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This Week's Podcast: The Great Health Care Reform Debate

May 15, 2009 9:08 AM

On this week's Shuffle podcast, we spoke to the incoming president of American Medical Association Dr. James Rohack, who met with President Obama to discuss cutting health care costs by $2 trillion over the next decade.

You can listen to the podcast HERE or on iTunes.

As we reported Monday, Rohack at the meeting said that one of the reasons doctors conduct so many unnecessary tests is because they practice "defensive medicine" for fear of malpractice lawsuits.

"What we asked the president is that if we as physicians are willing to tackle the issue of looking at variation of care and reducing unnecessary tests, we also have to have protection in the courtroom," Rohack told us, that "if we didn't order a test, that we subsequently aren't going to get sued because we didn't order that test that shouldn't have been done in the first place."

So for example, not everyone who comes into the emergency room complaining about a headache would automatically get an MRI, Rohack said.

But what about the idea that these measures to save money could cost more lives? That some people's lives might be saved because of that MRI?

"I think we need to highlight that life is a matter of risk," Dr. Rohack, a cardiologist, responded. "We know that 24 percent of Americans purchase tobacco products and use them every day knowing there's a well documented risk of heart disease as well as cancer so life is a decision of choice. We have people who drink alcohol and get behind the wheel of a car and create a burden on our current American economy with trauma funds because of some of them being uninsured and still our government has said that any one who shows up to the emergency room, regardless of their ability to pay, the health care system has to take care of them."

"So all we're saying is that we need to have a better discussion over what's the cost of different procedures, what's the benefit and ultimately have that patient and their physician come down and having some decisions made," Rohack said. "What we don't want to do is have a process where suddenly someone whose not involved in care is making an arbitrary decision that gee we're not going to cover this when the patient clearly needs it."

Rohack acknowledged that Democrats in Congress have historically opposed efforts at malpractice reform.

"I think the president recognized that if the commitment to control cost -- if it was going to be presented in such a way that this was part of the package to control unnecessary costs but still preserve an ability -- that if a patient was harmed because of neglect or clearly improper care -- that there still would be a preservation of access to the court system," he said. "So this is not a prevention of being in the court system. This is also looking at again alternatives to the liability system, perhaps there is a dispute resolution, there is a health court, there are expert witness guidelines."

Dr. Rohack also touched upon other issues that came up in the meeting with the president and tough choices for patients.

Listen to the podcast HERE or download it on iTunes.

-- Jake Tapper and Huma Khan

May 15, 2009 | Permalink | Share | User Comments (104)

User Comments

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Wow! What rock are all of us living under?
As far I've been able to find out, it is virtually IMPOSSIBLE to sue for damage done by the medical industry, since the passing of the FDA preemption four years ago. This includes all of the "mistakes" done by doctors. How can these insipid doctors keep trolling around about this fraud, saying that they are "practicing defensive medicine"? What a great cover to waste your money!
From my viewpoint and after years of being harmed by the police state medicine that we are subjected to now, I DO NOT support socialistic "insurance". For all of the comments from the distracting pundits, more protection to the "bad" doctors and giving "free" drugs to everyone will complete the task of bringing the country down - healthwise and financially wise. The only positive point that I've read from all of the comments is that the UK has finally come to their senses that "preventative" medicine does more harm than good and is extremely expensive. This only provides the illusion that these "preventative tests" are accurate. We treat cancers and other diseases that have no hope of recovery and we treat cancers that are not there. We treat vitually every "mental" disease, real or not, when there is no concession of when to treat with drugs. We brainwash everyone with endless commercials, so that everyone believes that their lives depend on many drugs.
As I've posted on many websites, we need to:
1) STOP the advertising on the TV. This will save trillions every year.
2) STOP the protection of "bad" doctors, by the FDA preemption and the endless legal remedies that they have to protect themselves. I don't know that this will save money, but it will save lives. If doctors don't like being sued, there is always jail.
3) Make it illegal for the insurance companies to be front companies to defraud patients.
4) Get involved in what the politicians are doing to the "disabled". This is the most horrendous way to treat people. Since I've been harmed, deeply and permanently, by the medical industry (and yes, this was clearly improper treatment), I'm eligible to get SSDI. But only if I give away my home for unnecessary medical "expertise" that the government mandates. If I do this, the only way to have a roof above me, would be check into the nursing home at the tune of $75,000+++/yr (I can't pay for this waste, can you guess who would pay for this?). I've been illegally fired from my job - again, without no redress; I've had my retirement taken away forever - no redress; I've been scammed out of the rest of my life savings by the Vocational Rehabilitation - no redress. Believe me, all of the money that we are pouring toward the "disability" issues are not getting to the "disabled". HOW DUMBER CAN WE GET?
4) And finaly, take some responsibility for your actions. Just because your doctor is pushing drugs and "preventative tests", or just because the drug companies are pushing drugs, that doesn't mean that these drugs are health food. Follow the money.
Sorry for the long post, I've probably taken a little time from you to take your statins, or Viagra, or your antibiotics, or your SSRIs, or your antidepressives, or whatever. We should be the healthiest people on the planet, if the advertisements were actually true. Instead, we are stumbling around in drug fogs, whining that we need more drugs. Please don't only rely on your doctor for his advice, he's making a great living on harming you and picking your pockets.

