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,
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.
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
* 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
* 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".
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
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)