Dr. Daniel Palestrant

Dr. Daniel Palestrant

Posted: July 23, 2009 11:33 AM

What Doctors Actually Endorse For Healthcare Reform (Hint: It's Not In This Bill)


On July 16th, the American Medical Association endorsed the House Healthcare Reform Bill. Since then over 10,000 US physicians have used Sermo to voice their position on the Bill. 94% do not support the bill, and 95% state that the AMA does not speak for them with its endorsement (see full survey results and comments). The numbers are astonishing, almost as astonishing as the fact that none--not one--of the three topics that physicians state are the most important for comprehensive healthcare reform are even addressed in the Bill at all: malpractice reform, limiting impact of third party payors on the doctor patient relationship, and evening the playing field between doctors and third party payors.

It took the AMA less than 36 hours to endorse a 1,200-page bill that seasoned legal scholars are describing as "puzzling". It is a complex document that touches almost every aspect of the healthcare system except, perhaps, the ones that can have a material impact on cost savings. While the Bill does nothing to address ballooning administrative costs that are thought to consume 15-40 cents of every healthcare dollar, the bill does protect the AMA's proprietary CPT codes and will lead to a windfall in revenue that the AMA gets for licensing these codes to insurance companies and hospitals. With less than 15% of revenue now coming from physicians, one doesn't have to look far to see who the AMA is truly advocating for in this decision to endorse the Healthcare Bill. It's the AMA.

---------------------------------

First posted to the Sermo physician community on July 17, 2009:

From the Founder: Sermo Physicians Respond to AMA Endorsement of HC Bill
Congressional Leaders and Media Call Upon Sermo Physicians to Comment on AMA Endorsement of House Bill

Yesterday, the AMA publicly endorsed the House Healthcare Bill. In its current form, the bill fails to address any of the major issues that physicians have consistently voiced and demonstrates the tremendous risk of physicians not having a voice in the current healthcare debate. Sermo has issued a press release refuting the endorsement of the bill.

Today, the Sermo community has been asked by the media and members of Congress to join the healthcare debate as a voice for US physicians. Please take a moment to vote and comment on what issues you see as most critical for healthcare reform.

Here's how your voice will be heard:
• Sermo will be issuing another press release detailing the results of the survey
• Daniel Palestrant has been invited to meet with Congressional leaders in Washington, D.C. to present the Sermo community's voice in the healthcare debate.
• Your colleagues on Sermo are organizing a grass roots movement for physicians to take coordinated action to block the further destruction of our profession through the Take a Stand. Tie a Knot campaign.

After you have voted and commented, it is critical that you engage your colleagues and ask them to participate as well. Together we can ensure that the voice of dedicated, practicing physicians is accurately represented in this debate. Our strength is in our numbers.

Daniel Palestrant, MD
Founder & CEO
Sermo, Inc.

View over 500 comments from the Sermo physician community

On July 16th, the American Medical Association endorsed the House Healthcare Reform Bill. Since then over 10,000 US physicians have used Sermo to voice their position on the Bill. 94% do not support ...
On July 16th, the American Medical Association endorsed the House Healthcare Reform Bill. Since then over 10,000 US physicians have used Sermo to voice their position on the Bill. 94% do not support ...
 
 
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05:40 AM on 07/27/2009
It's interesting to know that such a large majority of the people who will actually be doing the work dont support this plan.. Just another example of liberal lies and made up support for such a bill...
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CJWebber
02:32 PM on 07/27/2009
In 1962, when healthcare reform was initiated in Canada, 90% of the doctors shut down their offices and went on strike. It wasn't an easy time; you can't have reform without upheaval. But the doctors now sure aren't complaining.

Don't base your opinion on what doctors think. Is it possible they have a different agenda? Use your head.


