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Letters to the Editor  |   December 2009
Yes, Virginia, There Will Be Healthcare Reform
Author Affiliations
  • Richard F. Multack, OD, DO, CS
    Midwest Physicians Group, Olympia Fields, Illinois
Article Information
Professional Issues
Letters to the Editor   |   December 2009
Yes, Virginia, There Will Be Healthcare Reform
The Journal of the American Osteopathic Association, December 2009, Vol. 109, 621-622. doi:10.7556/jaoa.2009.109.12.621
The Journal of the American Osteopathic Association, December 2009, Vol. 109, 621-622. doi:10.7556/jaoa.2009.109.12.621
To the Editor:  
More than 100 years ago, a young girl named Virginia O'Hanlon wrote a letter to Santa Claus.1 A newspaper reporter, impressed by the girl's innocence, editorialized this quest to believe in a fantasy representing good in the world by penning the famous line, “Yes, Virginia, there is a Santa Claus.” 
This story came to mind a few weeks ago, when I was having breakfast with my daughter-in-law and she asked me what I thought about President Barack Obama's proposed healthcare reform. Because I have been associated with the National Academies of Practice, a 10-profession interdisciplinary national health policy forum, for some years, I felt well positioned to answer her question. 
I replied, “I do not believe that we will see universal healthcare in the United States in my lifetime.” I added, “I do not believe that the `public option' [ie, government-run health insurance] included in some of the current proposals will be part of the legislation in its final form.” 
I answered as I did because I believe that our capitalist society will resist the socialist nature of the public option. Indeed, this Robin Hood–like take-from-the-rich-to-give-to-the-poor approach has met a great deal of opposition. The public option flies in the face of former President Ronald Reagan's “supply-side” economic approach—destroying financial incentives for the entrepreneurs and movers and shakers who drive our economy. 
My daughter-in-law responded, “That's because all you greedy doctors don't want [healthcare reform with the public option] to pass.” I then felt that I had to explain some facts to her about the current financial pressures, including declining revenues and increasing costs, faced by us “greedy doctors.” 
I informed her that in 1990 I received about $2000 per cataract surgery in Medicare reimbursement, but today I am reimbursed only about $500 for the same surgical procedure. Physician Medicare reimbursements have been steadily decreasing2—at the same time that physician costs for basic practice operations and medical malpractice premiums have been increasing.3 I also told her that hospitals have agreed to forgo about $155 billion in reimbursement over the next several years.4 These reimbursement reductions come as the hospital I am associated with is losing about $1 million to $4 million a month. 
I was quite surprised by my daughter-in-law's focus on “greedy doctors,” because she has been exposed to the ups and downs of medicine in our family. My brother, two of my sons, and one of my other daughters-in-law are also osteopathic physicians. In addition, my wife is a master's-prepared nurse, as is another of my daughters-in-law. I pointed out that although my physician sons do not have to pay off their medical school tuition, they still have to pay off loans used for campus living expenses, and my physician daughter-in-law still owes $400,000 in loans. If they can live on little more than their resident salaries for 10 years, they can finally pay off these loans. 
In summary, most physicians and other healthcare professionals are not getting rich in medicine these days. 
I further pointed out that although the salary of the chief executive officer of a major health insurance company may be as high as $125 million,5 these funds—when prorated over the possibly 100 million uninsured or under-insured individuals in the United States6,7—amount to only about $1.25 for each of these individuals. These figures indicate that a middleman is using up a great deal of valuable resources, which is a good reason to have a single-payer universal healthcare system only if you trust government's traditional inefficiency to run it. 
I next explained to my daughter-in-law that a pharmaceutical company may sell an eye ointment for more than $100 per bottle in the United States—when it may cost less than $10 to make—because of high research and development costs. However, the company may sell this product overseas at a 25% to 50% lower cost. 
Finally, I informed my daughter-in-law about the projected physician shortage in the United States.8 Although many new osteopathic medical schools have recently been established to meet the expected demand for physicians,9 no consideration has been made for osteopathic graduate medical education to train these new physicians after graduation. This situation seems like a disaster waiting to happen—and it is occurring just as the millions of baby boomers are entering the chronic illness market. 
There are rumblings in the healthcare reform debate of rationing healthcare—an issue of great importance for those aging baby boomers. Will we invoke the utilitarian perspective of what is good for most is good for all? In other words, will we say, “Well, grandma had a good life. Now it's time for her to go take a pain pill and free up some healthcare resources for younger people.” 
I concluded my discussion with my daughter-in-law by noting that I did not see an easy fix for the complex problems involved in US healthcare, including inadequate physician reimbursement, growing physician financial pressures, high pharmaceutical costs, and the projected physician shortage. I do not think that things will change much in the US healthcare system, but who knows? I tend to feel that, like the young believer in Santa Claus, believers in healthcare reform may be in quest of a feel-good fantasy. So perhaps I should have answered my daughter-in-law by paraphrasing the newspaper reporter, “Yes, Virginia, there will be healthcare reform.” 
Yes, Virginia, there is a Santa Claus. Newseum Web site. http://www.newseum.org/yesvirginia/. Accessed September 21, 2009.
Physician fee schedule. Centers for Medicare & Medicaid Services Web site. http://www.cms.hhs.gov/PhysicianFeeSched/. Accessed September 21, 2009.
Furchtgott-Roth D. The high cost of medical malpractice. RealClear Markets Web site. August 6, 2009. http://www.realclearmarkets.com/articles/2009/08/06/the_high_cost_of_medical_malpractice_97346.html. Accessed September 21, 2009.
Levey NN. Healthcare reform gets boost from hospital group. Los Angeles Times. July 9, 2009. http://articles.latimes.com/2009/jul/09/nation/na-health-hospitals9/. Accessed September 24, 2009.
Kirschenbaum I. CEO compensation: who said health care is in a financial crisis? WebMD Web site. August 23, 2007. http://blogs.webmd.com/mad-about-medicine/2007/08/ceo-compensation-who-said-healthcare-is.html. Accessed September 24, 2009.
The Lewin Group. A Path to a High Performance US Health System: Technical Documentation. Falls Church, VA: The Lewin Group Inc; 2009. http://www.lewin.com/content/publications/LewinPATHTechnicalDocumentation.pdf. Accessed September 24, 2009.
Schoen C, Collins SR, Kriss JL, Doty MM. How many are underinsured? Trends among US adults, 2003 and 2007 [published online]. Health Aff. 2008;102:w298-w309. http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2008/Jun/How-Many-Are-Underinsured-Trends-Among-U-S-Adults-2003-and-2007.aspx. Accessed September 24, 2009.
Smith J. Responding to physician shortage. Physician's News Digest [serial online]. April 2006. http://www.physiciansnews.com/cover/406.html. Accessed September 21, 2009.
Miskowicz-Retz KC, Williams A. New colleges of osteopathic medicine: steps in achieving accreditation. J Am Osteopath Assoc. 2008;108:121-125. http://www.jaoa.org/cgi/content/full/108/3/121. Accessed September 21, 2009.