Straight talk from the doc

Three-and-a-half years ago, frustrated by decades of what he calls “navigating the barriers thrown in front of us by the American health-care system,” Dr. Jeffrey Lobosky decided to investigate those obstacles.

That, of course, was before the 2008 presidential campaign put health-care reform in the spotlight. Yet, as Lobosky told a capacity crowd at the Enloe Conference Center last Wednesday (July 14), “Health-care reform is not a new issue. From as far back as we’ve had a health-care system … presidents from Theodore Roosevelt to Barack Obama have tried to reform it.”

Obama’s big push culminated in the Patient Protection and Affordable Healthcare Act, signed into law March 23 after a lengthy tug-of-war between congressional Democrats and Republicans. Will it work? The title of Lobosky’s talk—“American Health Care System: How It All Went So Wrong and Why Washington Can’t Make It Right”—reveals what he thinks. The audience of 375 (triple the number expected) came away with that conclusion reinforced.

That Lobosky drew such a crowd is not surprising, based on the topic and his tenure. A longtime Chico neurosurgeon who helped found Northstate Neurological Associates, he’s a former hospital chief of staff who serves on the clinical faculty of UC San Francisco, where he previously delivered this talk. He’s lectured around the country and written two-dozen articles. Now he’s authoring a book on the state of health care.

Looking at statistics compiled by the World Health Organization, Lobosky came to a startling conclusion: “We’re spending twice as much as other industrialized countries, but [American health care is] mediocre at best.”

Of the 192 countries in the United Nations, the United States ranks 30th in life expectancy and 33rd in infant mortality. Where we’re first: percentage of gross domestic product spent on health care (17.3) and per-capita spending on health care ($7,300 per person annually).

Moreover, in 62 percent of bankruptcy filings, unexpected medical bills led to insolvency. “When we lose our insurance, we lose our homes,” Lobosky said. “That only happens in America, the wealthiest nation in the world.”

“Who’s to blame?” Lobosky posed. The “villain du jour” may be private insurers, but they have plenty of company in his lineup of suspects. He includes pharmaceutical companies, trial lawyers, hospitals and doctors—all heavy contributors to politicians, whom he also blames for the troubled system.

Finally, there’s “the culpability of the American public.” Thirty-three percent of American adults are obese, and with 18 percent of children also obese, that figure is projected to grow beyond 50 percent. “This portends ill not only for the U.S. track team but also the future cost of health care,” Lobosky said.

In assessing the new reform package, he concluded that the biggest loser was the American public. “You’re just not a special enough interest for our politicians,” he told the audience. “Costs are going to continue to go up without provisions to increase reimbursements [paid to health-care providers]. You’ll find we still have to practice assembly-line medicine.”

That’s why he feels doctors and hospitals also lost.

So who won?

Insurance companies, for starters—their customer base will increase by 32 million due to mandated coverage, and “they don’t have to compete with a government option,” Lobosky said. Even with the provisions that keep people from losing their coverage when they develop serious ailments or getting denied coverage because of pre-existing conditions, “the insurance companies made out like bandits.

“So did the pharmaceutical companies,” he continued. Big Pharma offered discounts worth $80 billion over 10 years in return for assurances that Medicare would not be allowed to negotiate prices for drugs. It has been estimated that if Medicare could negotiate, it could save as much as $100 billion a year. Big Pharma, in other words, will pay $8 billion to save as much as $100 billion a year.

Coming out even better, Lobosky said, were trial lawyers: “There will be no meaningful tort reform, and we’ll be left with the lottery mentality” of malpractice and liability suits. “The other group that made out: the politicians,” he said. “They were able to fill their war chests.”

In considering solutions, Lobosky raised a dreaded specter. “If we don’t ration health care appropriately, we’re doomed,” he said. “We ration health care now, but we do it in the meanest, cruelest ways … based on whether you can afford it.”

Asked about single-payer insurance, Lobosky replied he’s of two minds. For patients, “single-payer is very attractive,” since streamlining the process and unifying coverage should increase access to care. As a doctor, he admitted, the “take it or leave it” power of a single insurer “scares me.” It would take “a leap of faith” that the plan would work as advertised.

Based on the track record of government in health care, perhaps his skepticism is understandable. Nonetheless, he sees reform as vital.

“This debate is far too important to this country to allow it to be dominated by the fringes on the far left and far right,” Lobosky concluded. “This debate is for the soul of our country … it’s not about the ‘haves’; it’s about the ‘have-nots’ … each and every one of us is a closed factory or closed Aero Union away from being have-nots; each and every one of us is one premium raise away from being have-nots.

“If costs continue to rise, this will become a nation of have-nots.”