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A physician’s skeptical reading of the State of the Union address

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Gregory Hood, M.D.. ruminates  in Medscape  about President Obama’s remarks in his State of the Union address.

“The first mention of healthcare in his address was the crushing issue of drug abuse, which many of us are working very hard to improve. Next was personalizing medical treatments for patients. And then he did refer to the future: “‘For my final address to this chamber, I don’t want to talk just about the next year. I want to focus on the next 5 years, 10 years, and beyond.”‘

But “{u}nfortunately, there followed no pragmatic conversation about the healthcare system reformation. He spoke of the future but then immediately spoke of ‘how we reformed our healthcare system’ as if healthcare reform is finished, a fait accompli. Much needed to change in the healthcare system that we had, and much has changed. Through the Affordable Care Act, some good work has been done….”

“However, it is a mistake to view healthcare reform as accomplished, a box that has been checked, something to be filed away. Healthcare reform is not a closed folder. It is essential to review what has worked and what has not. Just as a care plan for a patient always requires reassessment and adjustment as time moves on, so too does the need to adapt healthcare delivery to the changes in the world: demographics, funding, technology, and medical sciences, among other variables.

“President Obama spoke of outdated regulations and the negative impact that they have on businesses. If he was serious about his approach to this, then he would have highlighted facility fees as an example, and how, in the words of Elizabeth Rowe, Marty Makary, and others, healthcare is being driven and consolidated into a system that is ‘too big to fail.”‘

Dr. Hood also took issue with “the narrative that system reorganization by consolidation will lower expenditures in the long term” (indeed the opposite may be happening) and challenged the “often repeated, oversimplified claim that growth in healthcare costs is the natural derivation of fee-for-service payments to physicians.”


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