By Susan L. Howell, MSS

Published April 2000

• React to this article in the Discussion Forum.

Marc A. Flitter, M.D. is running unopposed in the upcoming Democratic primary in the 21st District for the U.S. Congressional seat currently held by Rep.- R - Phil English. From 1987 until 1997, he was Chief of the Division of Neurological Surgery at Hamot Medical Center in Erie, Pennsylvania, where he continues to practice neurosurgery.

PND: Why are you running for Congress?

MF: I think we need physicians in Congress to try to reform health care. Congress has addressed the health care issue incrementally, in a way that has focused mainly on insurance issues. I’ve been a neurosurgeon for 25 years, an employer, and have had experience in the "real world," as opposed to career politicians who may often be somewhat remote from the day to day experiences of what most of us go through. For example, patients tell me about their need for prescription drugs, the sacrifices they have to make to pay for these drugs, the denied access to a specialist or for an operation—they are not abstractions. Being a physician and part of the medical profession prepares one well, I think, for dealing with legislative issues. We were taught to listen to symptoms and get to the heart of the problem.

PND: What reforms do you propose?

MF: A competitive model that will lower costs while enhancing quality, safety and effectiveness and where physicians, rather than the managed care administrators and bureaucrats, are in charge of patient care; a model where Medicare and Social Security are solvent, and that offers affordable health insurance premiums. Using Internet and wireless technology, we can move from ill-defined community standards and defensive medicine, to national standards for cost, outcomes, safety and effectiveness that are provided to physicians on a moment-to-moment basis. We have not taken advantage of the potential of information systems; even today many hospitals still don’t "talk" to each other.

By the kind of information that would be developed, we can lower the cost of taking care of patients, which should lower health care premiums and lead to more competition in the insurance market. As you drive down the cost of health insurance, many of the uninsured who now work but can’t afford insurance would be able to afford insurance, and you would lower the burden on government in providing insurance to those who don’t have it.

The market forces that will drive the product will be based on the excellence of physicians and the cost-effectiveness of what they’re doing rather than the gatekeeping method of holding down costs that insurance companies and managed care require at this time.

I’ve talked with an economist associated with the Progressive Policy Institute at the Democratic Leadership Conference. Though I can’t give an exact number, he felt that the kind of support mechanisms involved in this kind of technology would be a fraction of the cost of our total health care budget and a fraction of the cost of what our other alternatives are in terms of the failure to reform health care costs. So this is something we’re working on.

PND: How could that vision be achieved?

MF: We need to put the consumer in charge. Consumers need validated, understandable information to help them make decisions. Increasingly, patients are presenting their doctors with a stack of papers from the Internet and asking them to sift through it. When you have back pain, a headache or hypertension, for example, information should be available regarding who’s treating it, at what cost, and with what results. We are very close to realizing this vision. But we all need to be on the same page of understanding. As providers we seldom have adequate comparative data on the safety and effectiveness and costs of what we’re doing as opposed to a great many of our colleagues. It’s more anecdotal and individually dependent upon the idiosyncratic circumstances of our practice.

The FAA model for assisting pilots and the airline industry is analogous to what I envision for physicians and health care. Information reporting and exchange would allow us to continually update what is happening. Guidelines and best practices could be updated dynamically. We need this kind of reporting system for physicians and health care professionals as an ongoing quality performance program to help make health care safer, as well as to help guide physicians in their decision-making. The medical profession also needs the same kind of non-punitive error reporting system that the FAA has, where pilots and staff can confidentially report suspected error, and receive feedback to aid self-correction of the problem. I don’t think of it as government running health care but health care working in partnership with the government. I don’t see it as a loss of physician autonomy or as socialized or centralized medicine.

Such an effort could be funded through the general budget of a federal agency, at a projected fraction of the cost of the total health care budget, according to an economist at the Progressive Policy Institute of the Democratic Leadership Conference, which is committed to this issue and which has physician panels working on it. With physicians in Congress, we can enact legislation to get the federal government, either through an existing agency like the NIH or a new agency similar to either the FCC or the FAA, to set up the infrastructure for obtaining this information and making it available to consumers, hospital and physicians.

PND: Should all information be accessible to consumers?

