MMA Viewpoint
Responsibility is Key to Health Care Reform
One word that appeared repeatedly in our 2005 Physicians’ Plan for a Healthy Minnesota was responsibility. Our plan stressed the need for responsibility on the part of physicians, patients, hospitals, insurers, employers, and the government. Responsibility is a good word to keep in mind as we move through these difficult economic times, deal with budget constraints, and seek health care transformation in Minnesota.
As physicians, we have a responsibility to our patients. We must keep our knowledge base and procedural skills up to date, and we should fully disclose any financial relationships we have that could conceivably affect the recommendations we make. We should clearly explain to our patients whether our recommendations are based on evidence or on our opinions. And we must inform them when a treatment doesn’t have the level of evidence that we would like.
People who use health care services have responsibilities, too. Many diseases are caused or made significantly worse by personal behaviors. Patients can have a major impact on their health by stopping smoking, controlling their weight, exercising, and not drinking alcohol or drinking in moderation. Of course, these are personal decisions, and individuals must be free to decide what they will do. As we move forward with health care reform, especially in times of fiscal constraint, there should be consequences for decisions to engage in unhealthy behaviors. For instance, an insurer or employer might say, Yes, you can continue to smoke, but your insurance premiums will be higher.
Government has a responsibility to provide a strong safety net that allows the disadvantaged among us to obtain insurance coverage through programs such as Medical Assistance and MinnesotaCare and to provide reasonable compensation to physicians providing health care services to these patients.
Unfortunately, the government is not fully living up to its responsibility to provide a strong safety net. Payments for medical services for people in public programs do not cover the overall cost of providing care, which includes expenses such as rent, supplies, equipment, and salaries for nurses and other staff. Payments have been increased across the board only once in the last 16 years, a 3 percent raise in 2000. The last time the underlying basis for physician payments was overhauled was in 1989. This is not reasonable compensation. Now the governor and both the House and Senate have proposed a further 3 percent cut in reimbursement. This threatens access to care for people in public programs.
A great deal of effort went into the 2008 health care reform legislation. It has the promise of providing higher-value health care with better outcomes and lower costs for Minnesota citizens. It is important that we continue down this path. The government should not shirk its responsibility to provide the strong safety net that is integral to health care reform.
The months and years ahead will be difficult as our state and country regain their economic footing and establish the right balance of controls that decreases the risk of a future implosion while minimizing the negative effect regulation can have on creativity. It will be a road better traveled if all parties work together for mutual benefit and remember that word in the Physicians’ Plan for a Healthy Minnesota—responsibility.