The subject of health care reform has created a frenzy of debate nationwide, but the general internists at Hopkins Hospital seem to agree that reform is needed.
In a recent speech, President Barack Obama explained to Congress the need for health care reforms that focus on lowering the costs of health care, restricting the cherry-picking done by insurance companies and improving preventive care.
The White House website on health care reform also states that the plan calls for research investment and intervention programs, eliminating unnecessary procedures and paperwork and initiating a pay-for-performance plan for doctors.
Fred Brancati, chief of the Division of General Internal Medicine at Hopkins Hospital said, "I am personally 110 percent in favor of reform and I believe my zeal is shared with general internists across the country."
"In general, I am in favor of health care reform, particularly in providing access to care for all and lowering overall costs of health care," Rochelle Brown, medical instructor and General Internal Medicine faculty member, wrote in an e-mail to the News-Letter.
All general internists interviewed were in support of some form of health care reform, though many also took issue with the pay-for-performance aspect of the plan, an important point of contention among physicians nationwide that would result in the government paying physicians for high-quality care rather than for more exams, procedures and paperwork.
"I worry about some of the pay-for-performance programs," Leonard Feldman, assistant professor of Medicine said.
"I think pay-for-performance would certainly give incentive to provide great care, but physicians should not be held responsible for the patient's actions. Physicians counsel and motivate their patients. But we cannot control whether an individual will exercise, eat well, etc," Feldman said.
Steven Sisson, associate professor of Medicine and director of the Hopkins Medicine Internet Learning Center provided another difficult aspect of the pay-for-performance idea.
"Let's say I have a patient who is noncompliant," Sisson said. "She's got diabetes and she never takes her insulin. She doesn't get her mammogram. She doesn't get her colonoscopy. So when you look at my care of women with diabetes and screening women who need mammograms [and] colonoscopies, this patient is going to hurt my numbers and make it look like I am giving poor quality care," he pointed out.
"And the fear among doctors about these quality care initiatives is that some doctors are going to be tempted to discharge [noncompliant or complicated] patients from their practice."
"I would hate to see us moving from insurance companies denying patients care because of preexisting conditions shifting over to physicians denying patients care because of compliance and medical complexity issues," Sisson said. Jeanne Clark, Director of the General Internal Medicine Fellowship, stated that the complex pay-for-performance proposal would be hard to regulate.
"I do not think that the government will be inherently unfair [but] I just am not aware of a way to do this well in all, or even in most circumstances," Clark said.
But in terms of the governmental control over doctor salaries, the physicians explained that the government's influence on the payment of physicians is not new.
"The government already plays a role in my salary through Medicare reimbursement rates," Brown said. "Many private insurers use the Medicare rates as measuring sticks to determine their own rates."
Of course, the health care buzz has been featured by the media for the past several weeks and escalated into a fiery political debate.
Adam Sheingate, associate professor of American Politics and Comparative Public Policy at the undergraduate Political Science Department described the escalation of contention.
"Really what's motivating a lot of the opposition is a general anti-government sentiment, and frankly, in some cases, a misunderstanding about the role that government already plays in health care," Sheingate said.
Daniel Barash, president of the Student Democrats at Hopkins added, "Disapproval is in the majority because there is a lot of misinformation- like Governor Sarah Palin's Wall Street Journal op-ed about Obama's proposed 'death panels.'"
Lauren Lutz, Vice President of the College Republicans, also commented about the role of government in health care.
"The health care system works for most people," Lutz said. "People just can't afford it because of the controls that the government has over the health care industry."
According to Lutz, the way to solve the issue is to take away the government controls and allow the health industry to operate in the free market.
"It's not that the free market has failed," Lutz said. "It just hasn't been tried."In addition to Obama's troubles is the fact that he must earn the approval of Congress and its conference committees to fulfill his health care vision.
"People have to realize that for advocates of health care reform and the Obama administration to succeed, they have to win at every step of the process," Sheingate said. "The opponents of health care reform only have to win once and they have multiple opportunities to do so. That's why most presidents have not been successful in reforming health care."
Sheingate predicted that the ideal health care reform plan will not be passed the way the Obama administration would prefer. "Obama's administration wants to increase coverage, improve quality and control costs. Those three things are very difficult to do at the same time." But he added, "It's also possible it may not be the last we hear about health care. We may achieve something now and come back to it another time, in another way."
But some physicians believe the reform plan will change this, including Brancati, who said, "It'll have a ripple effect-it'll change the psychology of medical students and residents."
"I think there's going to be more money for more primary care residential programs to produce more primary care physicians," Feldman added.
"I think that proper counseling on nutrition and assistance with smoking cessation and with screening and improved vaccinations-those are going to have immediate ramifications, immediate savings," Sisson said.
"One of the hopes we have is for more funding for preventive services," Brancati said. "We'll be able to provide better care, because we'll have more funds to take care of our patients."
Under the current system, insurers do not support preventive care.
According to Sisson, insurers do not want to pay physicians to counsel their patients to lose weight or to get them off cigarettes.
"I [suspect] that they know that the patient, probably within five years or ten years, has a good chance of having a different insurance," he said. "So further down the line, when that patient doesn't get lung cancer or doesn't have diabetes, that benefit is going to be given to another insurance company, so I think that's part of why insurance companies don't like to pay for preventive health."
Some Hopkins doctors would like to see additional reforms, such as Clark, who wants to see reforms that would make accessing the past records of patients easier and reforms in malpractice law.
Overall, many Hopkins physicians have made it clear that they want what is best for their patients, but have been hindered by the current reform plan.
"You can't find people more motivated by mission than at Hopkins," Brancati said. "These are wonderful people, taking way below market salaries for the privilege of working at Hopkins. And even here, we're swimming upstream against a powerful current, a system where the only way to live and breathe financially is to do more complex care that may or may not have as strong a punch as basic things."
