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The Path to Profanity

May 2, 2011

Many people in D.C. are enjoying a quiet recess waiting for what could well be a difficult and profane battle over the debt ceiling. Debate on this critical issue probably needs to happen before the July 4th recess when members will go home to town hall meetings where they may face constituents with some strong views about proposals to change Medicare and the health care system. Reminiscent of the 2009 Senate Finance Committee's "Gang of Six" deliberations on health care, a confusing number of gangs are amassing in the halls of the Capitol and at the White House to hold various deliberations on how to resolve the debt, increase job opportunities, and make sure the nation's economic outlook rebounds.

Nonetheless, serious and difficult questions will have to be answered or at least acknowledged in the coming months. Can we cut our investment in medical research and continue to be a healthy, competitive nation? Can we block grant Medicaid without ripping the safety net? And then there's Medicare . . .

Every day for the next 19 years 10,000 baby boomers will turn 65. Assuming House Budget Committee Chair Paul Ryan's proposal became law and those age 55 and over were exempted, that still means about 32 million of those baby boomers, who will be living longer and using more resources, will receive a voucher rather than a Medicare card.

Would it work to give vouchers to seniors to buy their own insurance plans, even if the amounts were sufficient? I'm just imagining my mother (who is pretty smart) trying to navigate through a myriad of health plans, deductibles, co-pays, drug coverage, in-network or out-of network doctor visits, and all the other questions that even I have trouble answering. If cost limits were imposed on Medicare beneficiaries, would providers even be able to accept the rates private insurers were willing to pay under the vouchers? This could exacerbate the problems patients are already having finding a physician as more and more primary care doctors are thinking about closing their practices, and a doctor shortage looms on the horizon.

Hopefully, the various gangs of negotiators on the Hill are willing to be honest with each other and the public when it comes to answering these questions and others (many of which were well laid out in a recent New Yorker article).

Medical Schools, Teaching Hospitals Key to a Better System

Despite the uncertainty of the times, the work to improve health care continues. At this year's Atlantic health care forum, terrific speakers, including AAMC board members Sheila P. Burke (Harvard University John F. Kennedy School of Government), Peter L. Slavin (president, Massachusetts General Hospital), and AAMC President and CEO Darrell Kirch, laid out the challenges for moving health care forward.

One of the best discussions centered on the role of physician education, research, and new models of care in improving health—and how timely improvements are unlikely to happen without medical schools and teaching hospitals driving the change.

When talking to my friends and neighbors, I am often struck by the conflicting comments about the care provided in a teaching hospital. Most people look to teaching hospitals when they are victims of trauma or a serious illness.

For routine care, I know that some worry about students and residents "practicing" on them. In fact, that type of learning environment has long benefited those of us who teach medicine, keeping our knowledge and skill base up-to-date. Most of us believe that having learners present means better care for patients. In her New York Times column, Pauline Chen discussed a recent surgical study that demonstrated "having a resident scrub in on your operation is not only safe but might also offer a bit of protection against death." Having a team that includes students, residents, and other learners in the operating room can actually make care better for the patient no matter what the clinical situation. In this learning environment, nothing is viewed as routine when residents and students constantly ask questions and review the latest evidence, and each team brings a fresh set of eyes and a new perspective to a patient's situation.

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About the Author

Atul Grover, MD, PhD AAMC Executive Vice President

Atul Grover, MD, PhD
AAMC Executive Vice President

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For More Information

Peters Willson
Sr. Specialist, Policy and Constituency Issues
Telephone: 202-862-6029