http://en.wikipedia.org/wiki/Saskatchewan_Doctors'_Strike
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karela
01:21 PM on 07/25/2009
See Deepak Chopra's article today and you'll see what these doctors are on about. You notice that none of their three big concerns have anything at all to do patient care or patient suffering from lack of care. They're all about MONEY! With 30,000 Americans dying every year because they can't get medical care, our doctors are worried that they might make less money. The profession has attracted some kind and caring people, such as our new nominee for the office of the Surgeon General, but it has attracted more greedy little pigs who thought that was the best way to get rich. We'll need to have major shifts in this country. The medical schools have purposely kept the number of graduating doctors down so as to keep wages of doctors up. Too many doctors go into specialties instead of family doctor because of the MONEY. We need to change the atmosphere so that we're attracting more kind and caring people to medicine. And by the way, it isn't good for patients to have interns and residents working 24 or 36 hours straight. Mistakes get made. It's a hazing practice to keep the number of doctors down. We'd have better care if there were more doctors who made more reasonable incomes. We'd attract a better class of people.
03:12 PM on 07/25/2009
Karela; "greedy little pigs?" Really, you have completely missed the boat on what is driving up the costs of health care. Doctors pay for too long has been suppressed already. I've been in the field on the front lines with them for over 13 years now. You expect them to provide you with quality care, yet they are "pigs" in your esteem. Focus more on BigPharma and their BILLIONS in profits they get out of this reform package along with the insurance CEOs and the MILLIONS they take home in pay instead. Medical schools have nothing to do with doctors' pay and it is an empty argument. Lots of schools limit enrollment because they do not have enough staff or resources to accomodate additional students. What drives doctors pay are insurance plans and their confidential fee schedules that they determine usually annually through a series of complex formulas. It is in the ins. co. best interest to keep reimbursement low so they can generate more profits. I hope you don't need a doctor anytime soon for an emergent problem. You seem to feel they should provide services at indentured servant rates, which by the way, is not too far from the truth the way things are headed. Peace to you.
03:34 PM on 07/25/2009
I actually did not get to finish my comment. There are far better ways to "get rich" that do not involve incurring $200,000- 400,000 in debt from student loans, 4 years of college, 4 years of medical school, and a minimum of 3 years of post-graduate training working grueling hours and running a small business usually 24/7. Ask any doctor in private practice and they will tell you that. When asked, many of them tell me that they entered medicine to help patients, and it has evolved into nothing but a bureauracy. They constantly have to practice defensive medicine because of the fear of missing the one test that could have detected an issue in this litigious environment. Much easier to become a lawyer or banker and have a comfortable living with less time in school and less hassle.
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Lilith33
10:07 PM on 07/24/2009
FACT


: In Hospital Deaths from Medical Errors at 195,000 per Year USA



Litigation / Medical Malpractice Article Date: 09 Aug 2004 -


An average of 195,000 people in the USA died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a new study of 37 million patient records that was released today by HealthGrades, the healthcare quality company.


"The HealthGrades study shows that the IOM report may have underestimated the number of deaths due to medical errors, and, moreover, that there is little evidence that patient safety has improved in the last five years," said Dr. Samantha Collier, HealthGrades' vice president of medical affairs .



"The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S."



www.medicalnewstoday.com/articles/11856.php - Cached - Similar


But what we need is tort reform and caps on malpractice?


LOL! LOL! LOL!!!!!!
FaceReality2
Democracy in the U.S. is an illusion
10:32 AM on 07/25/2009
This and all your posts below are excellent.

Why is it that when the issue of medical malpractice comes up, the doctors and the Republicans never EVER propose preventing malpractice in the first place? It's always about caps on damages after the malpractice has occurred.

And of course they refer to malpractice suits as "junk lawsuits." How would they like to go in for a gall bladder surgery and wake up to find both their legs had been amputated? Would that be a junk lawsuit? They would like a world where such a person cannot sue at all for such a thing, like in the military. This actually happened recently to one poor airman. He may get a few hundred dollars a month from the military. How's that for caps? See:

http://kdka.com/health/medical.mistake.military.2.1092872.html
03:22 PM on 07/25/2009
This is too much of a generalization. Of course you want to prevent things before they happen. I don't believe that the industry feels all suits are "junk," but some are indeed frivolous. As in every profession, mistakes are made. Some clinics/hospitals that are accredited by health care organizations are required to conduct performance improvements studies and implement how the change has affected the way care is delivered to patients. I belong to one of these type of clinics. It is a lot of hard work, but keeps everyone on their toes to deliver safe, top notch care to our patients. Many malpractice carriers mail newsletters to subscribers setting up scenarios of actual cases that have happened, went to trial and the subsequent jury verdict. Many have lessons of how things could have been prevented and present ways of ensuring this does not happen in your particular practice.
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Lilith33
09:55 PM on 07/24/2009
Avoid Tort Reform in the Health Care Bill at All Costs!

by Tim Foley

Published March 17, 2009


Even the nonpartisan Congressional Budget Office in 2004 conceded that the legislation for tort reform, even if it instituted a federal cap, would barely dent health care costs: "Malpractice costs amounted to an estimated $24 billion in 2002, but that figure represents less than 2 percent of overall health care spending.



Thus, even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 percent to 0.5 percent [emphasis mine], and the likely effect on health insurance premiums would be comparably small ."