MF: If the hospital up the street can do a heart operation for 50 percent of the cost of another hospital, I don’t think the first one is necessarily obligated to share this information or how they did it for less, as long as they showed that safety and effectiveness are equal or superior. I don’t see that there’s any room for privileged information any more, nor do I think they have to reveal everything. In terms of revealing information that would allow consumers to make informed choices and allow providers to improve what they’re doing, that has to happen.

PND: What will you propose to do about the aftermath of the Balanced Budget Act of 1997?

MF: All Congress seems to be able to do is to cut back reimbursements to hospitals and physicians. This has placed our hospitals in a financially precarious situation and this has to be corrected. I disagree with these cutbacks. I think the only way we’re going to solve it is by reforming the health care system in a way that we can show we can lower costs. We can save our hospitals by helping them to provide quality care at lower costs by using information technology.

PND: What are your views of the Campbell Bill, which would allow independent physicians to negotiate jointly with health plans.

MF: Physicians should have collective bargaining rights, in view of the excesses of the HMO and insurance industry at this time. I think that these criticisms are the same kind of criticisms you hear for any kind of union activity. I don’t agree that managed care companies should be immune to prosecution by the injured parties. I see the Campbell Bill as a stop-gap measure. I don’t see physicians’ escaping anti-trust as the long-term solution to our health care problem. The Bill is a sign of the times, a reflection of what has happened to physicians in the last several decades. Before, such an initiative would not have been necessary but now collective bargaining is the only hope many physicians have. The abuses of the managed care industry have not been visited solely on patients, but on physicians as well; physicians have had their hands tied behind their backs.

PND: Can you describe your stance of the Patient Bill of Rights?

MF: The Patient Bill of Rights is the result of a great outpouring of the public, which perceives the injustice of what’s happening and is demanding that this kind of corporate abuse of individuals must come to an end. It’s not what Americans will tolerate. I don’t think managed care companies are a source of the problem, rather they are a symptom. They came into being to control health care costs. The point is, they have failed. Managed care companies, despite their best efforts, have injured patients. I don’t think they’ve failed because of poor management, they have failed because of the pressures put upon them politically and medically. They haven’t been given the tools to solve the problem adequately.

PND: What would you do to address Medicare Reform?

MF: As an alternative to price controls, which don’t work and which stifle free enterprise, I would consider offering tax incentives to pharmaceutical companies to lower drug costs for senior citizens. That is, to limit their marketing exclusivity, period, so that the product would be available generically and more cheaply, sooner. We have to keep the industry vital and keep research going, and not preclude an adequate reward for bringing a new drug to the market. On the other hand, when there’s a budget that’s so dependent on advertising these drugs, we have to see where this money is going. In the case of pharmaceuticals, those who are least able to afford it, seniors, are being asked to foot the bill.

PND: How do you explain your change of party affiliation last year, from Republican to Democrat?

MF: For any candidate to win, it takes more than party affiliation. I have been a Democrat more than a Republican throughout my life; I became a Republican in support of Senator Arlen Specter, a friend, who is considered a moderate Republican. I feel that having been a Republican for a period of time aids me in my current effort. I’m comfortable being a Democrat—it’s the kind of medicine I’ve practiced and it’s an honor to seek public office, under either party’s banner, but particularly as a Democrat.

PND: How will your campaign attempt to beat a three-term incumbent?

MF: The 21st Congressional District has a 22,000 Democratic-to-Republican edge, and this is potentially a swing district; and we think health care is of great concern to the voters. I think the idea of a practicing physician/non-career politician resonates with voters. If my lack of governmental experience is at issue, my reply is, I don’t think the government’s doing such a great job right now. I think there will be enough voters who will see that as a plus. If the career politicians with all their experience could solve the problems, then I wouldn’t need to run. A victory is obviously going to take a great deal of money. Our campaign goal is $1 million. As we just started, we have a long way to go. Among those constituents we’re anticipating support from are physicians and Labor, whose interests the Democratic party has traditionally served. This is a great country and I’m impressed by the collective wisdom of the voters. Part of the education of being a candidate is this paradox of opening yourself to that kind of scrutiny, and ultimately, decision.