By Arthur Lightbourn
When he's not putting in 60- to 80-hour weeks as an obstetrical anesthesiologist at Sharp Mary Birch Hospital for Women, you'll probably find Dr. Robert Hertzka on a plane to Washington, D.C., or Sacramento to lobby politicians on both sides of the aisle on health care and patient safety.
He is a former president of the California Medical Association (2004-2005) and currently serves on the American Medical Association (AMA) Council on Medical Service, a group of nine physicians responsible for developing many of the AMA's public policy positions on health care access, cost and quality.
"In my position," he said, "I meet with Democrats and Republicans all the time, and, I think I'm viewed ... as a pretty straight-forward source when they are trying to figure out what's going on."
Asked to comment on the recently passed health reform legislation, Hertzka said initially he was hopeful it would contain some of the reform proposals he had been urging, but, as the legislation took shape in Congress, "I couldn't support what they were trying to do and, although the American Medical Association stayed supportive, I no longer was.
"The plan as passed is a reckless social experiment and it will not work and it will either go into effect in 2014 ... and create problems," he said, "or people will come around and come up with some kind of alternative and change it dramatically."
Under the new legislation, he said, two-thirds of the uninsured will be provided with cards similar to current Medicaid or Medical insurance now available to low-income recipients, which few private primary physicians or specialists accept because the Medicaid and Medical payments are so low.
As a result, the only places that will accept the new 20 million below-poverty-line patients nationally (2 million in California) will be already over-burdened hospital emergency rooms and clinics. "And that's a cruel joke," Hertzka said. "That's not health care coverage."
If the proposed cards would at least pay doctors as much as Medicare allots for seniors, that would be somewhat more acceptable, he said, but "a Medicaid card is nothing, unless you are a child or you are pregnant," since payments are higher for those patients.
On his most recent trip to Washington late last month, following the passage of the new health care legislation, he met with 15 members of Congress, Republicans and Democrats, and this was his message:
"To the Democrats, I say, you've pushed through something that is deeply flawed and hastily drawn and will need significant adjustments (to fix its structural problems) and additional funding ... and they are taking that under advisement."
Because Democrats just voted for it they are understandably vested in it, but he believes, "the sooner people start thinking about this," the sooner there will be a cadre of Democratic members of Congress who will be willing to say, "This needs to be significantly revised."
He said, "Republicans are completely focused on repeal."
His message to his fellow Republicans is, "Repeal all you want, but this replacement is going to be a heavy lift and it's going to cost money. And you're going to have to be prepared for that. The American people will not be happy. By the time you get a chance to repeal, they won't want to repeal it anymore, unless you can show you have a viable replacement."
And any "viable replacement," he insists, will have to figure out how to provide health care for low income, below-the-poverty-line people, other than handing them a worthless Medicaid-type card.
"You can't just mail them a card. You need to set up some kind of program for them, whether it's through clinics or whatnot. In Johns Hopkins, they have a program for 140,000 destitute people. They don't just mail them a card. They have visiting nurses, clinics, outreach, people call them at home, make sure they take their medicines. The focus is: Let's improve health outcome, as opposed to the political win of saying, 'Here's a little plastic card, have a nice day.'"
Since 1988, Hertzka has taught a 40-hour elective introductory course on "the politics of medicine" to first- and second-year medical students at UCSD's School of Medicine and, for the past two years, a more advanced 20-hour seminar course on the subject.
When asked if he was just beginning his career, given the problems in health care today, would he choose medicine he said, "Oh, sure. There are few professions that allow you to work so closely with people and help people's lives.
"And I think that's why I'm so interested in trying to make sure the system works."