They were even reluctant to say that a cap would even make a dent on defensive medicine. What about the access question - the notion that medical malpractice causes physicians to flee states without caps to states with caps? Turns out the only states that did not see an increase in the number of practicing physicians between 2003 and 2008 were Alaska, Georgia, Montana and Utah - all states with liability caps. A 2005 study in Health Affairs suggested that if we look county-by-county, we would see an increase of doctors in rural areas where states have caps - by all of 3-4%

. healthcare.change.org/.../avoid_tort_reform_in_the_health_care_bill_at_all_costs -


Fact are funny things and the almost never reflect Repug reality.

Whats up with that?
FaceReality2
Democracy in the U.S. is an illusion
11:03 AM on 07/25/2009
All the Republicans have to offer are lies, half-truths and fear.
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Lilith33
09:48 PM on 07/24/2009
FACT:

U.S. group sees little progress on medical errors


Tue May 19, 2009 6:34pm CHICAGO (Reuters) -


Despite a decade of promises, little has been done to fix the problem of preventable medical errors that kill nearly 98,000 people in the United States each year, a consumer group said on Tuesday

.
Consumers Union, the nonprofit publisher of Consumer Reports magazine, said lawmakers largely have failed to enact patient safety reforms recommended by a 1999 report by the Institute of Medicine or IOM that found that medical errors cost the United States $17 billion to $29 billion a year


. "There is little evidence to suggest that the number of people dying from medical harm has dropped since the IOM first warned about these deadly mistakes a decade ago," Lisa McGiffert of the Consumers Union said in a statement. "That means a million lives and billions of dollars have been lost over the past 10 years because our health care system failed to adopt key reforms recommended by the IOM to protect patients." www.reuters.com/article/.../idUSTRE54I6U320090519 - Cached - Similar
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Lilith33
09:44 PM on 07/24/2009
FACT:

USA Leads the World ... In Medical Errors


Taking The Pulse Of Health Care Systems: Experiences Of Patients With Health Problems In Six Countries
by Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Kinga Zapert, Jordon Peugh, and Karen Davis

Overall, the findings reveal strikingly similar deficiencies in care in many areas. Medical errors and failures to coordinate care, especially during transitions, emerge as shared concerns, along with missed opportunities to elicit patients’ views and engage chronically ill patients in their care. However, the study also finds sizable differences across countries.


The United States often stands out with high medical errors and inefficient care and has the worst performance for access/ cost barriers and financial burdens. In contrast, Germany often ranks high for timely access. On a composite variable including three types of errors—medication or medical mistakes or lab errors—U.S. patients were the most likely and U.K patients the least likely to report errors.


Driven up by relatively high medication and lab or test errors, at 34 percent, the spread between the United States and the countries with the lowest error rates was wide as well as statistically significant. Yet in all countries, more than one of five sicker adults reported at least one of the three types of errors, with patients often reporting more than one type of error

.
WERE #1

WERE #1

WERE #1
Wait a minute.......
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rlugbill
07:09 PM on 07/24/2009
The problem is that in our political system, the legislation will be made to accomodate the insurance companies, the AMA, Big Pharma, and other wealthy and powerful interests.

It's not based on what is reasonable or good public policy.

First, we need to reform the political system, then we can get reasonable public policy in all areas- financial, health, transportation, housing, foreign policy, etc.
FaceReality2
Democracy in the U.S. is an illusion
07:40 PM on 07/24/2009
That is indeed the root problem. The politicians represent their contributors, not their constituents.
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Feanor
I want my jewels back.
06:50 PM on 07/24/2009
Who cares? The current 'reform' effort is a complete scam that won't help. It's pointless to waste energy on it.

Hopefully I won't get sick until I'm eligible for Medicare.
08:53 PM on 07/24/2009
Depending upon when you come of age for that entitlement, it may be too late. Funds for medicare are projected to be tapped out by 2017, I believe.
03:29 PM on 07/24/2009
I agree with other physicians that we need malpractice reform.
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Lilith33
06:03 PM on 07/24/2009
Getting rid of the insurance companies would do that.they rip you off.
FaceReality2
Democracy in the U.S. is an illusion
07:59 PM on 07/24/2009
Read the following story about a young soldier who went in for gall bladder surgery and came out with both legs amputated.

http://kdka.com/health/medical.mistake.military.2.1092872.html

Here's the best solution I know of for malpractice. How about making each doctor in each town (or each hospital or each clinic, etc) pay his proportionate share of the malpractice damages caused by every other doctor in the group? On its face it sounds unfair but the good doctors would then have an incentive to cull the bad doctors from their ranks. The good docs know who the bad ones are. In addition of course, the docs themselves would have to have the right to yank the licenses of the bad docs.
03:29 PM on 07/24/2009
I endorse Single Payer, and I am a physician.
02:37 PM on 07/26/2009
yeah ok I'm Robert Redford and I oppose this bill.
02:54 PM on 07/24/2009
I'm a physician and I endorse Single Payer.

