion dollar surcharge that the private insurance industry imposes on our system which could pay for first dollar coverage for all Americans. Instead, congress passed a law which mandates emergency rooms and hospitals to care for all Americans without funding, you ER doctors and hospitalists figure out how to deal with it.

Once again Doctors getting stuck with the hot potato without the control to find a sustainable solution. We will return to this topic in the future!

Back to the question of why 1% of the uninsured die every year due to lack of insurance.

Physician Quality of Life

• Physicians in 1997 were less satisfied in every aspect of their professional life than those asked similar questions in 1986.

• They were dissatisfied with the time they have with individual patients and their lack of incentives for high-quality care.

• 1. Murray A, Montgomery JE, Chang H, et al. Doctor discontent: a comparison of physician satisfaction in different delivery system settings, 1986 and 1997. J Gen Intern Med. 2001;16:451-459.

Burnout

•Malpractice

•ACOs/HMOs control our practice

•EMTALA

•Salaries stagnant

•Growing underinsurance

Burnout causes

• sense of control over the practice environment

Freeborn DK. Satisfaction, commitment, and psychological well-being among HMO physicians. West J Med. 2001;174:13-18.

Physician Quality of Life

Physician Salary

Physician SalarySpecialty US Canada

Family Medicine $164,952 $167,064Internal Medicine $170,889 $248,721Ob/Gyn $253,160 $261,412GeneralSurgery $278,433 $247,375

Anesthesia $309,019 $205,441Urology $317,778 $279,982

P-PACACut Costs?= Doctors

Fees

Source - The Advisory Board Company

P-PACAThe long term goal- Capitation

Cost ControlPPACA• Medicare Payment Reform• Delivery Reform• Fight fraud and abuse• Coordination of care• Electronic records• Comparat effect. research

NHP• No more private insurance• No more for-profit hospitals• Bulk Savings on Drugs/Devices• Global planning• Malpractice settlements cut

UniversalPPACAGuaranteed coverage!• Unless you lose your job• Unless you don’t pay yourpremium• Unless you don’t pay yourcopay• Unless it’s not included• Unless you don’t pay yourdeductible• Unless you’re undocumented

NHP• Everyone• First dollar full coverage• For Life

QualityPPACA• Choice of insurance co.• Provider network• Copayment reduces basic care• For profit hospital reduces quality• 24 million uninsured

NHP• Free choice of MD• Free choice of hospital• No financial barrier tocare• No for profit hospital/surgicenters.• Global budgeting reduces financially incentivized overtreatment

Physician Quality of Life

PPACA• Accountable Care Organiz-ations designed to control physician practice• Physicians quality controlmeasures• 50 million in demonstrationgrants to explore alternativesto tort litigation• 24 million uninsured• Referral problems for under-insured• Administrative overhead con-sumes 10% of income• Medicare SGR Unsustainable

NHP• No insurance industry• No more HMOs the way weknow them• Physicians and pts in charge• Malpractice settlement costscut in half• Dramatic reduction in admin.overhead• Canada Primary Care Makes More $