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Discussing health care in a normal voice

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By Sherry Robinson

Civil discussions of healthcare reform are possible. I heard one just last week when three panelists took up the subject before a business group.

Jim Hinton, CEO of Presbyterian Healthcare Services, set the tone: “There are no villains in this debate.”

Daniel Derksen, a professor in UNM’s Family and Community Medicine Department and president of the New Mexico Medical Society, said healthcare reform is too important to be a partisan debate.

Bob Schwartz, a UNM Law school professor and expert on health law and bioethics, called for more consumer information.

All three talked about costs and waste.

If we could save even a small percentage on waste in the system, we could easily pay for healthcare reform, Derksen said. “We waste $210 billion a year on over-testing, another $200 billion on claims processing and $50 billion on defensive practice,” he said.

Last year Americans received half the world’s CT scans, which deliver 20 to 40 times the radiation of a chest x-ray, Hinton said. “We should remove the incentive to use CT scans and quit doing unnecessary back surgeries and prescribing unnecessary antibiotics,”  Derkson said.

It’s a matter of incentives. If a doctor treats you, whether you need it or not, he or she makes money.

“Much of the system is designed to get what it’s getting,” Derksen said.

Doctors get paid to treat hypertension or diabetes, not prevent them, but they will respond to fiscal incentives. “Why are we not spending money on programs to manage diabetes instead of spending money on dialysis and amputations from unmanaged diabetes?”

Incentives are tools of a working market.

Schwartz believes in markets, to a point. “No other developed country depends on markets as much as we do to make health care available,” he said. The average cost of a health insurance policy for a family of four is up 131 percent in the last 10 years. “If you want to know the future of health care, follow the money.,” he said. “Those with the biggest financial interests have no incentive to reform. We have tried again and again to make the market work and failed.”

Hinton countered: “I think the answer is within the capitalist system.” He doesn’t have a lot of confidence in government solutions. “Our political system is so short-term in focus, there is no momentum to improve beyond the current administration,” he said.

It was a gentlemanly way to sum up the discomfort with market solutions or government solutions, and I could see both sides. A working market is a marvel of ingenuity and economy. Computers, for example, have gotten faster and more powerful – and cheaper and more available. Health care  on the other hand has gotten qualitatively worse, more expensive and less accessible.

Derksen votes for a public-private partnership. “We need to replace the fat hogs with skinny pigs, even if they have lipstick on them,” he said, to laughs from the audience.

Derksen and Hinton didn’t spell out how their solutions might come about. But markets usually have the guiding hand of regulation, like a teenager with a curfew.

They all agreed on the need for patients to be informed consumers. Imagine having something like a Blue Book and using it to shop for healthcare services.

“There’s no transparency in prices,” Hinton said. “The patient is still a victim of broader incentives in the system.” And obtaining estimates up front is difficult, Schwartz says.

I wished mightily I’d had this consumer information in July, when a doctor ordered a CT scan I suspected even then was unnecessary and then cost me $300 out-of-pocket because it (and many other services) wasn’t entirely covered by my health plan.

Despite the heat in the kitchen, Derksen, the physician, urges action. “We need to act now. We can’t afford the system we have. This opportunity doesn’t come up often.”

© New Mexico News Services 2009