Yes, we need malpractice reform as well.
FaceReality2
Democracy in the U.S. is an illusion
07:56 PM on 07/24/2009
Just read a story about a young soldier who went in for gall bladder surgery and came out with both legs amputated. Read about it here:

http://kdka.com/health/medical.mistake.military.2.1092872.html

How about making each doctor in each town (or each hospital or each clinic, etc) pay his proportionate share of the malpractice damages caused by every other doctor in the group? On its face it sounds unfair but the good doctors would then have an incentive to cull the bad doctors from their ranks. That is the best cure for malpractice I can think of. The good docs know who the bad ones are. In addition of course, the docs themselves should have the right to yank the licenses of the bad docs.
FaceReality2
Democracy in the U.S. is an illusion
02:06 PM on 07/24/2009
Why don't doctors form another organization and use it to lobby for the changes they want?

BTW, some doctors, those who see their patients as revenue streams, are a big part of health care inflation. This article by a Harvard doctor is a must read:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
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SamEllison
I feel so clean!
12:40 PM on 07/24/2009
Hey Doc, with lawyers we know they are in it for the money.
With doctors we have to guess.

Should I guess with you?

The last thing we need to do is throw more money at the
health care insurers so what about single-payer?

How does it go?
There can be no "status quo ante"?
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timhere
03:30 AM on 07/24/2009
Its seems to me this guy thinks the purpose of health care reform is to make doctors richer. Just another special interest willing to let sick people die for profit.
10:15 AM on 07/24/2009
better the doctor who went to school 12-16 years be richer than the CEO of the insurance company who learned no skills other than cutting cost by firing staff and denying coverages....it 's about freakin time that our culture start rewarding people for hard work that benefits the community and saves lives...
11:14 AM on 07/24/2009
Amen. We want the best medicine, and the best doctors, but for some reason, feel it is not ok for a doctor to make money. This topic would not even be a discussion for any other service industry/profession but perhaps the banking/wall street crew who pillaged our country with TARP money. We have socialized medicine in this country right now and it is not working. Look at the VA system and the Military clinics as prime examples. I worked for the VA system during my residency. Did you know some people wait 4-8 months just to have an MRI as an example? Resources are rationed all of the time. I grew up the child of a multigenerational military family. Until the age of 23, I received all of my care at these type of clinics. When I was 17, I was told by one of the doctors there that a cholesterol of 900 (no typo) was NORMAL! My point is that resources are rationed in this type of model, and that you do not recruit top notch doctors into these type of settings. There are often shortages and civilian doctors are contracted to fill in the holes. It was not uncommon for us to wait months for appts or hours to pick up medications on an extremely limited formulary. We were grateful for the free care, but if you needed something major done, there was always a waiting list for everything.
03:00 PM on 07/24/2009
Remarkably, insurers hire physicians to do the denying of coverage. It's a sorry and difficult problem. I know one such administrative physician who would love to be out of a job if it meant that the nation went to a Single Payer system.
FaceReality2
Democracy in the U.S. is an illusion
08:02 PM on 07/24/2009
The doctors are getting screwed by the insurance companies and Medicare/Medicaid. Most of them are not getting rich. The insurers and govt are seeing to that.
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Antifascist-08
02:58 AM on 07/24/2009
Dear Mr. president:

Any bill endorsed by the AMA should be dimissed out of hand.

If you don't know why, we will never get a good bill, even just a stepping stone.
08:40 PM on 07/24/2009
You mean endorsed by the Doctors' Union. Right on. It they like it there's something wrong.
09:09 PM on 07/24/2009
Many people do not know that the AMA does not support the vast majority of physicians and their views, particularly the doctors who are in private practice. True, it is a lobbying group for doctors, but many have abandoned their membership in this organization. So just b/c the AMA may support something, it does not have a monumental impact with doctors anymore. If you are truly wanting to know a doctor's point of view on health care reform, ask them directly and not the AMA, which are primarily a bunch of bureaucrats who are becoming no different than our representatives in congress. Doctors on the front lines everyday making life altering decisions on the fly at times, should have more of a say in this reform bill than people dictating to us from their ivory towers in Washington.