Posted by: kittyfool | May 19, 2009 4:21:05 AM

Tort reform. Why would politicans want tort reform, They are all lawyers anyway. Take away money from lawyers is the same things as taking money away from themselves. We could save trillions just by Tort reform so why isn't the lawyer mr Obama supporting this. Go figure

Posted by: JC | May 18, 2009 9:08:18 AM

Yes, we'll have government run health care and be paying 75% of our income in taxes. Has anyone in the Obama administration ever noticed that this country is really really broke?

If we are truly a democratic nation, then why are we talking about state run health care - rationed as if it were boots in Russia during the Cold War.

Posted by: Jon F | May 18, 2009 3:20:03 AM

another union disaster comming up

Posted by: donttaxmeman | May 17, 2009 9:57:02 AM

Thatsthetime, kay, & formerflowerchild – I believe that you are mixing apples and oranges. “Government union workers” which you all refer to is a misnomer, there are federal government workers (those who are on the government payroll) and union workers (those who are members of a union but DO NOT work on the government payroll). The health insurance available to federal government workers can be found by Googleing FEHB, the plans listed are the plans available to ALL federal employees including members of Congress. Members of Congress do not have a separate plan from other federal government employees, this has been the way it is for them since passage of the 1983 Civil Service Reform Act. Union workers receive their healthcare insurance through their employer and in the case of the auto companies the government is not the employer they are a stockholder.

Posted by: Sandcrab1612 | May 16, 2009 8:02:59 PM

Under President Obama's health care plan, government union jobs will expand, costs will skyrocket and in order to pay for all of this, taxes will go up and health care will be rationed until no one but the politically connected, will get any health care what so ever.

Posted by: thatsthetime | May 16, 2009 5:11:13 PM

Formerflowerchild, "The lions share of the billions of dollars in President Obama's health care reform budget will go into the pockets of government union workers while everyone else will get the shaft."

Not only that, as government union workers get more and more of the health care dollar the amount spent on providing actual care to the people will go down and people will be left with less and less health care at higher and higher costs.

President Obama has a track record of making sure his main supporters, unions, get the lions share of any deal. Just look how he shafted the Chevrolet Bond holders when he ignored the rule of law in contract law in order to benefit the auto union. Look at what President Obama is doing in California by threatening to withhold stimulus funds if California goes through with laying off government union health care workers. The same will be true in any health care reform plan if people do not wake up before it is too late. President Obama will do anything to pay back his union supporters at the expense of everyone else.

Posted by: kay | May 16, 2009 2:13:53 PM

The only group who stands to benefit from President Obama's health care reform is government union workers who will get the lions share of the health care dollar while everyone else will get the shaft.

Posted by: formerflowerchild | May 16, 2009 1:23:07 PM

Put another way, we will be yelling and screeming to get more from our healthcare dollar, and finding ways to meet those demands, forever...hopefully with at least as much spirit as egyptians at an open market. People that have no influence over the prices and values of what they get have little reason to complain.

Posted by: MarkLeavenworth | May 16, 2009 12:34:20 PM

Phallon- Politically, there's no country in the world where so many of us have the knowledge that 'elite' is not that much better than anyone else. I hope that never changes. Economically, we share too much of the technical advances of our system when these other systems come back and start pushing their ways on ours, in my opinion.

Posted by: MarkLeavenworth | May 16, 2009 11:02:53 AM

It is interesting to note that Canadian health plan has lots of rationing but would the populace vote for our style of health care? Doubt it...despite their flaws, they would rather have their system than ours. Interesting to note that most European countries also have socialized medicine...why aren't their citizens requesting for American health care system?

Posted by: phallon | May 16, 2009 9:19:48 AM

Not inflation generally, but in the sense of a lot of funds flowing into healthcare as more people get older.

Posted by: MarkLeavenworth | May 16, 2009 1:51:33 AM

Sandcrab1612- With my father, it was a long process of physicians coming in with updates and always saying 'we have this chance' or 'we have that chance'. It was later that I realized, they MUST build their lives on hope in the midst of death on an hourly basis. They are on the front lines of death in every terminal case, and their whole lives are devoted to preserving life. None can expect a physician to give an estimate for the probability of death. That is what could be referred to as the hippocratic oath. Clearly, if limits are to be imposed, they cannot be imposed on a case by case basis, and certainly not by physicians. It is this limiting function which I believe should be made transparent and far enough away from the individual cases so that the hospital, or groups, must base their decisions on what they have available. Ultimately, that limit will be our ability as a nation to absorb inflation, and how we are going to do that is also necessarily a matter for public debate and discussion.

