October 16, 2009

Panel examines nuances of health care reform

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Taking part in a panel discussion on health care reform are, from left, John Sergent, M.D., Harry Jacobson, M.D., Larry Churchill, Ph.D., and Clayton McWhorter. (photo by Anne Rayner)

Panel examines nuances of health care reform

Sharp opinions, rather than sharp words, punctuated a panel discussion of health care reform last week at Vanderbilt University Medical Center presented by the Shade Tree Initiative for Health Policy and Education.

“What's going on with health reform is futile right now … I think we should start over,” asserted Harry Jacobson, M.D., Vanderbilt vice chancellor for Health Affairs, Emeritus.

Jacobson and Larry Churchill, Ph.D., Ann Geddes Stahlman Professor of Medical Ethics, said they supported universal coverage and access but worried the current effort in Congress to reduce the ranks of the uninsured will ultimately fail because it doesn't control costs.

“If we don't pass legislation that's got some pretty good bipartisanship support, it won't last,” added veteran Nashville health care executive Clayton McWhorter, who chairs the venture capital firm Clayton Associates.

John Sergent, M.D., professor of Medicine, vice chair for Education and director of the department's residency program, agreed the reform bill would require “a lot of downstream remodeling.”

But if progress toward universal coverage stalls, “I'm really worried … we'll find ourselves several years down the road before we get to that,” he said. “That is the one thing we have to accomplish pretty soon.”

So how would these experts reform the nation's health care system?

As chair of the Rolling Hills Group (Web site: www.rollinghillsgroup.org), McWhorter helped hammer out a health care reform plan last year that urged the federal government to assist state reform efforts before attempting it on a national scale.

He also recommended financial incentives — perhaps in the form of lower premiums — to encourage consumers to take better care of their health.

Payment or insurance reform alone will not solve the problems of cost, quality or access, Jacobson countered. Cutting reimbursement rates, for example, only encourages physicians to see more patients, order more procedures and fill more prescriptions.

Not only is the current fee-for-service reimbursement system out of whack, but the current model of delivering care “doesn't have the right integration of people, process and technology to get the job done,” Jacobson said.

Ultimately, said Churchill, health care reform may depend upon how Americans view themselves.

“We're highly individualized,” he said. “We tend to be moralistic about health, saying 'the sick may have brought it on themselves.' There's this sense that we ought to compete for health services the way we compete for other things like jobs.

“All of these are fundamentally inimical to (understanding) we're all in this together.”