Article Contributed on: 9/10/2009 9:38:57 AM
When we push aside all the fearmongering (if we don't have universal health care, we are in deep trouble; if we do, we are in deep trouble, etc.) the posturing, the rhetoric, the oversimplifications and the outright fibs, only two questions actually exist in the world of Health Care Reform: "What do we really want to see?" and "Can Congress get us there with legislation?"
My answers to the first question are below. I'm assuming (to some degree, we are all assuming) that some of these are what everyone wants to see:
Patients with pre-existing conditions need medical coverage, instead of being treated as though they never existed, bumped off plans their employers paid for, and shut out of plans anywhere.
Those who cannot afford insurance need to be able to get low-cost services and preventative education and care, so they can fend off costly trips to the emergency rooms, and get an early handle on conditions like diabetes and heart disease.
The stunning delays that many folks currently experience when attempting to get medical appointments, surgeries, and other services, should not continue under a new system.
Medicare patients should be able to find doctors. Many doctors no longer take Medicare because they can't get paid what the procedures and treatments actually cost; now even insurance companies are refusing to pay the higher rates put in place to make up the difference and keep doctors in practice.
Insurance companies and pharmaceutical companies bargain for special treatment, getting breaks and special considerations from hospitals and from one another, keeping medical costs high and insurance payments low, providing more benefit to investors than to patients. This should not continue under any new plan.
Doctors and hospitals should be able to order (or not order) whatever tests or treatments are pertinent to the patient's care, not just those that are required by medical or malpractice insurance providers. Doctors are moving to other countries to avoid having to deal with the incredible amount of paperwork, rules, and other elements of current insurance and programs for the elderly, that make it harder to focus on treating the patient, and expensive to process all the documentation and reports.
Patients should be able to choose their own doctors and hospitals; now many are shut out because government plan payments are too low.
Hospital and medical costs should be lowered, but not by lowering services. Efficiency and technological advancements are the normal ways to get there, but the current system makes this more difficult.
Those who do not want to have medical insurance (those who wish to self-insure) either because they have sufficient funds to cover their own costs, or because they wish alternative medical treatment that insurance won't pay for, should be allowed to opt out.
There are some things I'd like to see that maybe others feel less sure about:
Doctors should be able to practice without the constant threat of lawsuits from patients who would rather sue than pay medical bills. Doctors and hospitals currently have to pay huge malpractice insurance costs, mostly because our legal system has no way to screen out (and discourage) frivolous or opportunistic lawsuits.
Patient Care needs to be the focus. Not whether or not the patient's employer happens to be flush enough at the moment to afford really decent health care. As company bottom lines are impacted by the economic downturn, fewer and fewer employees get to decide which health care options are available to them.
People who like the insurance they have should be allowed to keep it (assuming their employers allow them to).
Initially insurance was designed to be a "share the load" mechanism, almost like a charity, where those fortunate enough not to be ill were willing to pay in so that those less fortunate would be able to get help. When computers made it possible to cherry pick patients, however, the entire concept was destroyed, and there are now "winners and losers" in the insurance industry.
Patients should be able to get minor medical services without resorting to hospitals. The trend (already well underway) of patient care units in malls and shopping areas is going in the right direction.
But now, we get the bigger question, "Can Congress get us there with legislation?"
There are some things that any action by Congress will need, that make it debatable:
Oversight and checks and balances: In our partisan times, any legislation put in place has to run the gauntlet created by the party out of power when the legislation passed. If there are any flaws, they are immediately attacked, so whatever is done needs to have benchmarks that can be pointed to, to show whether the program is working or not. To accomplish this, there needs to be a lot of reporting, adding further to the already onerous paperwork load for both the doctors and the hospitals.
Current bills do not address any of the issues of tort reform needed to keep frivolous and opportunistic lawsuits from pushing malpractice costs ever higher, regardless of what system is in place.