Posted by: MarkLeavenworth | May 16, 2009 1:48:00 AM

Mark - When my mother got cancer and I was living 1200 miles away I could only get up every 6 - 8 weeks to see her and each time I could see the downward change in her condition. My brother who lived just a couple of miles from her didn't notice this in his day to day visits and he told me that the doctors were saying she was getting better. On one occasion where they took her to a hospital in Seattle the doctor that was treating her remarked that they would send her home as she had already undergone surgery, radiation, and chemo. She told him that she hadn't had chemo and he told her that it wouldn't make a difference as she was terminal. She went back home and after about two weeks made the decision to enter hospice and let nature take its course. In my mother’s case once in hospice they just gave her pain killers to lessen the pain from the cancer and what water they could, the cancer was in the jaw so everything was through a tube to the stomach. I think that in a lot of cases the doctors need to be more up front and tell folks the real truth instead of giving them false hope and prolonging the pain and suffering for longer.

Posted by: Sandcrab1612 | May 16, 2009 1:15:03 AM

Sandcrab1612- Thank you for the time you've taken with that. What do you think is the best way to limit the investments we make in terminal care, seeing that there is almost no limit, naturally, to the investments we can make in trying to keep someone alive who is terminally ill?

Posted by: MarkLeavenworth | May 16, 2009 12:21:17 AM

Anyway, I say let's do all we can to help out the old folks, the weak, and the infirm, in healthcare, in government, or around the home, and pay down our personal debts in the process. It won't be tech stocks, but it'll be a living!

Posted by: MarkLeavenworth | May 16, 2009 12:10:57 AM

As far as the federal government cost of health care to its own employees you can Google FEHB and see what the different plans available to federal employees are. It should be noted that these are the same exact plans which are available to our elected federal officials. The government does not pay 100% of the employee health insurance and the portion they pay is considered a benefit in lieu of wages just like most major employers who provide a health benefit to their employees. Usually the larger the company (more employees) the more likely is that they provide the health insurance rather than paying the larger wage as most employees would rather have access to the health insurance instead of the small increase in wages. For an employee in California with a family looking at an HMO (California Health Net, High Option) this amounts to roughly $4.40 an hour. For the same family in California looking at a FFS (Blue Cross Blue Shield Service Benefit Plan, Standard Family) this also amounts to $4.40 an hour. Small business's which have fewer employees cannot afford to offer this type of benefit to their employees without having to make drastic cuts (layoffs# or drastically raise the price of their finished product/service both of which will probably cause the business to fail in time due to lack of profit. The federal employee still has to pay to participate in the insurance #$292 a month for the HMO and $357 a month for the FFS# so the government does not provide 100% of the insurance to the government employee. Probably the best that the government could do for health care would be to somehow expand the FEHB type of insurance for the general public to participate in but with no government funding for the general public. You have to remember that the federal employee is receiving his government share of the insurance funding as part of his wage and benefit package and performing labor in return, the general public would provide no benefit to the government for any government funding of their health care. Perhaps another question you may want to ask yourself is how much would I pay for healthcare insurance? Would you pay $1055.00 per month to be able to partake of the HMO I used as an example? Would you be willing to pay $1120.00 per month to be able to participate in the FFS I used as an example? If yes then maybe the answer is not government paid healthcare but the government allowing all citizens to participate in their healthcare programs at their own expense #they would have to pay the total of what the government pays for their employee plus what the employee pays). I would imagine that there are some plans which would be cheaper but they might not offer the same level of health care as a more costly one. If this was the way they go then it would be up to each individual to carefully compare costs and benefits between plans before making possibly a wrong choice.

Posted by: Sandcrab1612 | May 16, 2009 12:06:02 AM

MarkLeavenworth - Should have been "Bottom line is the Government does not have this kind of money and there is no way they can get this kind of money without a large tax increases on the entire population." I just don't see any way to achieve what Obama wants without a huge tax increase, you can borrow but you can't get away from the interest on the debt which has to be paid each year.

Posted by: Sandcrab1612 | May 16, 2009 12:05:02 AM

What I would like to know is, who in the Hell planned these demographics for us?!

Posted by: MarkLeavenworth | May 15, 2009 11:54:15 PM

Herendra Desai- We don't none of us like communism, and most of us are armed. CAll is 'single payer', as if it has something to do with individual liberty, but there are too many of us in power that know better.

Posted by: MarkLeavenworth | May 15, 2009 11:52:43 PM

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