As the Senate debates health care reform legislation, lobbyists across the political spectrum are busy trying to make themselves heard both by legislators and the American public. In an attempt to blunt the impact of the numerous campaigns aimed at killing or gutting the legislation, the White House has released a video called “Who Do You Trust?”, in which Rebecca Patton, president of the American Nurses Association (ANA), appears with Joe Biden and Lori Heim, president of the American Academy of Family Physicians.
But questions do remain. Despite the obvious need for many of the insurance reforms proposed in the plan, the Democrats have yet to fully address the question of how this will be paid for by real changes in the delivery of care or real limits on the influence of pharmaceutical companies or medical device manufacturers.
How, for example, can cost controls ever occur in a system dominated by a fee-for-service model in which physicians’ income is often directly related to the numbers of tests and procedures they recommend, one in which they are rarely bound or directed by evidence-based guidelines or protocols? Would physicians’ organizations like the one represented in the White House video ever support a plan in which most physicians were, like most nurses, on salary? Why is that unthinkable?