Congress would have to either mandate that employers currently providing insurance be forced to keep providing it under penalty of law, or disallow employees currently in an employer plan from joining any "public option," assuming the goal (as we've been told) is not to force a full socialization of the industry by fiat. Either of these would seem to be very unfair to the employer or the employee. Not to mention that mechanisms would need to be identified to discover when employers were dropping features from already existing programs due to economic stress to the employer. There is a chance some employers would be forced out of business.
Insurance providers spend a lot of money on campaigns, as do doctors and hospitals. It is hard to know if this (in addition to massive lobbying efforts ongoing for many years) will make it likely that Congress will feel comfortable voting against medical and insurance provider interests. There's a bit of "chicken and egg" here; did they start lobbying to get what we have now, or to keep Congress from doing more harm?
Costs of the plan are high even just to set up the reporting structures, oversight committees and infrastructure that would be required. Calling something "Revenue Neutral" because it may in the future create lower costs is disingenuous to say the least. With the current state of the economy, increasing debt (without actually decreasing costs that were expected to be decreased, like military spending) could well trigger more difficulties down the road.
Over the past 20 years, Congress has made repeated attempts (pages and pages of them -- check it out at www.thomas.gov) to "fix" the medical systems in the nation. Many of those efforts caused the conditions we are experiencing right now. Is it sensible to believe that suddenly they have a better handle on everything that's gone wrong? With medicare insolvency looming, is it wise to re-create a similar system and assume that the new one, based on the old one, will be solvent? Even those on Medicare need "supplemental insurance" so it's somewhat clear the system is not providing for all needs.
Doctors are very concerned about pending legislation. Here's one example of an article about why primary care doctors are leaving the field (and they don't believe the current legislation will help):
http://www.cnn.com/2009/HEALTH/08/25/harris.primary.care.doctor/index.html
On Sept 8, over 10,000 US Doctors presented the following appeal to the Senate, telling them why they think some things need to be done *before* healthcare reform can become a reality
http://sermo.com/news/media/press/appeal_delivery
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To the American People,
We, the physicians of this country want to reform healthcare to improve the quality and access to care for our patients while reducing costs. True healthcare reform will only succeed if:
1. Unnecessary tests and procedures are reduced through tort and malpractice reform.
2. Doctors are allowed to spend more time with their patients and less time on paperwork by streamlining billing and making pricing more transparent (create an alternative to CPT codes).
3. Medical decisions are made by physicians and their patients, not insurance company administrators.
4. Adequate supply of qualified physicians is assured by revising the methods used for calculating reimbursements.
We invite policy makers to work directly with the men and women who are on the frontlines of healthcare each and every day caring for the citizens of this country.
We pledge to be partners in true healthcare reform, improving the healthcare delivery system in this country while honoring the Hippocratic oath that we all have taken.
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Oddly enough, this got little if any press.
http://www.sermo.com/reform/read_md_quotes and
http://www.sermo.com/reform/get_survey_results
give a clearer picture from the physicians point of view, showing their deep distrust of the AMA's support for current legislation, and their focus on getting health care to patients first.
The way I read it, the doctors are anxious to reform health care, but feel the politicians and their various "fixes" have not helped and are actually getting in the way of real reform. Maybe if we see the legislators start taking on the legal system (arguably, since many of them are lawyers, they might be less than anxious to take that course) and the insurance companies, that will change.
Once you add the frustration that this legislation is being forced through (a frustration that even centrist Democrats are feeling), I'm not sure that what will come out of this process will be any more helpful than the rest of the Congressional attempts to micromanage health care. Time will tell. In the meantime, I will keep reading the bills as they change and shift (and let's hope the legislators are doing so as well), and keep reporting to my legislators where I feel all this is going.
The question is, if the legislation is *not* going to give us what we want, should we support it? Should Congress pass something, anything, just so we feel something is going foreward? Will this help?
We may be back to the old axiom: The definition of insanity is doing the same thing over and over again, and expecting a different result.