This post was written by Pat S,  a recently retired physician who practiced in the Midwest for 30 years.  He has worked for both private practices and for large multispecialty groups, spending about half of his career in each setting.

Doctors play a critical role in any potential health care reform.  Although they have very little impact on attempts to broaden access to health care, they are central to efforts to improve the lagging quality of US health care and to address the issue of the cost of medical care in the 21st century.

Our national health care bill now runs over $2.5 trillion a year, consuming 17% of GDP. The cost of health care threatens to overwhelm the economy, and ultimately, as President Obama has noted, undermine any economic recovery. Unless we change the way we practice medicine, the adoption of new policies to improve health care access through universal insurance and improve benefits in both private and public programs will make our financial problem even worse, since greater access will lead to increased spending as new people enter the market for medical services.

If we imagine a long train of carloads of cash from both government and private sources entering the healthcare market, it is doctors who have their hand on the throttle.  Most medical spending occurs because of orders written by doctors: tests ordered by doctors, hospital admissions carried out by doctors, procedures recommended and performed by doctors, and drugs and other treatments prescribed by doctors.  When it comes reducing health care costs and improving the health of most Americans, doctors have greater power than anyone.

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We know that
health, education and poverty are linked. This is why, at one time,
the U.S had a Secretary of Health, Education and Welfare. Restoring
that cabinet post might go a long way toward inspiring discussion
about how to approach all three simultaneously. By viewing them as
separate problems, we “see” only one part of the
elephant. With that in mind, I have decided that, from time to time,
HealthBeat should look at ideas for educational reform.

The facts about
the connection between education and health are grim. A year ago
the Congressional Budget Office (CBO) issued a report
titled “Growing Disparities in Life Expectancy” which
revealed that “the
gap in life expectancy at age 25 between individuals with a high
school education or less and individuals with any college education
increased by about 30 percent” from 1990 to 2000. The
gap widened because of increases in life expectancy for the better
educated group,” the report notes. “Life expectancy
for those with less education did not increase over that period.”

People with less
education also are m ore likely to suffer from the disease many of us
dread most, the scourge we call
“Alzheimer’s.”
A 2008 study published in the medical journal Neurology  reveals those
with at least 15 year of education have a “cognitive reserve”
of extra neural connections, which allows their brain to handle more
plaques and tangles without showing Alzheimer symptoms. Conversely,
according to a 2007 study from Finland,
“people who don't finish high school are at a higher risk of
developing dementia and Alzheimer's disease compared to people with
more education regardless of lifestyle choices and [other]
characteristics.”

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Some
of President Obama’s critics have expressed disappointment with
his plans for healthcare reform. Why is the president raising taxes
to sink more money into an already bloated healthcare system? Why
isn’t he doing more to cut wasteful healthcare spending?

Earlier
this week, New Yorker writer and surgeon Dr. Atul Gawande
testified before the House Committee on Energy and Commerce
Subcommittee on Health. 

As
usual, he was eloquent, and, as it happens, much of what he said
speaks directly to the critics’ objections. But
first, consider what the skeptics have to say about the budget. Not
long ago The HealthCareBlog’s Matthew Holt declared
“There is NO
reason to put more money into the health care system.

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Over at  Centered Politics.com  Jim Jaffe once again has written a provocative piece about health care reform.  I don’t agree with him on every point. But I am persuaded by  his opening premise: the main lesson we need to learn from the 90s involves managed care, not the Clinton effort, which “was a one-off effort with unique problems.”.

The failure of the Clinton plan is all tangled up with the unique personalities and circumstances of the time. Dwelling on the Clintons’ experience only distracts us from the task at hand. The times and the cast of characters involved are very different—as different as Obama and Hillary, Peter Orszag and Ira Magaziner, or Mitch McConnell (Republican leader in the Senate today) and Bob Dole ( the Republican Majority leader in the early 1990s).

