Industrialized Health-Care Mess

" X picked up where you adopt ad kind of way I didn't indeed he did well yet you examine not any formal education. True I think doctor Erika Schwartz your general internists. And you're joining us today talk about hot topic of the day health health care reform. And what health care that healthcare crisis means for Americans down the road and really share with you that's your overall plenary I health care reform --"

" Actually I've been a physician practicing physician for over thirty years sightseeing healthcare coming Obama. And I've run a trauma center had done private practice. I teach I educates physicians and the public and -- a big mess. The health care system as a big -- And led the applause what do you what do you mean by that well the health care we're getting is not then I mean here we are top country in -- top. Industrialized. Educated. Highly. Intelligent country and the health -- providing our people -- horrible. And right now obviously there's a lot of opposition to president Obama's -- health care plan and what. How you see it what does that mean for everybody watching right now what does that mean for the consumer what does that mean for the taxes. That we're about to pay what does that mean overall for all of us I think the only thing I -- addresses as a physician taking care of patients and I think that that's the part that seems to be overlooked at all times. I don't really know what it's about I mean as a physician and my -- yes -- is I think there is I don't know what it's about what do you know what it's about -- how arrogant industry -- out of the value of the business and and you know it's interesting that none of us really understand what's going on. I'm not in favor of the hand me stopping in and going against that but I'm also not clear what's going on -- IC patients every day. And the patients ask me how is this going to affect me I can't answer. The thing is that I know that my patients are not getting good care of them and I didn't hear from me. And then I'm getting good care because they're doing too much testing. Because we're scaring people and because nobody is really focused on the individual patient. I think that as we change. And what ever direction we need to change and we need to change there's no question about it doesn't work the way this. Whatever direction and -- actually focus on the individual. And that's the focus on you bet on you and how the health care system makes you better. We're not dealing with prevention we're not addressing how to keep you healthy we address mostly how to keep you scared and intimidated. And set. There's a lot of room here and the -- us to come from. Looking at the politicians and the polemic has to be really about. You and I the individuals and we've got a -- at him from Virginia timing in write down he's saying. There's too much emphasis on after care right now rather than. A focus on preventing -- convention exactly the problem is that all we're looking for in the health care system today is not to find something wrong with you. We're not looking to teach you how to stay healthy. We're not looking to say okay here's the lifestyle that you leading and this lifestyle can be adjusted an altered. To make you better healthier longer than the other thing we have a big problem with the doctor patient relationship. Physicians are we even regarded as God's -- better than you what's going on inside your body which is pretty insane. Because the only persona -- is going on inside your body is you. No matter how great the positioning right. Or there actually angry at the patient because of all the problems that the health care system that's created. And -- stumbling blocks so when you don't have the room with a patient examined the patient there a lot of other people there. Maybe not a person but -- there. And the doctor patient relationship has suffered. Doctors need to look at that the patient is someone they want to hold certain that they had there to serve the patient and the patients look at the doctor as a part."

" Okay hang onto this here doctor Schwartz you've got Tom Miller resident fellow at the American enterprise institute joining us here as well and Tom. And we've you've heard our discussion here on not the issue is right now on the table. Well one thing I heard is that doctors right now we talk about care the patient being conservative patient I've heard a lot of doctors say. Look I'm going to spend as much of this insurance companies money and give this patient -- many tests as I could possibly give them. To ensure. That I don't have a malpractice suit down the line or something might that mean. Have you heard that is is that's something that is part of the problem is that there isn't really -- cost thought involved here there's there there are other thoughts involved and not it was really involve the patient's health."

" Lot I've heard that it depends upon what those specialty in what situation. There are some doctors are much more susceptible to that malpractice pressure I think is an across the board statement that doesn't explain. The degree to which our healthcare system is not functioning well ended we tend to spend more than the value we receive in return. If someone else though is largely determining. How you're going to be paid in in what amounts then that's going to break down that direct relationship and communication and that partnership. Between the physician. And the patient but but doctors need to get some money and the current system is driving us towards saying you're going to have to listen to the real customer which increasingly under these proposals will be the government. And -- directly taxpayers than even the patient in the room. Won't that lead."

" Lower quality of care because ultimately. It it'll be. I guess more expensive so to speak the doctor will be well. Maybe willing to do less willing to see fewer -- VC that would Medicare. Lately where a doctor -- must think a certain percentage of his patients -- Medicare."

" Patient's right. We get right yet to connect this -- and several degrees depends what what package you talking about but as we first. Might politically promise to do a lot more cover more people and offer all these benefits. The financing to actually pay for it let alone a way to deliberate efficiently and had the incentives where the person receiving care is part of the equation and knows what because what they're getting forward in return. It is we get that squeeze a little further down the road. The the only thing that a government run system can essentially do is to cut back to renege on that initial promise and squeezed the physicians in terms of what's allowable what's permissible in terms of medical practice what products can be -- and pay less which is what we've seen through programs that you're referring to Medicare and Medicaid Medicaid the -- but Medicare also pays less than what it actually costs in many cases the."

" Let -- have just political polemic at the end of the day doesn't matter was running yet it's what happens in the room between the doctor and the patient. End of the doctor is trying to figure out how to make the money. And the patient is not getting good health -- it doesn't matter who holds the purse strings doesn't."

