ORLANDO, Fla.—Donald Palmisano, Esq., MD, believes the key to curing the health care crisis in the U.S. involves respecting the sacredness of the doctor-patient relationship and capping the size of malpractice awards.
In his keynote address at the Triological Society’s Combined Sections Meeting held here Feb. 4-7, Dr. Palmisano, who served as the 158th president of the American Medical Association from 2003 to 2004, asserted that the U.S. offers “the best medical care in the world,” and that many of the problems with access to medical care “are due to government intervention in the practice of medicine.”
While viewing health care as a market commodity best exchanged through a private contract between doctors and patients, Dr. Palmisano argued that the free enterprise system provides the best protections for such contracts. “The doctor-patient relationship can only exist in a system where doctors and patients can have freedom of choice through the selection of each other,” Dr. Palmisano said.
The doctor-patient relationship can only exist in a system where doctors and patients can have freedom of choice through the selection of each other.—Donald Palmisano, Esq., MD
Dr. Palmisano, clinical professor of surgery and medical jurisprudence at Tulane University School of Medicine in New Orleans, said problems of access to health care could be solved by an expansion of free enterprise principles. People who cannot afford health care should receive tax credits to buy private health insurance, for example. “Here’s the way to fix the current system,” he said. “You allow the purchase of health insurance across state lines. You allow tax credits—whatever you pay for your insurance comes back to you as a credit, not a deduction. You allow private contracting between patients and physicians without penalty. You allow individual ownership of a policy and enhanced medical savings accounts. Get people off of Medicaid. Get rid of that program. Give [Medicaid recipients] a voucher and allow them to buy health insurance just like the people in the federal employees’ health benefit program.”
Despite widespread public support for Medicare, Dr. Palmisano considers it “a failed system” that shortchanges doctors and interferes with the private contract between the doctor and the patient. “If you treat a Medicare patient, and the patient says, times are tough, can you forget the co-pay, you can’t do that,” he said. “That’s illegal because that’s considered fraud. Also, if the patient wants to give you $20 more because the payment for you is not adequate, you can’t accept that. They kick you out of Medicare for two years. When you tell the public that, they say, ‘You gotta be kidding me! Why should there be coercion?’”
In his speech, titled “Health System Reform and the Arrogance of Power,” Dr. Palmisano provided this definition of arrogance: “an attitude of superiority manifested in an overbearing manner,” often accompanied by an “offensive display of superiority or self-importance.” In calling for greater humility, he recalled the advice given by Donald Jacobs, then the dean of Northwestern University’s Kellogg School of Management, when he conducted a course for the American Medical Association’s board in 1998. “He said when somebody brings you a disconfirming opinion, you should not get reactive, you should not attack the person,” Dr. Palmisano said. “You should go up and hug the person, because that person might be bringing you the solution to the problem. It might be junk information, but you can be respectful and listen.”
Legal Reform
Dr. Palmisano also denounced court decisions that strike down limits on the amount of money that plaintiffs and their attorneys can seek in a malpractice suit. Such laws are usually found unconstitutionally restrictive, Dr. Palmisano said, but he believes state constitutions should be changed to allow the legislature to set caps on damages in malpractice cases.
During the question-and-answer period, J. Regan Thomas, MD, a Chicago plastic surgeon and professor at the University of Illinois-Chicago who is president-elect of the American Academy of Otolaryngology-Head and Neck Surgery, announced that the Illinois Supreme Court had, just three hours earlier, struck down as unconstitutional the state’s five-year-old law that limited compensation to injured patients for pain, suffering and other non-economic distress. “That’s certainly distressing news,” Dr. Palmisano said. “The trial lawyers will be very happy about that.”
Reaction
Although the speech extended well into the lunch hour, the vast majority of attendees remained until the end, and questions from the audience indicated support for Dr. Palmisano’s views.
At least one attendee, however, expressed a desire for more original solutions. “I have a great sense of disappointment as we see meaningful health care reform slip away,” said Jonas T. Johnson, MD, editor of The Laryngoscope and professor and chairman of otolaryngology at the University of Pittsburgh School of Medicine. “I am disappointed to think that organized medicine has failed to contribute in a positive way to progress toward universal coverage. The impediment seems to be a commitment to the economic status quo, an inability to embrace evidence-based practice, and an enduring distaste for our tort system.” ENTtoday