Questions for the primary care panel
Wednesday, July 15 2009
This Friday’s “Putting Patients First” has a primary care panel; Kevin, MD and Dr. Rob are on it, along with two other names I don’t recognize.
Let me say first, I am totally in the tank for primary care. Kevin, MD and I don’t see eye to eye on… anything? But I agree with him that primary care needs a lot more support. I think that inevitably means spending a bit more up front, but Kevin might argue that cutting costs is more important. Point is, that’s an argument about means, not ends. Meanwhile, Dr. Rob has been just tops about reaching out for comment and dialogue. If you haven’t already, go vote in his poll.
In theory, I could ask these questions of Dr. Rob and Dr. Kevin any time I wanted, and they would probably answer me. But part of the reason for doing it this way is to get other people thinking about these issues, and maybe elicit some dialogue and further questions. So here goes.
1) Dr. Rob, you in particular have argued that Medicare is highly flawed, and I respect your perspective on the question. Obviously, I’ve never been on Medicare myself – but from what I have seen, it looks a lot better than my insurance company in terms of headaches, hassle, and – yes – cost. Are the problems with Medicare fixable? If they were fixed, would you be more sanguine about a public program for other sick people?
2) For the whole panel: my sense is that most patients have learned – as I have – to focus mostly on the specialist who treats their main disease. For me, this is partly because my primary care physicians have always punted on any decisions related to that disease. That said, it’s clear to me that primary care ought to be more than just a referral factory for specialists. So how can patients and primary care physicians work together to better manage chronic disease? What can patients specifically do?
3) I have had good experiences with nurse practioners and physicians’ assistants, and I have been among those who argue for more mid-level providers in primary care. I’ve been surprised to find that some physicians resist the idea – including Kevin – but is there a more cost-effective way to expand primary care? Would it be an acceptable approach if it also meant you earned more? [Edited 7/15; see comments for more info, but suffice to say that I mischaracterized Kevin's view of mid-level practitioners.]
You misrepresented my blog post.
The argument is that mid-levels are, i) not immune to the incentives favoring specialist care, and ii) there simply are not enough of them to make up for the primary care shortage.
No where in that post did I say I was against mid-levels in primary care.
In fact, I’ve written the opposite, like in this NY Times piece:
“The lesson here is that universal coverage must go hand in hand with the training of more primary care providers — not only doctors, but also nurse practitioners and physician assistants who can provide excellent primary care.”
http://roomfordebate.blogs.nytimes.com/2009/02/25/ideas-for-fixing-health-care/#pho
Kevin
Kevin – You’re right. I got it wrong. I think I over-edited the piece, and lost the original intent of your post somewhere along the way, but that’s not in any way an excuse for misrepresenting your views. I’ve edited the post to reflect that.
I do think problems with M’care are fixable. The rule that people with M’care can’t get assistance on the cost of the drug is crazy. They just need to change the law. The 2-year mandatory opt-out for docs who drop Medicare also just needs to be changed. No other insurer does this.
The problem is not the fact that it couldn’t be fixed, the problem is that politicians and bureaucrats are the ones who have to fix it. I do think the idea that all members of congress (and their staff) would have to use the public plan is a VERY good idea and would potentially short-circuit some of these crazy rules.
I do look forward to seeing you on Friday. I may not have time for the beer, however.