Patients and Impatience

Patients and Impatience


Leonard Zwelling

         The next few weeks will be critical ones for medicine in
America, but most vital to those practicing or receiving their medical care at
MD Anderson. It will be hard to wait for these decisions to be made in Houston,
Austin and Washington, but we must have patience.

         On Wednesday, the initial arguments before the Supreme Court
in the King v. Burwell case will take place. The high Court’s decision could
render ObamaCare inoperative if it rules that health insurance premium
subsidies are only available to those who purchased coverage on state exchanges,
as the law’s language reads precisely. This would mean those who purchased
insurance on the federal exchanges would not receive the subsidies and it is
likely that this would make these premium payments unaffordable to millions,
especially in Florida and Texas (

         For patients treated at MD Anderson, especially, but not
only, those from Texas, this could place their access to MD Anderson quality
care in great jeopardy as their insurance premiums (even private insurance
premiums) would leap and many could not afford health insurance at all. Once
insurance is unaffordable in any location, the individual mandate is suspended.
ObamaCare would probably collapse, as Margot Sanger-Katz describes in the
article from Sunday’s NY Times (url, above), in a “death spiral” of
accelerating premium prices that only the very sick will pay thus inducing even
higher premiums as the well leave the insurance pool without penalty or
coverage.  The actual decision in this
case is not expected until June.

         But for the faculty and patients of MD Anderson, the
question is more immediate. Will the current chaos and conflict of faculty v.
faculty, Ex-Senate Chairs v. Ex-Senate Chairs, and current Faculty Senate v.
Executive Leadership continue?  My guess
is that it will, and that soon enough it will spill into the patients’ side of
the clinics as faculty leave, waiting times increase, and inevitably the press
to have the remaining faculty see more patients each, leads to a hurry-up
mentality prone to error.

         No one wants that to occur and there is a way to end it, but
it is in the hands of the people in Austin, not those here on the ground in Houston.

         The Chancellor himself is scheduled to address the faculty
on March 18. If he comes to Houston with any messages other than “Ron’s my guy
come hell or high water” or “he’s gone,” he may as well not show up. The entire
system has grown impatient with the inability of the leadership in Houston to
articulate a comprehensive or comprehensible plan and the inability of those in
Austin to speak the words that would question the competence of the current MD
Anderson leadership. I guess Chancellor McRaven’s relationship to the words “ineffective
leader” are the same as President Obama’s to “Islamic extremists.” He just
can’t say it and every time he gets up and doesn’t say it, his credibility is
eroded a bit more.

         For the sake of patients everywhere, I hope the Supreme
Court can find the wisdom to not undermine what is admittedly a lousy plan (ObamaCare)
by making things worse, but I must admit I could see that happening. There’s no
splitting the baby on this one. Either the subsidies can continue or Congress
has to go back to the drawing board re: providing affordable health insurance
to those needing it in states without exchanges like Texas. Most states without
exchanges have no contingency plans in place if the Supremes rule the federal
subsidies unconstitutional.

         For the sake of the patients of MD Anderson, I hope the
Chancellor can comprehend what is needed of him by the faculty and realize he
really does have to take sides. You would think a warrior would know that.
We’ll see.

         I think the time has long since passed when the leadership
in Austin must determine clear, quantifiable milestones for the MD Anderson
leadership to attain with regard to faculty morale, fairness in resource
distribution, and ethical conduct by leadership. The faculty members have had enough
with the stock deals and the disappearance of faculty leaders overnight. This
is just bad policy and bad management as well as bad leadership and ought not
be rewarded.

these goals are not attained by September 1, 2015, a change in leadership at
the very top of MD Anderson is indicated and the Chancellor must demonstrate
the backbone to do it now. A warning shot across Dr. DePinho’s bow is in order.

         Once again, I am shocked that I am writing about these
things concerning a man who led the Navy SEALS and who was instrumental in
bringing Osama Ben Laden to justice, but the UT System is not the military. He
cannot snap his fingers and send SEAL Team Six in to fix a problem. Or can he?

         Try to have patience.

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