Oscar, Schmoscar: Shalala Stands Up for the Dermatologists

from the annual meeting of the American Academy of Dermatology, Miami

Dave Barry was supposed to be the light fare to close out the Sunday plenary session at the dermatologists’ annual confab. After a morning filled with the complexities of hedgehog pathway signaling and mapping the melanoma genome, the program planners had scheduled some time for a few laughs.

Then Dave got another gig at the Academy Awards ceremonies in L.A. on the same day.

Courtesy the University of Miami

So, another notable Miami resident took the podium as the session’s closer.  But there can’t be many laughs in store when you’re University of Miami President Donna Shalala and your inevitable assigned topic for discussion is health reform. Yet the  Health and Human Services secretary during the Clinton administration gamely stepped up to the challenge and even managed to work a joke or two into her presentation.

Some highlights:

Health reform is about covering the working poor.

Medicare and Medicaid have covered the elderly, the disabled, and the impoverished. Now it’s time to cover the working poor. Of the 48 million people who don’t have health insurance, 80% either work or members of their family work, yet their jobs either don’t provide health care insurance or it costs too much. And then there’s the other 25 million who have “lousy health insurance because it really doesn’t offer adequate coverage,” she said.

The health care reform bill will pass.

House Speaker Nancy Pelosi will get the House to pass the Senate version of the bill. Then the Senate will make the bill more palatable to House members during the reconciliation process. Once passed, the focus will shift to cost containment and will become more bipartisan. Be prepared for the long haul: It’s going to take years to get the elements into place and implement the process.

Physicians are key to health reform success.

The government needs a body of doctors and other health experts to tell it where to cut costs, how to maintain quality, and how to eliminate fraud. Politicians are not equipped to make those kinds of judgements. Also, the country will need more doctors, more nurses, and more educated patients who take responsibility for maintaining health and seeking care before the advanced stages of disease.

The states must solve tort reform.

Malpractice law varies by state; that’s what’s standing in the way of federal tort reform. Tort reform will need to be achieved on a state-by-state basis. Demonstration projects on best treatments and arbitration boards will help the process, but most are only beginning to get underway.

Politicians want to fix the physician payment system.

Congress has delayed the big physician pay cut to April and will likely further delay it through 2010. But the issue will continue to haunt doctor and Congress until Congress can figure out how to save enough money to fix the payment schedule on a permanent basis. No politician wants to cut physician payments; the issue is finding the money to afford the fix.

Means testing won’t be used to limit Medicare eligibility.

A call for means testing, other than age, to cut Medicare costs is a political “third rail” with no support. Medicare is a popular program, and means testing is typically applied to unpopular programs. Alternatively, Medicaid is means tested and that legislation likely would never have passed without the influence of a politician who wanted to assure that the south would get a sizeable share of Medicaid’s associated health care business and dollars. Disparities in Medicaid spending continue to this day in southern states.

That influential politician was former representative Wilbur Mills, who is perhaps better known for his career-ending midnight romp in a Washington fountain with an exotic dancer. The anecdote even got a laugh.

—Mary Jo Dales
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This post also appears at The Mole, our sister blog. To get great insights into dermatology, visit www.skinandallergynews.com.

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Filed under Dermatology, Health Policy, health reform, IMNG, The Mole

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