Health Care Reform HR 3200
I'm a bit off this year w/ documenting stuff. If you're still reading my blog - here are a couple of notes from Jon on the health care reform issue.
HR 3200
Here is my basic stance on HR 3200 (with a little background information).
I welcome all comments, questions, discussion, concerns etc. (For a few quick bullet points scroll to the bottom.)
First, I do not think the current health care system in the United States is perfect. I do believe reform is needed. So I do not oppose this plan just because it is new or different or because I am scared of change. I oppose it because I think it will worsen overall health care in the United States.
The first thing that must be recognized is that money and health care cannot be discussed separately. Regardless of your stance on the issue, health care costs money and uses resources.
I oppose HR 3200 because it does not adequately address the costs related to health care. Without adequate cost savings, there are only two choices for a government run health care system: bankruptcy or rationing of care. I do not support either of those options.
According to a letter send by the Congressional Budget Office (CBO) to the U.S. House (http://www.cbo.gov/ftpdocs/104xx/doc10464/hr3200.pdf) the estimated 10 year cost of the bill is $1.042 trillion. They also project cost savings of $219 billion and increased federal revenue of $583 billion, so that the overall national debt would only increase $239 billion.
I admit, at first it seems an increase in the national debt of only $239 billion for universal health care is not a whole lot (that in itself is a fairly sad statement about the national debt). However, I (yes, I’m not an experienced government accountant or for that matter a very experienced doctor, but neither of those groups necessarily make the right decisions) feel the cost assumptions are wrong. The vast majority of cost savings will come from cutting reimbursement to hospitals and physicians for seeing Medicare patients.
Medicare (as it is now) is a government sponsored health care program (mostly) for elders. Participation by hospitals and physicians is voluntary. Already Medicare reimbursement is much lower than private insurance reimbursement and many doctors do not accept Medicare patients. How will this change when Medicare reimbursement is cut (estimated to be about 20%)? Basically, many more hospitals and physicians will stop accepting Medicare. So now there will be many elders out there “with insurance” but with insurance that no one accepts. The two options then will to add these patients to the government option (thereby increasing costs) or forcing hospitals and physicians to accept Medicare patients (thereby effectively nationalizing the countries doctors).
It’s that second option that scares me the most. Yes, I am not an impartial observer. I am a doctor and I don’t want the federal government telling me which patients to see and how to treat them.
I admit that these are just my predictions and could (hopefully) prove to be wrong. But they scare me. Once physicians are forced to see Medicare patients at reduced reimbursement rates, I think current private insurers will attempt to also reduce rates. Currently if a private insurer reduces rates, the hospital or physician can just stop accepting that insurance and the federal government would not get involved. However, when the government knows that these patients will be transferred to the federal system, I foresee government intervention in again forcing hospitals and physicians to accept the lower rates from private insurance.
Being forced to see more patients while receiving less reimbursement will result in one of the two choices above: bankruptcy or rationing of care. Rationing of care will likely first be seen as the relatively innocuous “less time with the doctor” that patients are already complaining about. It will not stop there. Already every hospital in the country has a “preferred drug list” that basically includes the cheapest drugs in each class of medication. Currently I can write for any medication I want, even if it’s not on the preferred list, but I must sign stating why I want it. I see much tighter control and more effective rationing of medications with the proposed system.
I’ve written too much and probably no one cares, but I thought I would throw it out there. There are many other reasons I oppose HR 3200 and would be more than happy to expound on any if you are interested, but briefly the bill:
Will decrease funding of teaching hospitals
Does not meaningfully encourage use of preventive health care (which if done properly really could save money and insure all Americans)
Allocates taxpayer money to fund union health care programs
Disproportionally and arbitrarily increases taxes (instead of allocating responsibility for the nation’s health care to all citizens)
Increases regulations on small businesses (while exempting union contracts)
Transfers oversight further from the patient-doctor to a federal Health Benefits Coordinator
The full text of the bill can be seen here:http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.+3200:
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