The politics of healthcare reform

November 1, 2009
Ronald G. Wheeland, M.D.
Ronald G. Wheeland, M.D.

Ronald G. Wheeland, M.D., is a private practitioner in Tucson, Ariz. He is former president of the American Academy of Dermatology, the American Society for Dermatologic Surgery and the American Society for Laser Medicine and Surgery, and a long-standing

Even if one accepts that healthcare costs are rising at an unsustainable rate, why is there such a current rush to find the "magic" solution to the problem, when it is such an important issue? I believe the one-word answer to this question is this - politics.

Key Points

Except for a total knee replacement at 80 years of age and a fractured humerus at 88, I don't recall him ever being seriously ill. While he qualified for medical benefits through the Veterans Administration, his employer offered private health insurance that he used until he retired. After that, he was covered by Medicare.

Viewed from the perspective of the ongoing healthcare debate, and the recognition that more than 40 million Americans lack health insurance of any kind, my father was incredibly fortunate. With his private health insurance, and later, with coverage under Medicare, he was able to see the physician of his own choosing at any time.

Sadly, that is not the case for many; hence, the reason for the current debate about how best to reform healthcare in this country.

I am in agreement with the majority of Americans who find it hard to believe that we are the last of the industrialized countries to not provide healthcare insurance to all of our citizens.

What I don't agree with is the unprecedented speed with which attempts to reform healthcare are currently taking place.

I am astounded by the fact that the last five or six presidential administrations have made their own attempts to reform healthcare, and all have failed for one reason or another.

Even if one accepts that healthcare costs are rising at an unsustainable rate, why is there such a current rush to find the "magic" solution to the problem, when it is such an important issue? I believe the one-word answer to this question is this - politics.

I'm left with a certain amount of indignation that our elected political representatives seem to react to any serious condition or situation (like this one) with the apparent belief that they can hastily develop solutions to a chronic problem simply because of their ability to pass legislation. This whole opportunistic, "white hat" response by some lawmakers to any high-profile issue is evidence of politics at its worst.

All too often, our elected representatives develop legislation based on the latest polling numbers or what would be best perceived by their constituency rather than what might actually be best for the country and its populace. Such is the case today with healthcare reform.

There's no doubt that there is grave concern in the electorate. Those with good healthcare access don't want to lose it, and those without healthcare insurance not only want it, but also they need it.

What could be better for a politician than to be on the side that can offer the most votes or the most money for a re-election campaign, and quickly develop a hasty reform without having all the facts or the chance to deliberate in a thoughtful, informed way to come up with a plan that truly does the most good for the most people?

After all, improving access to healthcare is as wholesome as Mom and apple pie, isn't it? So, what could be wrong with proceeding with legislation as quickly as possible, before the next campaign season starts?

No quick fix

How ludicrous and egotistical it is for legislators - many of whom are trained as lawyers and not as physicians or nurses - to quickly try to "solve" a complex problem like healthcare reform and develop legislation to attempt to correct it!

In my opinion, these legislative activities are nothing more than political grandstanding and pandering to the voters in order to get re-elected.

As a fairly knowledgeable physician myself, with previous extensive national experience in healthcare issues, I do not pretend to know all the problems or even how best to solve them.

I do, however, recognize some of the problems that are contained within the current proposed healthcare legislation; for example, correcting the sustainable growth rate, oversight of the Independent Medicare Commission and elimination of the reduction in physician outlier payments.

Complexity

There is no doubt that the healthcare industry is an extremely complex system. The sheer complexity of this system requires a thorough understanding and definition of the problems, followed by an extended period of time working in a comprehensive, collegial and collaborative fashion with legislators, physicians, nurses, hospital administrators and patients. Only then will we be able to develop a prudent package of legislation that can truly improve access to high-quality healthcare for all Americans.

Meanwhile, all physicians must continue to practice medicine with their patients' best interests in mind. Politics and politicians should not interfere with that basic principal; rather, they should work together with physicians and other providers of healthcare to evaluate the problems and then develop the best plan to solve them.

This is the only way the public will be best served, and those legislators responsible for taking careful, deliberate and appropriate action will be rewarded by a grateful electorate.

Ronald G. Wheeland, M.D., is chief of dermatologic surgery, Department of Dermatology, University of Missouri, Columbia, Mo.