Dr. David Lynch

In an interview excerpted below, Dr. David Lynch, Medical Director of Family Care Network in Whatcom County, shares his thoughts about the need for and opportunities of healthcare reform. He points out that while the healthcare reform law makes some important changes enabling more access to healthcare insurance, it does not significantly address issues such as the quality and cost of care. He proposes organizing caregivers in the region to provide more effective and affordable care for people with chronic diseases.

Q: You’re giving a talk tonight called “What you have to know about healthcare reform law.” What are the main things that we need to know about health reform?

A: Well, there are three things we have to think about: we have to think about cost, we have to think about access and we have to think about quality. The health reform law that was just passed only deals with access to insurance. It’s taken a barrier away – there are people who will have access to insurance now who didn’t have it before, and that’s a tremendous benefit. But that’s really the only thing that’s happened. So we have not really done anything about access to the kind of care that they need, we have not really done anything about changing the quality of the care, and we have not changed how we pay for the care, or done anything to rein in the cost, so it’s a very limited change that’s occurred, even though it’s being portrayed as radical and revolutionary… We need to understand that, and if we find that a lot of people seek care and can’t get it (which I’m absolutely sure is what’s going to happen) and if we find that costs go up because a lot of people who never had care are now coming in to get things taken care of (which I’m absolutely sure is what’s going to happen), that doesn’t mean it’s failing, it means we haven’t done a complete job.

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Q: Say more about what in our healthcare system still needs to improve.

A: There are two important things that people need to understand before we start talking about healthcare reform. The first is that most (75 percent) of our healthcare costs are driven by chronic disease. The next thing you need to understand is that our payment system today does not help us do a good job; it isn’t designed around taking care of chronic disease; in fact, it gets in the way of doing a good job with chronic disease.

The next thing that you’ve got to understand is that of people who have chronic disease, more than half of them have more than one chronic disease. So it’s not at all unusual to have high blood pressure and heart disease or diabetes and high cholesterol and high blood pressure and heart disease.

The final really important thing to understand is that of the people who have chronic diseases in the United States, if you ask them if they know how to take care of themselves and prevent their disease from getting worse, most of them, 70 percent of the people, say no.

So the situation is that we have a huge cost driver (chronic disease), it involves most people, their conditions are not well controlled, and they tell us that they don’t have the tools they need and the knowledge they need to take care of themselves.

To me, that’s a huge call to action.

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Q: What are the opportunities with reform to address some of these problems?

A: With the new healthcare reform law, we’ve got something called Accountable Care Organizations and what those might look like is really up for debate, but one choice is organizing as a community to provide care. I’m hoping that the Whatcom Alliance for Health Care Access can be a stimulus for that, an organizing force for that. Because I think organizing as a community, having direct accountability to the stakeholders in the community, and trying to bring all the caregivers together in an organized way to provide the best kind of care is really what we ought to be doing.

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View the video below to hear the story of Nicky White, a patient who lost access to the care she needed keep her chronic condition under control.

Read Dr. Lynch’s blog at http://drdavelynch.blogspot.com/.

This is the second in a series of interviews with community members about their perspectives on healthcare reform.

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