Patient-driven healthcare in the era of health reform

by Robert Mayanrd

“A workshop that presents how patients and consumers of healthcare services, doctors and other healthcare providers in Vermont will be affected by the healthcare reforms passed by Governor Peter Shumlin and legislators in Montpelier.”  That is how the Green Mountain Patriots and Vermonters to Economic Health billed a workshop titled “Patient-driven healthcare in the era of health reform” they sponsored this past Wednesday night at UVM’s Aiken Center.  The audience was encouraged to:

• Gain a point of view different from the current media-driven story.

• Learn how to influence thedirection of Healthcare Re-form.

The following speakers addressed a near capacity audience:

Jeff Wennberg, Vermonters for Health Care Freedom: His topic was the current status of healthcare reform and Green Mountain Care in Vermont. He pointed out that the number of uninsured in Vermont make up about 7% of the population, with half of that amount eligible for government provided health care, but choose not to go that route. The question he raised waswhy have the government take over the whole system to address a matter that impacts one half of 7%?

Dr. Robert Letovsky, Chair, St. Michael’s College Business Administration & Accounting told stories of his personal and professional experiences under Canada’s single-payer and the U.S. system as well as economic and financial considerations for Vermonters. He pointed out that, when the government takes over health care, it becomes yet one more item on the government’s budget and political special interests drive health care policy. This has led to a doctor shortage and a rationing of care in Canada.

Dr. Robert Emmons: Clinical Associate Professor, UVM examined the ethical issues with reform that affect the doctor-patient relationship. In doing so, he gave examples from a few composites of actual clinical cases of how the third party payment system impacts the that relationship.

Dr. Dan McCauliffe: Adjunct Clinical Professor of Dermatology, Univ. of NC; Practicing Dermatologist, Rutland explained the effects that Green Mountain Care would have on patient wait times and rationing of services. He outlined ten factors that will affect the access to care and pointed out that the exodus of doctors and other care providers from Vermont has already began.

Bob Gaydos, Digital Benefits Advisor: Explored the nature of our current insurance system, pros and cons and how it affects medical care. He also laid out alternatives to reforms currently pushed by Vermont’s legislators. In doing so he argued that we will either have to gain control over our own health care costs, or the government will do it. No one is controlling costs at present and there are no other options to either individuals gaining control, or the government doing so. There are numerous examples of how government control of health care costs end up with actual increase in costs as it encourages mere people to access the system whether they need it or not.  On the other hand, giving individuals more control over their health care decisions has proven to be effective in controlling costs.

The fact that the health care industry is one of the few in which technological advances result in actual cost increases.  In just about every other field, technological advances result in a decrease in cost.  This indicates that the market for health care has a problem.  The speakers all agreed that the fundamental problem driving health care costs is the third party payment system and the solution was to remove the third party and empower health care consumers with the information needed to make their own decisions in a truly open market.  On the other hand, the advocates of Green Mountain Care see the problem as the fee for service system itself.  The fact that the two sides do not agree on the fundamental cause driving higher health care costs, is a big reason why they are talking past each other.  Jeff Wennberg noted that, if the problem was actually the fee for service system itself, we would see the same problem of rising costs in other industries.  The fact that we do not, would indicate that the fee for service system is not the problem and that we really need to back up and correctly identify the actual problem before trying to propose a solution.

Dr. Letovsky pointed out that to believe in the possibility of a market actually working, one must believe that consumers are generally capable of making the right choices about their own health care given adequate information.  There is an opinion among some the single payer advocates that the average person is not intellectually capable of making such decisions for themselves, but the members of the appointed board are intellectually capable of making such decisions for all of us.  Dr. Emmons argued that he has discovered during his years of practice that the average person is more than capable of making decisions on matters related to their own health.

In the end it looks like we are faced with two irreconcilable viewpoints.  One the one hand their is the belief that the average person is capable of making his own decisions given adequate information and that the problems with our high cost in health care are related to a payment system that introduces a third party into the doctor-patient relationship.  The other side does not believe that the average person is capable of such decisions and sees the problem in the fee for service system itself.  Instead of exposing the public to a debate on these two points of view, we are rushing down a path that takes the second point of view for granted and not allowing for any dissent from those premises.