By By JONATHAN CLAYBORNE
Staff Writer
GREENVILLE — Far removed from negotiations under way in Washington, D.C., Dr. Paul Cunningham assayed the congressional formula for health-care reform from a moderate’s perspective.
“Washington, D.C., seems to be a long distance away,” he mused Thursday.
Cunningham, dean of the Brody School of Medicine at East Carolina University, said that some outcomes of the still-solidifying legislation are yet unclear, and that important changes are taking place out of public view.
“It’s like reading tea leaves,” he said in his office at the Brody Medical Sciences building.
Yet, what is clear is that health care in the United States is undergoing seismic shifts, albeit in gradual tremors.
“None of this is going to happen overnight,” Cunningham observed. “The efficiencies will not be realized for years.”
Asked to define the patient’s role in health-care reform, Cunningham prescribed some pointed advice: “When you hear the rhetoric, go talk to your doctor.”
He didn’t say anything about seeking the wisdom of politicians, editorial writers, industry lobbyists or other special-interest advocates.
“Wait and see,” he said. “Be patient. Remember to continue to advocate for your needs at the community level.”
Though the full spectrum of health care has been dissected thoroughly in this ongoing debate, one thing that appears to have emerged intact is patients’ trust in their doctors, Cunningham said.
He added that patients should “learn as much as they can, and speak to their physicians.”
Whether one classifies it as insurance reform, patient protection, affordable care or a mistake, the regulatory requirements of the coming law will be set in the rarified air of the nation’s capital.
But the measure’s directives will be put into practice on the ground, Cunningham said.
“That’s where the fine tuning will take place,” he said.
He suggested that it will take the cooperation of the medical community and the people it serves to make the altered system work — that, at some point, policy debate will give way to the hands-on job of redefining health-care parameters.
“The ideology has been so divisive at the political level that the public has been injured by the rhetoric,” he said.
Cunningham avoids highly charged phrases like “death panels,” a term preferred by some reform opponents. He said the term was created to induce anxiety.
“Why bother?” he said. “I don’t think it’s necessary to go that far.”
The doctor also steers clear of utterances like the scuttled “public option” favored by House Democrats, noting that the same goals can be arrived at with different terminology.
He said that, personally, “I’m not married to the public option,” and “All of these catch words have generated their own political wind, it seems.”
Effect
Cunningham does see some benefits coming down the pike.
For instance, he contends that North Carolina hospitals are poised to take advantage of a universal electronic-records system that currently doesn’t exist, but could be created in response to reform.
The medical school and Pitt County Memorial Hospital have a working relationship, recognizing that the two are separate entities, but reform could deliver opportunities for increased connectivity, he related.
“Investment in innovative delivery models may be supported by this legislation,” Cunningham said.
The legislation being hammered out by House and Senate leaders could extend coverage to most Americans, and is intended to blunt the skyrocketing costs of treatment and insurance, he relayed.
In order to expand coverage, “One has to create new structures,” he said.
“There seems to be some aspect of the health-care reform that speaks to pilot programs or initiatives that might be helpful to us,” he said, referring to the medical school.
The doctor had hoped to see more educational slots identified via reform, explaining that he forecasts more of a reallocation of graduate-level resources to be shared by rural and inner-city areas.
“We’re looking for a more robust response than that because the community is facing a physician shortage,” he said.
One of the expressed goals of the reformers was to create a benchmark for insurance premiums and curtail costs while shifting part of the tax burden to so-called “Cadillac” insurance plans, Cunningham said.
The nonprofit exchanges through which people would be able to buy their health insurance are supposed to have cost controls, he said, cautioning that any one of these constituent parts “is going to require enormous investment at the grassroots level.”
Overall, the changes will come, but they will be incremental, and the medical community will have to figure out how to implement them, Cunningham asserted.
Health-care reform is “a modernized vehicle,” he continued, “but it still needs drivers and passengers and others to make this vehicle perform.”
And, of course, medicine will continue to be imperfect.
No one foresaw the emergence of H1N1, also known as the “swine flu,” Cunningham said, adding that no one anticipated that obesity would become an epidemic that costs billions of dollars per year.
“We haven’t even begun to figure out how to cure most cancers,” he said. “We can treat them; we don’t know how to cure them.”
But more effective controls can be put into practice if enough smart people get to work on making that happen, and it’s up to physicians and other professionals to make health-care reform work, he reiterated.
Still, there will always be glitches.
“The human elements, the biology of who we are as human beings, drives this process in ways that are beyond our complete control,” he said.
In the final analysis, from a local perspective the shakeups in medicine matter less in Washington, D.C., than in eastern North Carolina, he indicated.
“All politics is local,” Cunningham concluded.
The key is to keep trying new modes of care and keep discarding what doesn’t work, in essence changing the means of production to achieve better results, he said, summing things up this way: “I’m not aware of any other so-called industry that does that on a regular basis.”