Stanford Medicine Newsletter Updates For the Local Community

 

Medical school dean discusses concerns of a flawed system

   

Philip Pizzo, MD, dean of Stanford University School of Medicine, shares his perspective on health-care reform in this recent interview with Paul Costello, executive director of the Office of Communication & Public Affairs.

Q: Should having decent health care be considered a right in America?

A: It depends a lot on what you think is the purpose of government in our society. From my perspective, in addition to protecting its citizens, government should help provide or ensure the opportunity of its citizens to receive health care. We frequently hear that the United States should not ration health care. Unfortunately, there already is a “have and have-not” system of health care in this country, which, to a degree, rations health care on socioeconomic status. This is not appropriate for a great nation like ours.

Q: Well, if health care is a right, is it a moral issue for you?

A: Yes. I believe that it is very much part of our obligation as members of the community to care for each other and help those who become ill, to do our best to prevent illness and to do our very best to provide care to those in need.

Q: Currently, a major plan, proposed by Sen. Max Baucus, is being debated in the Senate. This summer we saw what I’d call an odd display of democracy. Are you optimistic about what you see?

A: “Concerned” is perhaps a better word to express how I feel. I think that the debate has almost moved away from health-care reform to ideology to a large degree. I don’t want to engage in becoming personally politicized over this except to say that the focus of the discussion has been lost. What’s really at risk is the health care of individuals in this nation and the health care of our nation as a whole.

What we are talking about in reform is trying to measure the quality of the care that we give, the evidence that supports its administration, the cost for the care that is rendered, the impact on individuals who do and don’t have health-care insurance, and how we could actually move as a great nation to having a health-care system we can be proud of. It’s somewhat amazing to me to listen to a variety of arguments that are made against reform. One is an assumption that things are OK, and they’re not. The status quo is not an option.

Q: Many people believe we have the best health-care system in the world. Do we?

A: I guess I’d have to ask, by what standard? We have outstanding health care in selected in-stances, but we have so many problems within the system that it’s hard to put it on a pedestal of being the best. I think many people have lost sight of the fact that their own insurance is vulnerable. I’d bet we all know someone who has lost their health insurance because of either a pre-existing illness or perceived utilization costs. It’s hard to say our system works well when health-care dollars consume 16 percent of our gross domestic product and will soon grow to 20 percent unless some significant alteration takes place.

Q: In a recent survey of physicians by the New England Journal of Medicine, a strong majority said they believed it is their professional responsibility to address societal health policy issues. Were you surprised by that?

A: Interestingly, when physicians have been queried about their views of health care, usually between 60 to 70 percent favor significant health-care reform. In fact, in a number of physician surveys, 70 percent have been in favor of a single-payer system and up to 70 percent favor the public option.

So it is ironic to me when I hear the President referring to the AMA as if it represented a majority of physicians, which it doesn’t. The vast majority have a different point of view than the AMA. They believe there needs to be significant alteration in the way insurance is constructed and see a public option as a way to change significantly the way competition works in our current insurance system.

Q: It seems that the public option is now dead. How do you see it?

A: I have felt from the beginning that the public option was a very important part of health-care reform — that it drives the health-care reform agenda in a more serious way. I think taking the public option off the table means that the opportunities for serious changes in health insurance reform are significantly reduced.

Q: Cost-effectiveness analysis is strongly supported in Washington, yet surveys show that many physicians are wary of it. What’s your take?

A: It’s a very important question. My view is that it has a lot to do with the sense among physicians that we have the right, the obligation and the knowledge to make individual decisions and that we shouldn’t allow rules and regulations to get in the way between what one believes as a physician is the best care of her or his patient. At the same time, I also think that there are ways of coming up with guidelines and guideposts that can make a difference for patients in an effective way.

Q: The most contentious issues are, how large is the reform package and how do you pay for it? Some have offered new taxes, for instance. One proposal is to tax sugar drinks so you address obesity and make some revenue at the same time. What do you think of that approach?

A: I’m not convinced we should be taxing those products to make up the shortfall or to pay for health care. As a matter of public policy, I do think we should be doing a lot more as a nation to advocate for safer health in general, and no question that there’s an epidemic of obesity in the country. I’d rather see us incentivizing positive behavior.

Q: What impact will health-care reform have in general on teaching hospitals, medical schools and medical education?

A: Well, I think the clear consequence of health-care reform is going to be a reduction in payments that come to institutions, hospitals, clinics, providers, physicians and communities. Otherwise, there is no economic benefit. You might argue, well, is that really just what health-care reform is about? Is it just about cost reduction?

We need health-care reform independent of cost because the way we deliver health care today is not optimized in terms of what we know, and how we deliver it with quality and effectiveness that impact outcomes. So we have to consider, for instance, whether how we conduct education is economically sound and reasonably exercised. We may have to rethink the whole compensation and motivation schedule for how tests are done, how costs are rendered within our clinical enterprise. These are all important parts of the dialogue.

Q: You may not be a betting man, but what is your guess now on the chances for passage of significant reform?

A: I guess if immediate history is a predictor to where we might wind up, it doesn’t look very promising that we’re going to reach a very strong resolution. I hope that at a minimum, we can come out of this with some very effective measures for health insurance reform. At least that would be a start.

We need health-care reform independent of cost because the way we deliver health care today is not optimized in terms of what we know, and how we deliver it with quality and effectiveness that impact outcomes.”

To hear a podcast of the entire interview, go to http://med.stanford.edu/121/2009/pizzo_healthcare.html.

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