PHILADELPHIA REFLECTIONS
Musings of a Philadelphia Physician who has served the community for six decades

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Reflections on Impending Obamacare
Reform was surely needed to remove distortions imposed on medical care by its financing. The next big questions are what the Affordable Care Act really reforms; and, whether the result will be affordable for the whole nation. Here are some proposals, just in case.

Merging Insurance Companies with Health Delivery Systems

{Geisinger Clinic}
Geisinger Clinic

Not long ago, a presentation about payment reform was conducted by the CEO of the Geisinger Clinic, which has been praised as a model for many features of Obamacare. It seemed clear that many of the ideas coming from Geisinger emerged from the circumstance that Geisinger owns and operates a health insurance company, and could therefore see both sides of many questions. Listening to this talk was highly reminiscent of the fruitful results which once grew out of the Pennsylvania Medical Society owning and operating a Malpractice Insurance Company. Although that relationship has been dissolved, it exposed practising physicians to many unexpected revelations which continue to be useful. No doubt Geisinger profits from similar insights into the health insurance world, which is in a sense a competitor with physicians for medical domination. Geisinger is definitely a physician-dominated system, so it could gain insights for its physician leaders, similar to what hospitals once learned by starting Blue Cross plans. Following this particular lecture by the doctor from Geisinger, a panel of six eminent commentators was seated on the stage, not one of whom had spent a single day in the practice of medicine. In some circles, this phenomenon is called the "silo effect". Those who are preparing to dominate 17% of the Gross National Product, really should have been expected to have spent more time in the existing system than appeared to be the case. If exceptions to the antitrust laws are required to permit bridging of these coveted information secrets, they should be re-visited immediately.

It is not too late to change, even though it may be too late to rescue Obamacare from a bumpy beginning, if not an implementation train wreck. We have heard testimonials from organizations which have navigated one or two implementation hazards. We will soon see whether the rest of the health industry can safely navigate all of them at once. Teams of practicing physicians, experienced hospital administrators and thoughtful insurance executives should be assembled to design pilot programs for best practices in fixing engines while the motors are running. Clever work-arounds are most likely to grow out of small teams which share effort among veteran warriors in former conspiracies for power. The silos, if you please.

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