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Inevitably, the debate over healthcare reform will inspire some to try to broadcast misinformation, sowing seeds of doubt, false hope or fear in the public mind.  I will try my best to rebut some of the more flagrant attempts, on both sides of the issue. In the past, I have complained that progressive single-payer advocates sometimes exaggerate just how much could be saved if we eliminated private insurers’ administrative costs from the nation’s healthcare bill here (For an excellent, even-handed analysis of administrative costs for private sector insurers compared to public sector insurers, see this Urban Institute report)

But this post is not about single-payer. (If you comment, please stick to the subject at hand. Posting off-topic messages is considered “trolling,” and your comment will be removed.)

Instead, in this post, I want to talk about an example of fear-mongering by conservatives. Thanks to reader Brad F. for sending me this link to an AP video available on Yahoo headlined “GOP Challenges Obama’s Healthcare Plan.” 

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The Guardian asked me to watch and comment on President Obama’s HealthCare Summit.   The post, which I wrote yesterday, begins:

The White House Forum on Health Reform ended in a dialogue with President Obama that turned out to be the most revealing part of the afternoon. In that final hour, you began to hear the anger of the opposition – and you caught a glimpse of which principles the president himself considers most important. 

You will find the whole story here.

Regular readers may recall a blog where I questioned CNN chief medical correspondent Sanjay Gupta’s qualifications as a potential surgeon general.

I had planned to write a part two to that blog, but as Gupta’s name began to disappear from the press, I decided I would be beating a dead horse. I suspected that either the administration was having second thoughts about the nomination, or that Gupta himself was concerned that his ties to drug-makers might lead to embarrassing questions during confirmation hearings.

 Let me be clear: Dr. Gupta has not been charged with any wrong-doing.  But as Dr. James Floyd, researcher at consumer advocacy group Public Citizen, told ABC News yesterday: “Several of Gupta's broadcast reports undermine his credibility," whether reporting on autism or screening tests and prevention. 

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From Media Matters

“During the March 3 edition of Fox News' Special Report, correspondent Molly Henneberg reported on the opposition President Obama's health-care reform plan faces from the nonprofit organization Conservatives for Patients' Rights and stated: "Democrats control the White House and Congress, and they want Government-run health-care programs. Republicans may need groups like Conservatives for Patients' Rights — and their ads — to encourage public support for free-market solutions." In fact, the Democrats who "control the White House" have not proposed "government-run health-care programs." Indeed, according to the White House health-care Web page: "On health care reform, the American people are too often offered two extremes — government-run health care with higher taxes or letting the insurance companies operate without rules. President Obama and Vice President Biden believe both of these extremes are wrong

“Host Bret Baier introduced Henneberg's report by stating that Conservatives for Patients' Rights is launching "a multimillion-dollar advertising offensive." The report included a video clip of the group's chairman, Richard Scott, saying, "What ultimately happens is, the government always runs out of money, because they offer too much, and they offer — and so they always run out of money, so then they end up having to ration." Henneberg reported that Scott ‘started the Solantic urgent care centers in Florida,’” but  failed to mention how he created an empire of Medical fraud. (See my post below)

The conservatives have every right to organize opposition to health care reform. But tapping someone like Scott as their leader—without disclosing his background—means that they are reverting to old bad habits: Lying to the American People.

Perhaps Fox News will say “we didn’t know.”

 They don’t know how to Google?

Reader Jim Jaffe has written an excellent “prequel” to healthcare reform here.

He explains how we got where we are, and how and why the huge problem of over treatment was ignored for so long. 

Readers who are relatively new to HealthBeat may find this background particularly helpful, especially if you are not sure what I or other readers are talking about when we talk about over treatment as the big problem, or refer to “the Dartmouth Research,” or the fact that “higher quality and lower spending go hand in hand.” (For example, as Jim points out, the Mayo Clinic offers higher quality care than many other hospitals, at a lower price. Patients undergo fewer tests and treatments, see fewer specialists and
both outcomes and patient satisfaction are higher. )

Anyone who reads HealthBeat will, I think, find something valuable in Jim’s post.