What the SOTU Says to America’s Physicians

Gregory A. Hood, MD


January 13, 2016

In This Article

Healthcare Reform Is Not a Closed Folder

Last week I began thinking ahead to the State of the Union Address, wondering what the President might say. I was pondering the future and then recalling the past. I remember back to candidate Barak Obama's speeches about hope for the future. Now we are living years into that future and in the last year of his presidency. I wondered what he would say, what vision he would paint for the future—in particular the future of healthcare.

The first mention of healthcare in his address was the crushing issue of drug abuse, which many of us are working very hard to improve.[1] Next was personalizing medical treatments for patients. And then he did refer to the future: "For my final address to this chamber, I don't want to talk just about the next year. I want to focus on the next 5 years, 10 years, and beyond."

He and I agree: "We live in a time of extraordinary change—change that's reshaping the way we live, the way we work, our planet, and our place in the world. It's change that promises amazing medical breakthroughs but also economic disruptions that strain working families... It's change that can broaden opportunity or widen inequality. And whether we like it or not, the pace of this change will only accelerate." He is, of course, the man who promised in 2008 to "fundamentally transform America."

Unfortunately, there followed no pragmatic conversation about the healthcare system reformation. He spoke of the future but then immediately spoke of "how we reformed our healthcare system" as if healthcare reform is finished, a fait accompli. Much needed to change in the healthcare system that we had, and much has changed. Through the Affordable Care Act, some good work has been done and some cost savings have been realized.

However, it is a mistake to view healthcare reform as accomplished, a box that has been checked, something to be filed away. Healthcare reform is not a closed folder. It is essential to review what has worked and what has not. Just as a care plan for a patient always requires reassessment and adjustment as time moves on, so too does the need to adapt healthcare delivery to the changes in the world: demographics, funding, technology, and medical sciences, among other variables.

President Obama spoke of outdated regulations and the negative impact that they have on businesses. If he was serious about his approach to this, then he would have highlighted facility fees as an example, and how, in the words of Elizabeth Rowe,[2] Marty Makary,[3] and others, healthcare is being driven and consolidated into a system that is "too big to fail."

This consolidation and the mechanisms that are funding it are driving up the average cost per patient.[2,3,4] A 2014 research article in JAMA[4] documented that:

[F]or physician groups owned by local hospitals, the average cost per patient was 10.3% higher than for physician groups owned by physicians. Even more important for the issue of the effects of hospital consolidation on healthcare costs was the finding that the average cost per patient for physician groups owned by large healthcare systems with multiple hospitals was 19.8% higher than the cost for the physician owned groups.


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