Healthcare Reform: What can we really expect? – An Interview with David N. Sundwall, MD, MPH

Selected Interviews from the Coastal Research Group’s website.

This interview was conducted by Laura Turner and first appeared 26 July, 2009

[Below: Doctor David N. Sundwall.]

What do you think are the greatest issues facing the U.S. healthcare system today?

“Cost” control, i.e. restraining the rate of growth of spending for health-care services.  This is not unique to the U.S., but is a global challenge in that our capacity and technology have outstripped our ability to pay for them.

The U.S. is the only industrialized/Western nation without single-payer health care.  Why do you think that is?

It is a historical fluke, in some respects, in that the passage of Medicare/Medicaid in 1965 was made possible by compromising to use existing private health insurance to administer the programs, even though paid for by federal (and federal/state ) taxes.  The general skepticism of “government” has long been a significant factor in the various health policies we have enacted, and avoided.

What concerns do you have with the single-payer model?

Few, but we all need to acknowledge that if we eventually embrace a “ single payer” system it will likely result in delays, inconvenience, and frustration with coverage policies that will be based on the “public good,” not necessarily the best new technologies.

What impacts would you anticipate to physician income and quality of life if a single payer model were to be implemented?

There will likely be a more fair, i.e. “narrower” distribution of compensation among physicians, regardless of specialty.  Primary care physicians would be paid more, sub-specialists less but still more.  I do not necessarily think income is closely related to quality of life, but most strive for high incomes and associate this with “success”.

What do you think the best solution is for the U.S.?

Eventually we will have a single payer system, not because it is necessarily “the best” but because it will be more fair, and enable restraint of spending.  It will be a difficult but necessary transition in that we are accustomed to getting what we perceive we need and want and when we want it.  This is simply too expensive to sustain, so we must acknowledge that “he who pays the piper gets to call the tune,” and to the extent we pay for health care with public funds the “government” could and should determine what services are covered and at what level.

The health reform bills currently under discussion in the House and Senate all require that every U.S. citizen carry health insurance (“individual mandate”) – do you think this is a necessary element of any solution?

Short of a “single payer” system, this is an essential component of health reform.  If it is not an entitlement, it should be required.

Proponents of nationalized health care often cite information that U.S. health care lags other industrialized countries, including the U.S. being 42nd in life expectancy and 41st in infant mortality.  How do you respond to such criticisms?

When you compare health status of Americans with health insurance coverage with other countries we compare favorably (better than most aggregate data from other countries).  This is pretty good evidence that having health insurance coverage is important to improve health.  However, there are other important factors that are not necessarily related to coverage, e.g. economic status, race, access, etc.

What are the incentives a for-profit health care model to focus on preventative medicine and keeping people healthy versus having them consume as much care and incur as much cost as possible?

Not many – though there is little hard evidence that “preventive” health services pay off over time.  We still don’t have consensus on what constitute best practices for preventive care and what will improve health status and reduce costs over time.

Critics claim that pharmaceutical and medical device companies make egregious profits.  Do you agree or disagree, and what reforms, if any, would you like to see in this area?

In a free market economy, I believe there should be opportunities for medical device and drug companies to compete and charge what the market will bear.  However, there may be justification for imposing regulatory restraints when “public” health insurance programs (financed with tax dollars) are purchasing such.

What solution would you propose address the criticism that overseas businesses have an advantage on costs because they don’t have to provide private health care?

I haven’t proposed a “solution,” but I believe our country’s ability to reduce health care expenditures will improve our ability to compete, whether it is accomplished by private or public-based health reforms.

What will be the impacts on physician income and quality of life of the proposed reforms?

See the answer I gave to the fourth question.  “Quality of life” and income are not necessarily related.  Physicians motivated primarily by income will be disappointed and possibly seek other ways to make a living. Those of us who value the rewards of patient care, service, and life-long learning of new biomedical science will still find being a doctor very rewarding.