Choose Wisely

Wednesday, April 18, 12 To The Editor of the Miami Herald RE: “Better health, fewer tests”, April 16th, 2012 As a board-certified family physician and addiction specialist I endorse the initiative, Choosing Wisely, of the ABIM Foundation supporting evidence-based recommendations that should be discussed to help make wise decisions about the most appropriate care based on a patients’ individual situation. We must understand that health care costs are finite! We reached a tipping point that leaves only two options: health care rationing, or the efficient utilization of treatment resources. This requires a new health care delivery paradigm based on expanded primary care access, care coordination, utilization of information technology to measure quality and outcome of care, and the involvement of the patient as a partner and not the object of care. Such a Patient Centered Medical Home (PCMH) will not only contain and manage health care costs but, most importantly, will improve care. We also must shift from a volume to a value based payment system rewarding those health care providers who demonstrate accountable, efficient and safe quality medical care. We spent more than two-third of our health care resources on chronic disease management. We could stop the waste! Our patients need to understand that they have to share responsibility for their wellness care and treatment. Joint accountability implies that physicians and patients are partners in the healthcare delivery process. I am optimistic that we can succeed improving our country's health care system.

Healthcare and the Supreme Court

Attached a link to an interesting article "Is public option the last one?" emphasizing that IF the Supreme Court decides to strike down the entire health care law it might create a predicament for our legislators to resolve the healthcare quandary: Congress wouldn't be able to rely on the private market, because that would require a mechanism to force healthy people into the risk pool. And it would have trouble relying on a federal-state partnership, because that might be considered coercive. Ironically, striking down the individual mandate, or the entire law, would create an inevitable choice:a federal insurance program that would clearly pass constitutional muster. Medicare represents such a model, which currently covers the elderly and is run entirely by the federal government. Medicare gives no role to the states and therefore does not coerce them into anything. An expansion of this program to all Americans funded by a payroll tax would be a workable solution. In my opinion it would be fiscally and morally irresponsible to continue the status quo. Happy Passover and Happy Easter Yours Bernd