After much deliberation, I have decided to blog in response to the timely topic of health reform. I hesitated to blog about this topic because of the political “hot button” nature; however, I decided it was important because (1) it has such a tremendous impact on both physicians and patients and (2) physicians have to start speaking out.
My opinion of the issues at the forefront…
- First of all, we should not call it “health care reform” because it does little, if anything, to improve the care that people receive (see below – issues in the background). It should be called “health insurance reform” because it primarily addresses access to insurance. Just because somebody has insurance does not mean they can get care. (see below – issues in the background).
- I am in favor of the majority of the health reform bill including the following: stopping insurers from denying coverage due to pre-existing conditions or placing lifetime limits on benefits; allowing adult children to stay on their parents plan until age 26; stopping insurers from charging higher premiums to those with pre-existing conditions or based on gender (women currently are charged higher premiums); stopping insurance companies from dropping your insurance if you get sick; requiring insurers to provide women with mammograms and prenatal care with no out of pocket costs; changing income levels for Medicaid eligibility; giving tax credits to individuals who don’t qualify for Medicaid but make less than $43,000 per year; and requiring employers with over 50 employees to provide insurance.
- The most controversial aspect of the health reform bill is whether the government has the right to make health insurance mandatory and impose a penalty on those who do not have health insurance. Total health care costs for the uninsured is a tremendous financial burden on our society. In 2008 $43 billion dollars of healthcare was unpaid. Because of this, I think it is reasonable to impose a penalty for those who choose not to purchase insurance as long as insurance is affordable. I am hoping with the changes in Medicaid eligibility, tax credits, employer requirements, and a health insurance exchange, insurance will be affordable. Many people may decide that paying the penalty would be less costly than purchasing insurance.
More important issues is the background…
Health reform does not address the ability of doctors to provide access or their ability to give quality care. If the ignored issues below are not addressed, I predict that health reform will worsen access and quality of care. Here are the issues that are not at the forefront of the discussion but are in the minds of most physicians.
- You may have insurance but if you can’t get an appointment to see a doctor, you can’t get access to care. Thirty million Americans will have insurance in 2014. Are there enough physicians to see these insured patients? How will the quality of care be affected with this influx of patients into the clinics and hospitals of America?
- How will health reform affect insurance reimbursement that continues to decline? If reimbursement is not addressed, doctors will have to see even more patients and quality of care will decline. Fewer doctors will accept payment from Medicare and Medicaid. Many doctors will stop taking insurance at all or stop practicing medicine.
- Primary care physicians (family physicians, internists, and pediatricians) are amongst the lowest paid physicians. They are already seeing patients every 5-15 minutes, working long hours, and seeing their pay decrease every year. Fewer and fewer medical students are choosing primary care specialties. If this is not addressed, the health care system will likely not be able to accomodate 30 million more insured Americans.
- Medical school education is very expensive. Most physicians finish their training with a mountain of debt (average $200,000). The cost to attend medical school is $40,000 – $67,000 per year, total cost $160,000-$268,000 to become a doctor. After medical school, doctors make less than $50,000 for 3-7 years of advanced training for their specialty field. If we want more primary care physicians, we have to make this education more affordable.
- The cost of medical malpractice insurance has been completely ignored in health reform.There is no question that the cost of malpractice insurance and “defensive medicine” is a significant contributor to health care costs. Ignoring this piece is a huge mistake and leaves a giant obstacle for cost containment.