Another Approach at Achieving Reform

As the health care reform debate hits full speed, it seems lawmakers can’t agree on anything. What has been compromised on is that health care for Americans needs to cover more people and the overall cost needs to be dramatically reduced. What hasn't been agreed on is the correct path to achieve these goals.

Obama and colleagues are in favor of a public option or a co op plan that will achieve lower costs and expand coverage. The problem is that he will only cover 16 million or 1/3 of the uninsured and if you break it down it’s very expensive per person. This adds up to 10,000 dollars per person per year which is almost twice the amount of the current person pays, around $6,000. This plan is a wasted expenditure and the wrong way to approach this problem.

The problem with calculating the number of people covered under a public plan is a confusing one. Seeing how out of 48 million currently uninsured, two thirds or 16 million of theses are currently eligible for current government assistance like Medicaid, 12 million are illegal immigrants and the rest, roughly 18 million are offered insurance through their employer but refuse to purchase it because of its high cost.

It seems more approachable and less invasive to assist those whom are eligible for assistance get coverage and find a way to subsidize insurance premiums to those who are spending more than 10% of their income on health insurance. These approaches confront a much agreed on problem of covering those uninsured without creating another inefficient government entity while not further bankrupting the system.

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AMA Should Take Stronger Stance

In President Obama's address to the AMA yesterday, he laid out some basic framework for the health care overhall he is undertaking in his still very young term. As part of his reform, one of his key considerations is a public insurance option in addition to the many private insurance options. The AMA has long been considered a conservative organization and fundamentally opposed to a socialized or universal payer system. While Obama is not directly proposing either of these options, he is laying the groundwork for a state controlled health care system. Many would argue that a public option in a private market is simply a back door way to socialize medicine, much the same way the TARP funds were a back door way for government to intervene in the banking sector.

Unforunately, the AMA did not take a firm stance against this public insurance option and remained cautious. They, of course, did not specifically endorse a public option but they did not close the door on it. This is something they should have done to show that we will not tolerate any slide toward a state contolled system. Honestly, does any really believe that a public option will not attempt to push the private sector out of the health care industry? Any does anyone seriously believe they could even accomplish this goal efficiently? All one needs to do is take a look at the fiscally disaterous public options now available to specific populations, Medicare and Medicaid, to see this is not a vaible option. More and more doctors are deciding not to accept Medicare and Medicaid because reimbursements are declining and it is not financially efficient to do so. This problem will be expontenially compounded under a public option available to the general public.

Overall, the public insurance option is not a feasible plan in many aspects. This author believes the AMA should take a stronger stance against this proposition and let the administration know where we stand. There are many other health care reform changes that would provide better care for patients, lower costs, and be acceptable for physicians. These will be outlined in later posts.

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Reforming Medical Malpractice

Reforming the medical system is going to require more than one approach. It is going to have to play to both sides of fence. One side is the patient, allowing coverage to include more people at a more cost effective rate and the other side is for physicians. Its too bad for them because one of biggest topics they want addressed is medical malpractice reform and nobody is talking about doing anything.

Obama, as well as Ted Kennedy and Max Baucus, have not indicated that they are going to tackle capping malpractice payouts this time around. They site that this plays little part in the economics of health care spending and that it takes away patient's rights. According to a January 2006 report prepared by PricewaterhouseCoopers LLP for the insurers’ group America’s Health Insurance Plans, it showed that 10% of health care spending goes toward medical malpractice. This is in the form of gigantic payouts and unnecessary tests ordered in fear of getting sued. To say that lawsuits aren't a major factor in tests that are ordered would be a total fallacy.

It has also been suggested that medical malpractice is just a drop in the bucket in health care spending, but I argue that 10% of a 2 trillion dollar a year industry costs about 200 billion. Over ten years that is the estimated cost of the entire health care reform being proposed by Kennedy and Baucus. I hope that in the coming weeks someone can tune in Mr. Obama, break him away from his trial lawyer buddies and tell him how important this issue is for entire field of medicine. It will help curb costs and improve health care efficiency around the board.

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Obama's AMA Trip

President Obama laid out his floor plan to the AMA this morning. His reform platform has goals to reach coverage for millions of more Americans over the next few years in an attempt to spread the insurance liability. His approach is also tackles what he calls "inefficient medicine" or "wasteful spending" on items such as "EKG's" and "CT scans." He goes on to say that tests like this are often uneccessary and physicians are ordering them because he thinks doctors are getting kick backs for ordering them. I am not sure where he is recieving this information, but its far from the truth.

Doctor's order tests like EKG's and CT scans routinely for certain life threatening reasons and they are very neccessary, but there are times that you could probably get away with not ordering one because the odds are that the patient is fine. It is under those circumstances that lawyers jump right into our minds. Even if there was a 999 in 1000 chance that an EKG would most likely be normal, it is that one which ends up costing millions of dollars. Nothing in medicine is 100% and its for that reason that there are going to always be wasteful tests and procedures.

Obama either doesn't understand this yet or he doesn't care because it keeps his fellow lawyers in business. Either way it is on him to tackle reform with extreme liability and malpractice reform. If the government wants to stick their nose in this, they need to address that situation first. He needs to not only protect the people but also the physicians against this intrusion upon medical decision making.

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