Don’t stop the debate

To the editor:

Fear! Fear of Washington legislators NOT doing some significant health care payment reform to reduce costs and provide access… that is what should frighten all of us.

A great debate is raging across this country. Nothing, since Medicare was born in 1965, has caused so much polarized discussion about reducing the cost and providing access to health care. Much of what is being said is an honest questioning and turning over of what might happen when and if various types of reform and bills are passed.  Recently, however, profiteers and political powers, who would not benefit from change, have been spreading destructive rumors in an effort to halt the debate. We have even watched crowd panic and people shouting, all of which is aimed at stopping honest debate.

Presently the US has a system of payment for health care, which has driven costs twice as much or more than any other country in the world, and yet at least 45 million don't have insurance, and many more have only limited care due to "pre-existing conditions." Liability risk drives, in particular, emergency room doctors to use every technology available every time without concern for expense or value. At the same time patients and doctors alike are drowning in a sea of red tape, rules and regulations that no one can understand. 

What's more, the existing system encourages rushed episodic care and emergency room overuse because many unfortunate Americans do not have a personal "doctor." Multiple factors have resulted in fewer young physicians and practitioners choosing primary care fields, and the country is therefore facing a huge shortage of providers, who could supply that "medical home."  That is a major reason why other countries can do better care for so much less. Every person has a primary care provider. They have a medical home.

Somehow, all should have access to affordable, portable, health insurance without discrimination against those with pre-existing conditions; the medical liability system should be reformed to avoid excessive unnecessary technology; innovative methods to encourage high quality care and discourage irrational expense should be developed; and there should be incentives for medical students to go into primary care. 

For these reasons the SD organizations responsible for providing the majority of primary care in our state have met to help address these problems in a local way. These three groups represent the family physicians, the pediatricians, and the internists who provide a medical home to our patients.

The possibility that reform will not soon occur has brought us to fear for the wellness of our state and country.  There will be more uninsured patients, more cherry picking, Medicare insolvency, and a worsening of the primary care crisis. 

We must encourage continued rational debate on this topic.  We should not rush into it, but we also should not allow the discussion and the search for solutions to slow down.  Indeed if nothing is done, then there will be reason for shouting. 

Mike Holland MD, SD Chapter, American

Academy of Family Physicians

Jerry Blake MD, SD Chapter, American

Association of Pediatrics

Rick Holm MD, SD Chapter, American

College of Physicians (Internal Medicine)

And the SD Coalition for Primary Care

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