" No it doesn't matter who holds the first thing because last time I checked you will do some things based upon what will be paid and as opposed to whether or not they will be renamed."

" Earth but I think that's a problem because then the whole system is not a direct service which it should be about it should be about the doctor taking care of the patient serving the patient rather than the malpractice issue that you referred to. And about. Who's telling the doctor how much money because they can spend Ing think so at the end of the day the only way to correct the problem is to go back to the doctor and the patient. And teach the patient and the doctor that they got a got an added together."

" Time that's right we need a partnership with the invasion the doctors and and the payers Tom -- we do this without spending one and a half. Trillion dollars -- much it's going to be here. Over the next ten years had we use. Well first we have to focus upon what is actually value in health care we get a lot of services they may not necessarily be living so what matters is health and I agree with. That sentiment other a lot of things that produced our health it's not just -- health care delivery system he goes back to your family developing your early education a lot of your personal -- to -- better incentives in the system. But we get a wider base of tools and just thinking if you've got to coverage benefit. You're going to be healthy as a result of it. We also need to prioritize and target some people need a lot of help their low income their high cost high risk we need to folks on them but we can't have everybody subsidizing everyone. And think we're coming out ahead while the political brokers get their little commission along the way."

" I can come honey bring in some numbers here and doctor Schwartz feel free to chime in a while but. I'm looking at less than 13%. Of all health care spending is spent. Out of pocket and that sure continues to drop each year and we actually had we had a -- weighing in saying that. This is from best often I get a 30% discount for paying cash and that's just crazy how do you react that --"

" Crazy it's crazy and that the Fed up that has is the result of what's going non. And you know it's interesting that the number you quoted seems very low to and that's actually if you on the top right yet it's it's very low to me because being in the trenches and seeing patients with some really what I -- Patients are spending an enormous amount of money out of pocket and alternative medicine. On supplements. On. Different modalities. And the conventional medical system so if you have a system that's broken and that people are investing in my pain whether they're paying insurance -- the government doesn't matter where it's coming from. At the end of the day these people are spending their own money on other things trying to get healthy -- and doctor Schwartz oh -- that numbers to -- she sees people spending more."

" Out of pocket -- your acts. I I only wish it would was higher could then we'd have more patient control any more patient centered system those in the national numbers they've been steadily measured over time. We actually have less paid out of pocket as a share of national health spending. Then many of the European countries that more nationalized systems the OECD average of all those nations is higher than that and united."

" They -- found out are only looking at statistics. And the statistics are really not looking at anything but what's going on in the healthcare system. That we can measure. We're not looking at the alternative. Care that people are spending money on and that's eliminated from the statistics which is actually. Doing us a disservice in the long run because they don't really know what's going on out there."

" It's certainly true that more individuals are finding -- need for ways to improve their health outside of the conventional health system. But when you head up the dollar's most of the dollars are flowing through very conventional third party payment system."

" So the best way to really start. This discussion. To change to actually implement change is -- to go back to the doctor patient relationship and back to prevention for."

" All right doctor issuance this is it without question president Obama's biggest challenge to me he's had some big challenges so far in office and this is by far the biggest want to get this past. Will we have a public option when all is said and done. Will that not worked and will Washington in the parties it be that house in the Senate the Republicans and Democrats finally realize that that will not work. When all's said and done how was this reform going to look. I have no idea. That I don't know we have none of us all the time I'll probably in the same boat because that nobody I know."

" I I I. I have a few ideas because the pay attention to the process which on which is what. The -- trains run that the house will pass the public plan option is no doubt about that. And not that finished up by the end of July. In this candidates a little more skeptical. There's one committee through senator Kennedy's help committee which will will will push a very aggressive public plan option. Is some push back for moderate Democrats in the finance committee's site. This and it is the real action whether they can get that with a public plan before early August that's the main battle and unfortunately even if we don't get an official public plan. There -- a lot of secondary ways in which what we get will be so highly regulated. It'll look like the public plan whether or not to call at one and who pays that -- had -- benefits tax. That is the only place they can find money currently which is -- this place attacks on a portion of the health insurance many people are receiving."

" So what an idea I would really to find balance between the two well mean with the goal to actually help the problem. Well here's an interesting comment from of the art as -- and I have both -- you reaction that's. This New York Chris from Los Angeles Times that he says the problem it as I -- is the insurance companies don't want to show their hands the doctors don't want to show their hand safest. It's a stand -- the doctor bill more than they expect to get the insurance companies build more than they expect to get it to joke. How do you respond well unfortunately if it's a joke it's a joke on us the individuals. But an okay -- that -- currently engaged and what I'm not because I absolutely refuse to be intimidated and practice medicine based on fear of malpractice. And I think that if all the doctors practice medicine serving the patient you and worrying about how to help the patient feel better they're probably be less of a standoff. I also work with an insurance company that's not well. Approach is about prevention that's focusing on prevention of giving people up. A certain amount of money to spend on a doctor's visits so they don't lineup at the doctor's office when there half dead so I think that focusing on prevention. Focusing on the doctor patient relationship will eventually start. Getting us to anyone again."

" Couple months it'll be every day we're going to be talking about the Senate that is for sure OK doctor Schwartz we certainly do appreciate you very -- Erica Schwartz. And not Tom Miller resident fellow at the American enterprise is due Tom the decision."