When you take a look at mortality rates for heart attacks 30 years ago, if you had a heart attack and you made it to the hospital, you had a 30 percent chance of dying in the hospital. Now your rates are 2 percent or less. We have done wonderful, great things in the U.S. We just haven't kept up with the evolution of how we need to align incentives to have patients stay healthy and avoid the unnecessary costs.
So how do you change those incentives?
The most cost-effective treatment for diabetes is proper nutrition and physical activity. But guess what? No insurance pays for eating right or taking an hour a day for physical activity. But what they'll pay for is bypass surgery, stents, lots of drugs. So like many things, we need to have a discussion on how we can help people make choices.
Moderate Democrats say we need to change the way doctors and hospitals are paid and reward them for the quality of care they provide. Do you agree?
The AMA is very supportive of trying to allow our healthcare system to evolve. But the reality is that over half of healthcare in the United States, on the outpatient side, is delivered by individual doctors in their offices or by groups of less than three. Our antitrust laws prevent physicians from coming together to try to provide that better care [by sharing information]. So the issue is, it's a nice sound bite, but there are going to have to be some changes in barriers that currently exist that prevent doctors from coming together.
What could help?
People point to electronically integrated systems like the Mayo Clinic, Cleveland Clinic, even Scott & White healthcare, where I practice. We have our own electronic medical records that connect all 770 doctors, our hospitals, and our regional clinics. It's a wonderful environment to practice in, but our system doesn't talk to anybody else. In Temple, Texas, where I practice, we have a Veterans Administration, and we also have a military hospital, Darnall Army. None of them talk to each other. They've got three different electronic systems. So when I care for patients that are veterans, they go to the veterans system for their care, and they come to me for cardiology. We switch back and forth trying to figure out what's going on.
How did our healthcare system get to this state?
We are where we are because we have not focused on a goal. What's happened is that we have innovated, we have created wonderful ways to do stuff, but we still have a payment mechanism that's based in 1942, in which if the employer provides health insurance, it doesn't pay tax on it, but if the individual purchases his or her own health insurance, they have to pay after-tax dollars on it. And then we get to 1986, when you have the Emergency Medical Treatment and Active Labor Act, which says anybody who shows up in an emergency room gets healthcare. And then in 1997, the federal government says, 'You can't charge a Medicare patient more than what we are going to pay you.' So what's happened is that you have a confluence of cost shifting that finally has reached a point that we've got great technology, we've got wonderful ways to keep people alive longer, but we also haven't had a discussion of what's the goal.