Houston Chronicle

Health care, from the bottom up

Neurosurgeon outlines health care behind scenes

By TODD ACKERMAN
Copyright 2009 Houston Chronicle
April 4, 2009, 10:49PM
Reproduced by permission

Dr. Guy Clifton suggests that in the future the U.S. will be facing a health care cost crisis like the banking crisis.

Dr. Guy Clifton made a name in Houston as a neurosurgeon and the founder of Save Our ERs, a coalition of business and health professionals dedicated to solving the emergency care crisis in Texas, before heading to Washington, D.C., in 2006 to take on national health care reform. Last month, he returned to the University of Texas Medical School in Houston to talk about the results of his time in the nation’s capital, his new book Flatlined: Resuscitating American Medicine, a behind-the-scenes look at what’s wrong with America’s health-care system. He spoke with Chronicle medical writer Todd Ackerman.

Q: There are a lot of books about America’s health-care ills. Why should people read yours?

A: Most of the books start with a grand concept of what ought to happen and describe the problems from that grand concept. I looked at what would make me change my behavior if I were accountable for cost. I started from the bottom up rather than the top down and devised policy that would work at the point of patient contact.

Q: What’s the thesis?

A: We’re paying doctors for the wrong things. We’re paying for the volume of services rendered — irrespective of quality — when we ought to be paying for outcomes, for the quality of care. That would make providers appropriate and judicious in their use of resources.

Q: How does Houston come off in the book? It’s peppered with your experiences here, right?

A: The experiences aren’t unique to Houston, they were just unique to me. Houston comes off the best and worst in medicine, a place where you can get the best quality, high-technology services in the world, but where there isn’t ready access to good primary care and where there are far too many uninsured. The net result is high cost and low performances on quality measures.

Q: What do you think of President Barack Obama’s reform plan?

A: I think there’s a high probability he’ll get many of the uninsured covered and a low probability there’ll be substantive improvement in decreasing costs or improving care nationally.

Q: Is it possible to expand access and control cost?

A: Yes. You expand access by covering the uninsured. You control costs by getting payers — private and public — to simultaneously change the way they reimburse doctors and hospitals and by requiring the same quality measures. The problem is that the Democrats, at least the most prominent Democrats in Congress, hold the nsurance industry in low regard. They’ll try to do it with Medicare alone, which won’t work.

Q: So what will happen?

A: In about eight years, we’ll have a health-care cost crisis much like today’s banking crisis. Remember, we’re talking about reforming the single biggest component of the U.S. economy, 17 percent of the GDP. You can’t just cover the uninsured. You need something like a Marshall Plan to re-engineer hospitals and clinics. Nobody’s conceiving anything like that. They don’t have anything to blend Medicare, Medicaid and private payers into a united front.

Q: How do you do that?

A: Through public-private partnerships. It could be done at the federal, state or local level, probably all of them. We have a fragmented payer system — we have to build on it. It would take a big national effort, or a series of local Marshall Plans, but you could do it.