Peter Anderson on Healthcare Reform

What do you think is the biggest obstacle that plagues the American healthcare system?

PA: The very root obstacle that has led to the crisis in the American healthcare system is the breakdown of the doctor-patient relationship in primary care experienced in the past 15 years.  This has caused the weakening of primary care, thus allowing the U.S. healthcare system to become disorganized, fragmented, and wasteful.  

The cornerstone to quality, cost-efficient healthcare is an active personal relationship with a primary care physician, where the doctor takes responsibility for: timely acute care, quality chronic care, appropriate preventative care, coordination and integration with specialists, hospitals, and emergency rooms and compassionate end-of-life care.

The breakdown of this relationship has led to the present crisis in medicine, even while America has the best doctors, best medicine, best technology and the most money spent on healthcare in the world.

In your own practice, you threw out traditional care and created a new format. Could you explain exactly what you did? What problems did it eliminate or what benefits did it provide to both you and your patients?

PA: With the advent of managed care in the past 15 years, there has been a tremendous increase in administrative and bureaucratic responsibilities of the primary care physician. The increased demand has greatly limited time left for patients and made it even more difficult to meet bottom line. 

In 2003, I transformed my office into a team-based model that today is titled “Family Team Care.”  Family Team Care is a new approach to primary care that allows a doctor to see more patients without sacrificing quality of care or patient satisfaction.  

In this model, a well-trained nurse assistant takes the initial, complete patient history at the beginning of the appointment as well as handles all documentation, patient education, treatment implementation and administrative work throughout the visit.  This process frees the physician to focus on the areas where his or her expertise are actually required, including the analysis of information collected, the physical exam, and decision making and development of a treatment plan.  

The end result is a dramatic improvement over the traditional practice model in the areas of service quality, patient satisfaction, finances and physician satisfaction:

• Improved quality of care – the physician has time to focus on all the patient’s medical needs
• Improved capacity – availability for same-day service for all acute problems
• Improved productivity and finances – a 30%-50% increase in volume, creating financial stability without needing increased  funding
• Improved patient satisfaction – patients are delighted by the accessibility, by the attention to detail during the visit, and that they always see “their” doctor.
• Improved staff satisfaction – staff members have expressed much greater satisfaction with team care due to extended patient involvement.

PA: Our costs are out of control in our market-based system because Americans have demanded products that allow unlimited choices in their healthcare decisions, which is what Medicare and most insurance companies have tried to supply.  The current problem is that the cost of these products have become crippling to both the government and employers.

The public plan will control costs by restricting options and limiting care, which leaves Americans to answer whether they want to save money by allowing someone else to make their healthcare decisions.  The public plan is not free market competition, but the government managing and controlling the decisions of individuals. Individuals must be free to make their own choices but must accept some financial responsibility in these decisions.

To control costs in the current-market based system, Americans must understand and accept some limitations to their healthcare decisions due to expense.  But these decisions must be made by individuals and their families with the guidance and wisdom of a trusted physician. Unlimited care is unaffordable; controlled care is repulsive; coordinated care by a trusted primary-care physician is optimal. 

Opponents of a public plan have decried a potential government program as “socialism” and “rationing”, yet Medicare is one of the most consistently popular programs in our history.  From your perspective do you think that people relate the two?  Do you think a public plan gives too much control to the government?

PA: Medicare is popular because it has given both physicians and patients tremendous resources with very little cost.  The availability of these resources has been unlimited, with the consumption only dependent upon the physician and the individual, which has led to crippling costs.  

The public plan will be entirely different than what Medicare has offered.  To control costs it must significantly limit decisions and restrict care, otherwise our economy would be quickly paralyzed.

A large amount of fear and anger will be created if the government has control of our healthcare decisions, as Americans deeply desire the freedom of choice even in healthcare issues.  Since healthcare is such an individual, personal matter, Americans do not want someone whom they do not know making their decisions.  

PA: Since employers pay 60% of the healthcare costs they should have major involvement in these healthcare decisions.  Health insurance represents a huge cost to employers which certainly can make companies insolvent.  If small businesses are forced to assume costs for healthcare it may essentially eliminate small business.  There seems to be no meaningful attention in this debate paid to small businesses.

PA: Americans want and need quality medical care that is affordable, and this can be obtained.   The four main parts of our system—primary care, specialists, emergency rooms, and hospitals—are not effectively coordinated and integrated.  Because of this we have a staggering amount of unnecessary expense and poor outcomes.  

Only as we rebuild the primary care infrastructure can the U.S. healthcare system become coordinated and efficient.  A fundamental transformation of the healthcare system must take place that emphasizes the central role of primary care, which is then further strengthened by improving the efficiency of the primary care office visit.  

Family Team Care is one model that accomplishes this by restoring the doctor-patient relationship.  A “robust primary care system” will dramatically impact the quality of healthcare, the availability of care for all, and the cost of care.