To his credit President Obama has championed health care reform as an economic and moral imperative. Current increases in health care spending are unsustainable and the number of patients without access to basic health care is unacceptable.
Unfortunately the current plans being debated in Congress and supported by the president will do little to control costs or significantly improve access to care. In fact unintended consequences of the public option may actually increase costs and produce less access for many patients.
Meaningful reform requires that we first recognize several myths regarding our present health care system.
Myth 1: The primary determinant of health is timely access to quality, affordable care. The truth is that providing health care is only a minor contributor to overall public health. Individual behavior is the primary determinant of health.
For example, the leading cause of preventable death in the U.S. is smoking. It accounted for 435,000 premature deaths in 2007. Obesity and sedentary lifestyle accounted for another 365,000 deaths.
In contrast, each year an estimated 40,000 deaths occur from breast cancer and approximately 15,000 die from HIV infection. Unless we develop effective strategies to change behavior, reforming the present health care system will have minimal effects on health.
Myth 2: Health care is paid for by employers, government and individual insurance premiums.
Ezekiel Emanuel, M.D. (a clinical oncologist, author and brother of Obama's chief of staff Rahm Emanuel), has written extensively on this subject and points out that workers and households pay for health care through lower wages and higher prices. Failure to understand this perpetuates the belief that patients can get great health care benefits paid for by someone else.
Myth 3: A public plan that competes with private insurance will improve access and save money.
In my medical practice Medicare reimbursement is approximately 30 percent of reimbursement from private insurance. In many offices this does not cover the marginal overhead of seeing a patient. In Anchorage there are virtually no primary care providers accepting new Medicare patients.
Assuming the public plan provides similar reimbursement as Medicare, we can anticipate that patients with the public plan will face the same obstacles to access. It is also likely that many small employers, facing rising insurance premiums, will drop their private insurance benefits.
Myth 4: We can pay for a significant portion of health care reform by improving efficiency and eliminating "unnecessary" testing and procedures without rationing care.
Medicine is not like algebra; it is both an art and a science and often there is "more than one correct answer." It is impossible to provide appropriate care for patients without first taking into consideration their unique life circumstances.
Common sense, compassion, scientific evidence and respect for the patient's autonomy are the principles that guide the physician's care. I don't know what principles will guide those who write the money-saving rules that we will have to follow as we make medical decisions.
As a physician I firmly believe that we need meaningful health care reform. Unfortunately the present bills in Congress do not adequately emphasize strategies to achieve meaningful behavior change.
Access to care with passage of a public option may ironically worsen as patients lose private insurance and can't find providers who accept the public option. Claims of cost savings are highly speculative and represent primarily the triumph of hope over experience.
A primary tenet of medicine is "first do no harm." In addressing health care reform, Congress would be well advised to heed this.
Dr.John Clark is a lifelong Alaskan and a pulmonologist in Anchorage
By DR. JOHN CLARK