Saturday, March 20, 2010

The Ten Questions Walter Cronkite Would Have Asked About Health Care

I often yearn for the days when we had news people like Walter Cronkite, Helen Thomas, Peter Jennings, the tenacious reporters from the New York Times and others who could truly think and had a keen eye for the issues at hand. They did their homework and, when conducting interviews or participating in Capitol Hill news conferences, asked pertinent, meaningful questions even if it made the person being questioned squirm. They examined all sides of an issue – good, bad, and everything in between – to bring balanced reporting to important national debates – balance that is decidedly missing now.

Congress is poised to enact a health care plan that simply won't work and will cost taxpayers a small fortune for generations to come. And, so far, no one in the media - either broadcast or print - has asked any of the questions that really need to be answered and addressed in order to bring reform that will work and won't break the bank.

Following are the questions I feel need to be asked by the national media, and should have been asked as this process was getting underway. I will answer all of them in my blog posts over the coming weeks.

1. What is medical consumerism and what factors do you believe exacerbate this issue? Are you familiar with Professor George Annas’s article on the Baby K case in the May 26, 1994 issue of the New England Journal of Medicine (1) regarding the impact it is having on medical care in this country? How do you think we should address this problem?

2. Various experts using different methods have determined that Americans presently spend about $700 billion a year on inappropriate non-beneficial care and that this excess spending is primarily due to physician practices. What do you believe are the factors causing physicians to practice this way and how would you address these issues?

3. The business round table has stated that our present high health care costs as reflected by the percentage of gross domestic product (17%), that is much higher than other countries, is driving manufacturing and its high paying jobs out of this country. How should we address this issue?

4. Why does the cost of care in teaching hospitals vary so dramatically from hospital to hospital, as documented by the Dartmouth Atlas of Health Care, despite the fact that their physicians are salaried and do not charge fee for service?

5. Why do we have so many sub-specialist and so few primary care doctors despite the fact that primary care doctors are the key to providing coordinated care of high quality for less cost? How can we can we remedy this imbalance in the near future?

6. What has been the history of decreases in Medicare payments. Have they been successful and what effect do you believe these policies have had on American medicine?

7. What is the effect on working Americans of private insurance having to subsidize Medicare and Medicaid?

8. What do you think is the effect on state budgets of having to assume about 50% of the costs of Medicaid?

9. When can a patient reasonably utilize choice in care and in what situations are choices reasonably limited and who should determine when those conditions are reached?

10. What do you think is the result of cobbling together various constituencies in trying to pass a health care reform bill?

(1) New England Journal of Medicine, Vol. 330, 1542-1545,May 26, 1994, Number 21.