Experts unsure that the new administration will help EDs
Little relief expected for overcrowding
The natural excitement and optimism that normally accompany the transition to a new administration are not universally shared by ED experts, judging by their comments to ED Management. While they offer their good wishes to the new Obama team, they feel it may be missing the boat in terms of the issues that directly affect ED operations.
"Even if the next administration somehow finds the money, the initiative, and the political energy to create more health care coverage for everyone, they'll try to send people to their primary care physicians, but there are not enough to go around and there won't be for years unless we change the education system and incentives, so they will still come to us," predicts Charles L. Reese IV, MD, FACEP, chair, Department of Emergency Medicine, Christiana Care Health System, Newark, DE. "The thing is in both scenarios, we are probably going to be paid less per patient than we are now."
Tough years predicted
Gregory Henry, MD, FACEP, vice president of risk management, Emergency Physicians Medical Group, Ann Arbor, MI, says, "I wish the new president well — principally not for his sake; but for mine, my children's, and my grandchildren's." However, there's no reason to believe that former Sen. Tom Daschle, the designated new Secretary of Health and Human Services, has any knowledge of broader health care issues, Henry says. By that statement, says Henry, he means an understanding of the root cause of our current situation.
"Without understanding what the Germans and Singaporese and British are doing, we can't move forward," he says. "They actually put up intelligent limits to care; it's called health care rationing." The American people want access, quality, and quantity of care without any limitations, Henry says, "and that cannot be." In addition, he says, we must adopt a realistic approach to futile efforts to prolong life. "To believe for one second there are no hard choices out there is not to understand where we are," he says.
Reese agrees with Henry on rationing. "It will be nice to have more patients with insurance [as President-elect Obama proposes]; but in the long run, there will be a drift toward more socialized medicine," he says, adding that rationing is the next logical step. "You mandate all this care, give everyone insurance, and you won't have enough money to pay for it all, so some de facto rationing will occur," he predicts. The bottom line, says Reese, is this: "I expect the Democratic Party to be more sensitive to our mission but less to economics, and completely unsympathetic to malpractice reform — and that makes it a very tough environment for everybody."
But Steven J. Davidson, MD, MBA, FACEP, chairman, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, is extremely optimistic. "Based on the campaign I saw run this fellow run, he's really going back to first-leadership principles and trying to operate with some integrity," he says. Davidson also has a decidedly different opinion on Daschle than Henry. "He has apparently been going to school in health care for the last umpteen years, and that can only be a good thing," he says.
The natural excitement and optimism that normally accompany the transition to a new administration are not universally shared by ED experts, judging by their comments to ED Management.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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