Medical school community weighs in on health care

BY ESHWAR THIRUNAVUKKARASU
Daily Staff Reporter
Published September 8, 2009

Tonight before a joint session of Congress, President Barack Obama will give one of the most highly scrutinized speeches of his presidency. In an effort to rally support for his health care plan, the President is expected to clearly explain what he wants in a health care reform bill.

"People will leave that speech knowing where he stands," White House Press Secretary Robert Gibbs said on ABC's "This Week."

Health care reform has drawn considerable attention this summer, from raucous town hall meetings to factually incorrect talk of government “death panels.”

Much of that attention has come from politicians and the national news media. Meanwhile, the views of those in medical community seem to fly under the radar.

In interviews this week, members of the University’s Medical School expressed concerns about the changing landscape of health care but remain optimistic about the enhanced coverage.

Nat Schuster, a third-year medical student who has been closely following developments on the issue, said many of his peers are awaiting the forthcoming legislative decisions before deciding to pursue a career in primary care.

“I think generally within the med school that people are watching excitedly about what could happen over the next few months,” Schuster said. “All the stars are aligning right now for health care reform.”

Schuster welcomed the possibility of providing universal access to health care, citing substantial need in the United States.

In 2007, the U.S. Census Bureau estimated that nearly 46 million Americans were uninsured while another 25 million were underinsured, according to the U.S. Census Bureau.

Schuster, a member of the Health Policy Society (POSO), a student group in the Medical School that convenes weekly to discuss issues like health care reform, is convinced that a massive overhaul in the system is not necessary to provide access to health care.

“Health care in the United States right now is a patchwork quilt of public and private payers,” he said, “and that’s not going to change.”

Dr. Mark Fendrick, an associate professor in the School of Public Health, echoed the sentiment, saying, “incremental reform is the reform that happens.”

Fendrick anticipates that any policy detailing both access to care and quality improvement will unavoidably lead to an increase in overall expenditures.

“To take on cost-containment, [universal] access and make the promise of cost neutrality to the federal budget, in terms of no new deficit creations, was a Herculean task,” Fendrick said, referencing a pledge by the president to make his health care reform plans deficit neutral over the next 10 years.

Fendrick is also the co-director of the University's Center for Value-Based Insurance Design. He said the Value-Based Insurance Design model is the type of incremental reform that he would recommend to provide for long-term cost reduction and encourage general health.

“The basic premise of Value-Based Insurance Design is to set up the situation where, instead of all doctor visits, diagnostic tests and drugs costing patients the same, we actually put strong financial and non-financial barriers in place for people to do the things that we really want them to do,” he said.

Value-Based Insurance Design has gained recognition as the model for a recent legislative proposal in the U.S. Senate designed to benefit Medicare recipients. The bipartisan proposal intends to lower out-of-pocket costs and encourage the use of high-value treatments in lieu of patients undergoing more costly procedures.

While much of the focus on health care reform has been economic and political, institutional changes to medical schools are another important factor to consider in the long term, Fendrick said. A shift toward providing greater health care access, he said, would increase the demand for primary care physicians — a change that should be reflected in medical curriculum on campuses around the country and, later, in compensation.

“As the movement goes to pay clinicians based on the quality of care and health they produce, it would make complete sense to see a substantial increase in the payment of those primary care providers,” he said.

LSA senior Arun Hariharan, however, is not entirely convinced that a salary increase is awaiting primary care physicians in the near future. In the process of applying to medical schools, Hariharan said he is uneasy about the prospect of entering a potentially new landscape of health care.

“I’m nervous,” Hariharan said. “I was in the first class to take the new SAT, the new MCAT, but this is huge — it’s your profession.”

Hariharan said that a pay cut would not deter him from pursuing medicine, but given the state of the economy and medical school expenses, he said he might reconsider his options to pursue an administrative role in health care as opposed to a clinical one.

“Doctors are going to be affected monetarily for sure, but I don’t think it’s going to be substantial enough to change their way of living or patient care,” he said.

Hariharan, the president of Alpha Epsilon Delta — a pre-health honors society — said he is concerned about students meeting the demand for general practitioners. He anticipates not only decreased membership in pre-health organizations in the near future but also fewer overall students in the pre-medical track.

“I think they’re going to be dissuaded,” said Hariharan. “Given the economic troubles, it’s hard for people to make this decision and not know where they’re heading. When there’s a clear establishment of how doctors and patient care are going to be affected, then there will be more stability in students’ decisions.”