History in the Making

By Michelle B.Caughey, M.D.  

Michelle Caughey, M.D.

The Annual Meeting of the Medical Association was a historic dinner honoring us, the doctors of San Mateo County, and 100 years of organized medicine in the county. I am sorry for those who missed the fun. Visiting Ralston Hall on the Notre Dame campus was, by itself, worth an evening out. The food was great, the music fine, and the company stimulating. Friends, there is always next year.

On Friday, October 14, I attended another historic event. U.S. Representative Tom Lantos invited a small number of medical executives, physicians, and administrators, to a breakfast. Representative Lantos is the ranking democrat on the House Foreign Relations Committee, an economist by background, and an interesting, thoughtful gentleman. He said that he has not made health care his area of expertise, but he realizes that Congress spends a large amount of time on Medicare/Medicaid financing. He orchestrated this meeting to gain a better understanding of the concerns of the medical delivery system so that he can better advocate and construct policy for his constituents.

During the 90 minutes we had together, many issues were raised. There was no whining. There were no personal dramatic stories. I was impressed with the tenor of the discussion, and there was substantial agreement among us about what Congress needs to address.

Medicare financing and the annual increase in reimbursement of 2 percent a year will not cover medical costs, which rise at 8 percent to 13 percent a year. California has some special cost drivers, which the rest of the country does not have, including nurse ratios, seismic upgrade requirements, and unaffordable housing. The rest of the country shares the problems of nurse and technical shortages (and higher wages) and of an aging population, and the enormous cost of special drugs such as new chemotherapy agents. We told him that the Part D drug benefit is con-fusing to persons with advanced college degrees. Between the language the government uses in its explanatory brochures and the misleading advertisements for Part D drug plans, the elderly will be terribly confused. They may make wrong choices. Some of those misguided choices may cause them to mistakenly dis-enroll from their current health plan. And of course physicians are con-cerned about lower-income seniors when they are faced with the donut hole, e.g. out-of-pocket expenses for drugs.

We asked him whether he thought there would be unfunded mandates to improve disaster response systems in states and counties. He recognized that much of the disaster response system is the medical system. He also stated that for many situations the U. S. military has the necessary equipment and that state and local governments do not and will not own fleets of expensive helicopters and evacuation vehicles.

He was very interested in influenza immunization and, of course, avian flu. We told him that the distribution of vaccine seems random, with retail organizations receiving vaccine before physician offices. When shortages occur, there is no national plan for rational distribution. These issues will become extreme if or when there is a worldwide flu pandemic. Just the same, there is no plan for inexpensive production of anti-influenza drugs and a rational distribution plan of existing medications has not been finalized.

Legal prescription drug advertising is not in the interest of the citizens of the United States. In fact, it undermines effective pre-scribing and the physician-patient relationship.

Obesity, especially in childhood, is increasing at an alarming rate. We discussed the government’s role in providing parks, recreation facilities, and school programs that encourage physical activity.

Violence prevention and mental health resources have been declining for local Medicaid programs. He was encouraged to ensure adequate resources for these people.

Throughout, Representative Lantos asked perceptive questions. His staff took copious notes. He expressed his gratitude to the attendees for their time and consideration. The group will meet again in a few months. I am confident that he welcomes your participation as well. E-mail his office with your opinions on these subjects at cal2lantos@mail.house.gov.