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Letter to Obama From the Mad As Hell Doctors

Paul Hochfeld

As one of the Mad As Hell Doctors from Oregon, I had the surprising good fortune of being an uninvited, but welcomed, guest to the President Obama's recent meeting in the Rose Garden with "physicians from around the country."  I hand-delivered the following letter to one of President Obama's aides.  I wonder.  Has he read it?

October 5, 2009

Dear President Obama,

Although I would dearly appreciate being invited to speak with you and the other invited physicians this morning, I understand this is problematic and unlikely.  I must, therefore, settle for a letter in which I hope to express a great deal of compassion for the difficulty of your predicament.  You are caught between those on the right, some of whom want you to fail and accuse you of going "too far", and those on the left, like myself, who, passionately, want you to succeed and, equally passionately, want a real solution to our health care crisis.  

As you may know, in September, the Mad As Hell Doctors from Oregon wended our way to Washington, visiting twenty-six cities in twenty-two days, telling uncomfortable Truths about our health care system, none of which is news to you, but I state clearly for those who might be eavesdropping.

•    We spend more than twice as much per capita as most of the rest of the industrialized world.
•    By the standard measures of  performance, the United States ranks 37th, internationally, in health care outcomes.  Not exactly anything to be proud of.
•    Forty-five thousand people die every year in our country because of barriers to obtaining appropriate medical care in a timely manner.
•    And, finally, we are the only developed country in which people often go bankrupt because of health care costs and three fourths of them had health insurance at the time they became ill.

We spoke to people about the moral imperative of true Universal Access and the main barrier to accomplishing this: cost.   We explained why it cost us so much.  Undeniably, we waste 20% of all our health care money servicing an Insurance industry that adds nothing to the health and complicates the lives of our providers.   As you know, the other drivers on excessive cost, include, among others

•    the primary care crisis
•    the chaos of medical records,
•    the fear of liability,
•    the mass marketing of prescription drugs,
•    the pressure for profits,
•    "our" unrealistic expectations, especially at the end of life, and
•    the perverse incentive incentives that are created by the fee for service reimbursement mechanism that encourages physicians to do more and more and more without regard of  "just enough".

Bypassing the insurance industry with a Single Payer Solution is NOT just about saving 20%, immediately, so we can afford Universal Access.  It's about having a system with which to deal with the other drivers on cost, as does every other developed country in the world.   More accurately, today, instead of a health care system, we have a "for-profit private insurance-based sick-care non-system."  You know what I am talking about.

In the course of our trip, we learned as much we taught.    Enthusiastic supporters of our message told us a multitude of  stories that deepened our understanding that our system is broken and corrupt beyond most people's wildest dreams.  Our neighbors suffer in unimaginable ways, like the gentleman who lost his job after his wife was diagnosed with multiple sclerosis.  His employer simply couldn't afford to keep him on the payroll.  His insurance carrier would have increased the cost of  premiums for the rest of his employees.  As if having a wife with MS isn't painful enough, he might lose everything.   Only in America.   Shame on us.

In the meantime, Senator Max Baucus is proposing legislation that was literally authored by a health insurance insider.  Indeed, our legislators seem to be partnering with The Industry, whose financial well-being seems to trump the needs of our people.  It would appear that our Representative and Senators, on both sides of the aisle, think they need Industry money for campaign financing more than they need to show some courage to make the difficult decisions necessary to give us a sustainable health care system. 

I believe you understand that none of the health reform bills that are being seriously considered by either side of Congress will accomplish true Universal Access without  breaking the bank. Could it be that fixing health care is less about health care than our political process in which the Industry manipulates public policy so that it reflects profits more than public good?  Neither we, nor the American people, nor the families of the 45,000 people who died last year find this tolerable.  Neither does the gentleman who lost his job for merely having the misfortune of a wife with MS. 

Mr. President, tell us the truth about the failed health care reform debate that has been manipulated by The Industry.   It's a tough spot but we call on you and Congress to show some courage by delaying the passage of  health care reform legislation until public health authorities, health care providers, patient advocates, economists, and health system administrators participate in a public process to determine how we can get the most health for our precious health care dollars.  They should start the discussion with a clear understanding that access to essential health care is a basic human right.  The health insurance and pharmaceutical industry have demonstrated beyond a shadow of a doubt that they are only interested in profits.  They should be kept out of the room.

We think this is fair. We think this is democratic. And as physicians who have sworn an oath of care, we believe it is the only socially, morally and ethically responsible course of action.

Best regards and best wishes for a successful administration.

Paul Hochfeld M.D.
(representing the Mad As Hell Doctors from Oregon)

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