Why Solving the Access Problem First is a Bad Idea for Healthcare Reformists

By Alexander Strachan, Jr., MD, MBA

As a practicing physician for the last 20 + years in California, I have seen how the demand for healthcare services is the main driver of healthcare costs. As an activist, and recent MBA graduate from UC Irvine, I have been closely following the debate regarding healthcare reform. The dizzying array of solutions by various observers in Congress seems to be driven by a partisan debate regarding whose solution is right, and who’s wrong, and whose will cost more, blah, blah, blah. Unfortunately, many of the talking heads in Congress have never spent a day working a shift in the emergency room or as a hospitalist like I have for the last twenty years.

Before my graduation as a businessman from MBA school, or becoming a physician leader or an administrator or a consultant, I spent twenty years taking care of the sickest folks, primarily paid for by Medicare and Medical. These Federally and State funded programs, respectively, make up the bulk of the medical coverage of the patients that I have seen over the last twenty years.

Now, I have graduated to being a “policy wonk”. Despite working in healthcare as a consultant for hospitals and health systems, I have a very ominous feeling about where the debate has gone recently. Mr. Obama has decided to try to solve the access problem first, and despite being a card carrying Democrat for the last twenty years, I think that this is a really bad idea.

What has driven my practice over the last twenty years has been demand. Demand for services in healthcare is astounding. Emergency rooms are full, clinics are full and hospitals pray to be full. Physician offices are overrun with patients, either in need of or desirous of care…so called services.

“My name is Mrs. Jones, and I would like a second opinion regarding my back pain. Last week, I had an MRI at my doctor’s office, and he said it was normal. However, my back still hurts. Can I have another MRI please?”

What is a practicing physician to do but order it? I have no access to the results of her prior MRI (thanks to the mess that is healthcare IT). If she has a new spinal tumor, not seen on the prior study, she can sue me. She is on a public insurance program, and she has no skin in the game. It doesn’t cost her one red cent to get this test. I barely make $35.00 for the office visit. Is it worth it for me to deny her this imaging test, and risk getting sued if I am wrong, or better and less risky for me to just write the requisition for the test, and go on about my day, and not worry about practicing appropriately, just practicing defensively?

Since an MRI costs about $850.00, let’s multiply the above scenario by 47 million. Adds up to a big number, huh?

That’s why we need to decide whether health care services are a right, or a privilege or an entitlement, before we grant unlimited access to people who have no cost to bear when they demand services from their doctor. Without tort reform, doctors will simply say yes, since we are not protected if we are wrong. Sounds pretty conservative for a liberal democrat, huh?

Alexander Strachan, Jr, MD, MBA
CEO and Managing Director
CrossWalk Consulting Group, LLC
www.linkedin.com/pub/alexander-strachan-jr-md-mba/1/2b8/888