White House Report on Health Reform

Today the White House issued the Forum on Health Reform Report.  It is a summary of the events of March 5, 2009, and includes the remarks of President Obama, the findings of the “breakout sessions,” and a transcript of the Town Hall session.  I won’t repeat the report here.  All 54 pages are available at www.whitehouse.gov/assets/documents/White_House_Forum_on_Health_Reform_Report.  His attendees included representatives from Congress, physician groups, the insurance industry, the hospital industry, and the private/business sector. I do applaud the president on a carefully orchestrated public display of unity on a topic that is inherently divisive.  

 

Several common themes appear in the text of the breakout sessions.  The participants stressed the need for:

 

Access

Quality

Fair Payment/Reimbursement

 

Incidentally, those are three of the Priority Objectives for 2008-2009 for the American College of Emergency Physicians.

 

Not among ACEP Priority Objectives, but also stressed by participants in President Obama’s were:

 

Cost control

Expanded (insurance) coverage

Prevention of illness/Promotion of health

 

Each group expressed urgency in the need for reform to the delivery system for health care in this country.

 

I witnessed the press event on March 5, 2009, and I read the report eagerly.  Both times I found something missing:  EMERGENCY MEDICINE.  One hundred and nineteen MILLION patients seek emergency care every year in this country, and the only words spoken about emergency medicine were these, “Now, keep in mind, we’re already paying for those folks. Every single person at home, the average family

is paying $900 per family in additional premiums because of the care that people are receiving in emergency rooms. So we’re paying for it, but it’s oftentimes hidden.”

 

Mr. President, if you’re paying for it, I’d like to know where the money is going.  One of the problems in emergency medicine is the fact that emergency physicians are required by EMTALA to provide care for all who present with an emergency condition, without regard for payment.  Emergency physicians are not paid for that care forty percent of the time.  I dare you to name another specialty that donates forty percent of their income to charity care. 

 

I do not care to come across as another doctor whining about not making enough money.  I love my specialty, I love the practice of medicine, and I would rather spend seven night shifts in an row in an emergency department than spend one day as ......[fill in any specialty here.]  However, if we are to have health reform in America, some unpleasant truths must be told.  One of those unpleasant truths is that the system for delivery of emergency care is strained to the breaking point.  If meaningful discussion of reform is to be had, emergency physicians must be included.   The U.S. population was 263 million at the last census, and 119 million people seek emergency care each year.  You do the math.....