Op-Eds

Pursue Reform Not According To Party, But By Adherence To Certain Principles

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Washington, April 29, 2009 | comments
As a physician from Tennessee who has delivered babies for over 30 years, I have seen our healthcare system change dramatically. Some people said I must have gone off my meds when I decided to run for Congress, but having extensive experience as a physician enables me to lend my experience to the debate over health reform in Washington.

I was part of a medical group with 70 physicians and 350 staff, and we’ve lived through many attempts at reform at the national and state levels. Some may recall that in the early 1990s, managed care was pitched to physicians and the public as the cure for an ailing healthcare system, but all it managed to do was move revenue from providers and patients to insurance companies and third-party payers, and not decrease costs as advertised. It serves as a cautionary tale for anyone who would believe there’s a silver bullet out there for what ails our system today.
In medicine, there’s no such thing as a Republican disease or a Democratic disease — there’s just disease; likewise, good ideas on healthcare reform shouldn’t be defined by a party, but by meeting a series of principles for reform. Since arriving in Washington, I’ve listened to people from all sides of the political spectrum and have developed a few principles that I believe healthcare reform must encompass:

• Above all, do no harm.
A doctor’s Hippocratic Oath should be applied to any reform considered. While many have focused on what’s wrong with the current system, there’s still a lot that is right. Eighty-five percent of Americans today have health insurance and for the vast majority of them, the system works. They go in and see their doctor, who in turn diagnoses them and sends them home with a prescription or remedy that addresses the problem. When Washington tries to “fix” our healthcare system for one person, I want to make sure the result isn’t a downgrade of care for three others.

• Doctors and patients should make medical decisions.
I prefer a system with private health insurers, who ultimately do a better job of putting decision-making authority in doctors’ and patients’ hands. The problem with publicly operated health insurance (the new way of saying “government-run healthcare”) is that care must be rationed to meet the budget. Consider that here in America, the five-year survival rate for breast cancer has increased from 50 percent to 98 percent, largely because of education, early diagnosis and sophisticated medical treatment. But in England, which has a national health system, they’re no longer covering mammograms because too many false positives resulted in more costly biopsies being performed. While it’s less costly to wait for a lump to develop, no American in their right mind would think this is a reasonable approach to providing care. But these are the choices that have to be made in a public health plan funded with taxpayer dollars.

• Every American should have access to health insurance.
We should be able to agree that all Americans should have access to a basic benefits package that makes sure they are covered when they go to the doctor’s office or hospital. This isn’t Rolls-Royce coverage that includes cosmetic surgery, hair transplants or fertility treatments, but basic benefits.

• Healthcare costs shouldn’t bankrupt you.
Basic catastrophic coverage will prevent many individuals from being wiped out when they get cancer or a life-threatening illness. We had a good start when we coupled health savings accounts with high-deductible health plans. I’d like to see more done to move plans in this direction. I recently was helping a woman who worked in a local nursing home who was without health insurance and discovered she had lymphoma. What little money she had been able to save would soon be gone and then some to pay for her treatment. A low-cost catastrophic policy would prevent this from happening

• Health coverage should be portable.
Individuals who get sick often feel trapped in their current job because if they chose to leave their job, their health insurance would be terminated, along with their protection against pre-existing conditions. We need some changes to how individuals purchase their insurance so that if your job ends — by choice or by layoff — you won’t find yourself without the ability to afford treatment.

• To lower costs, everyone should have “skin in the game.”
Study after study proves that when care is free, it is over-utilized. In Tennessee under TennCARE (our state’s Medicaid plan), we saw firsthand that when patients got a cold, instead of simply going to the local drugstore and buying some cold medicine, they went to the doctor for a prescription so the cold medicine was free. Some argue that this is illogical or an anomaly, but the fact is, it’s a logical, rational decision — they saved money by going to the doctor and getting a prescription.

Everyone has a lot at stake in this debate, and there are many good ideas that deserve debate and a thoughtful vetting. I am hopeful if we come together to agree on a framework like what I’ve described, reform is possible. Then it will be incumbent on all of us to commit to getting it done — not fast, but right. Too much is at stake to fail.
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