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The remarks came during the second annual Convergence Around Technologies Cardiovascular Health Conference, held in late October at the Radisson Lackawanna Station Hotel in Scranton.
The CATCH '09 Conference - presented by the Community Medical Center, Mercy Hospital, Moses Taylor Hospital and the Commonwealth Medical College as educational partners - has quickly become a major local gathering for health care and community leaders, said Dr. Russell Stahl, an event organizer and CMC's chief of cardiothoracic surgery. Blue Cross of Northeastern Pennsylvania was a major sponsor for the event.
This year's conference focused on treatment of advanced congestive heart failure, particularly in the elderly, as well as palliative care and health care reform. Reinhardt, who teaches at Princeton University, gave the keynote speech before answering questions in a breakout session.
"CATCH '09 really focused on health policy, greater collaboration and technological convergence in the U.S. health care system and locally," Stahl said. "Health care reform is taking us toward global payment reform and an integrated delivery system model with new payment methods."
Next year's conference will discuss local convergence when it comes to how doctors can collaborate to avoid the duplication of services and promote high quality care, Stahl added.
In this year's keynote speech, Reinhardt stressed that the federal government must reform America's health care delivery system soon or risk skyrocketing health care costs that threaten to harm the middle class.
He thinks reforms will fail if they don't include a mandate for all individuals to carry health insurance and public subsidies to allow those who can't afford coverage to buy it.
Plus, he said the government should institute a guaranteed-issue requirement for insurers to cover everyone and a community rating provision so premiums aren't based on health history.
Rather than slapping negative labels on health reform initiatives and dismissing them, Reinhardt said providers, payers, pharmaceutical companies and patients must all collaborate for success. "We shouldn't default to cliches," Reinhardt said.
"We shouldn't just say 'It's socialized medicine, so let's not accept it.'"
If the medical community doesn't work together, "at least a decade of fierce insurgent war among tribal chiefs" will hamper reforms, he said. That's already a likely scenario, said Reinhardt, because any reforms to save the health system money will inevitably come from the bottom-line of one of the medical community's stakeholders.
At the current trajectory of rising health care costs, Reinhardt estimated that health care spending as a percentage of gross domestic product - which currently totals 16 percent - will grow to 40 percent by 2050. Rising health costs aren't primarily spurred by heart disease, the elderly, Baby Boomers consuming more care or "the myth of Medicaid bankrupting the system," said Reinhardt.
Instead, the 6 percent annual growth is driven by all Americans receiving ever more sophisticated and pricey tests and treatments, which represents our "passionate, promiscuous and illicit love affair" with medical care. Americans must now turn their relationship with medical consumption into a "mature" and "stable marriage," he added.
At the same time, health care spending is not a bad thing per se, said Reinhardt, because it's the "economic locomotive for America now." But he doesn't think we should lead industrialized nations in our rate of health care spending growth.
That's because the U.S. medical community can generate savings by installing electronic health systems and educating Americans to take better care of themselves from a young age, Reinhardt said. Other ways to reduce health system costs include using the most cost effective and appropriate treatments, lowering administrative costs, lowering profits, creating integrated medical delivery systems and cutting mistakes, Reinhardt added.
Until health care reforms are enacted, the 5 percent to 8 percent of Americans who buy individual health plans will continue to shoulder a disproportionate share of rising insurance costs, Reinhardt said. And the dwindling spending-power of the middle class will keep eroding precipitously, which ultimately will harm America, Reinhardt added.
Reinhardt's remarks dovetailed in part with the palliative care message of Dr. Eric Cassell. Though Cassell mostly stayed away from talk of money, the former Cornell University professor of public health stressed that resources devoted to palliative care are often the best spent. That's because doctors commonly focus on helping failing patients survive in pain rather than finding ways for them live in comfort as their lives end, Cassell said.
Cassell described a medical system in which doctors often think of very sick patients "in the language of disease." Such doctors see patients less as people and more as a set of vital signs that need to be improved at any cost. Yet, patients should be considered in the language of "well being, goals and functions," Cassell added. Cassell raised the proverbial question: at what point does the suffering a person is enduring to feel well cease to be worth it given the likelihood of recovery? That occurs, he said, "when a patient hasn't gotten better in the average time it takes for a patient to get better" given their age, condition, medical history and all the resources a doctor has expended.
For his part, Dr. John Boehmer, a cardiac transplant specialist at Penn State College of Medicine, outlined technological advances in ventricular assist devices that may improve the cost/benefit ratio of treating sick patients. Most of the expensive pulsatile and nonpulsatile devices require more research and refinement before they become mainstream treatments. But more surgeons are using them as destination therapies, Boehmer said.
"Dr. Boehmer reinforced the need for this technology and the fact it is evolving to the point it might become commonplace," said Dr. Richard Abramowitz, who heads Wilkes-Barre General Hospital's cardiology department. "Dr. Cassell discussed knowing when the need isn't there to implement the technology - that's the art of medicine."
In a separate conference breakout session, Dr. Stahl screened a film of his patient Charlie Flynn, now 83, who underwent valve replacement surgery. Flynn's strong will to live and his health history made the surgery possible even for an older patient in failing health. Yet, Flynn's story represented one of the tough choices doctors face daily about whether to continue treatment.
"CATCH '09 was successful because it really probed the questions surrounding when a doctor should intervene with cutting-edge technology and when it's time to stop and just make the patient comfortable," said Dr. Christopher Dressel, director of Mercy Hospital's cardiac cath lab. "This year's speakers provided their fascinating take on these questions amid the backdrop of Uwe Reinhardt's broader discussion on health care reform."
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