Today, the Executive Vice-President of the AMA sent a
letter to the Chair of the House Ways and Means Committee, Congressman Charles
Rangel. In that letter Dr. Maves expressed official
AMA support for H.R. 3300 and were "pleased" that the bill did many things. The
bill itself was discussed by CBO Director Doug Elmendorf today in Congress and
he advised the Senate that the bill would bend the cost curve up, not
down as was promised by the white house.
As the founder of Doctors for Patient Freedom, I have worked to analyzed the bill before the house and it appears the bill will create government run medical care, force all Americans into the system the government runs (with no way out), ration care and create unacceptable economic burdens on taxpayers, our children and our grandchildren. In the end patients won't be able to trust their doctors as they are forced to comply with government and insurance company rationing programs lest they be forced out of practice. Doctors won't work for the patients. They will work for bureaucracies and those who hold the purse strings: government and large insurance companies. I join many other state medical associations who are expressing concerns about this bill and its center piece: a public option.
There are better ways to solve our health care
problems that are directed at lowering costs of health insurance and medical
care. They are rooted in empowering Americans as individual consumers. The
President is right when he says we should change the status quo. Sadly, he and
Congress seek to maintain the status quo with money and power in the hands of
government and large insurance companies. A true change would mean changing tax
law to enable people to buy insurance outside of work, deregulation of insurance
companies that makes insurance more expensive, allowing consumers to spend money
across state lines. Further, ownership of health savings accounts would allow
individuals to demand more time with their doctors by paying them directly. It
would allow true consumer control of costs - when patients spend their own money
on routine annual health care, they will drive down costs and increase quality
of care. When they have a true catastrophe, they can still be covered by a 100%
coverage health insurance plan they need only use a few times in their life -
one that still covers preventative care such a mammograms as well.
As a leader in organized medicine, I believe it is
important to analyze some of the items that the AMA pointed out were good for
America.
"AMA: Promises to extend coverage to all Americans through health insurance market reforms;"
Congress loves to make promises, but it rarely keeps them. The CBO has pointed out that only about 12 million people would be covered even with spending over $1 trillion per year. Another 15 million would be pushed into Medicaid - a program in which 40% of Americas physicians won't see payment since payment for services is at 57% of Medicare rates. What happened to the 46 million Americans that Congress wants to cover? Also, what happened to the promise Congress made in 1965 to cover medical costs for the elderly? In the current bill, Medicare spending would be cut $400 billion to cover some of the costs of this bill.
"AMA: Provides consumers with a choice of plans through a health insurance exchange;"
Page 16 of the bill states that starting in 2013, Americans will only be able to purchase a "qualified health benefits plan" through the government exchange. In 2013 the plan you have now will not allow more people to buy in. In 2013, patients won't have any choice to buy insurance outside of the exchange or any insurance that is not deemed "qualified" by the government. The President likes to say that "If Americans like their health insurance plan, they can keep it". What is not said that the cost of that insurance will be driven up so high that no one will "like" it and the only "choice" left will be the menu created by a government bureaucracy - one in which lobbyists and special interests reign supreme.
"AMA: Includes essential health insurance reforms such as eliminating coverage denials based on pre-existing conditions;"
The regulations that the government will impose will drive up the cost of insurance so high, that Americans will lose more of their disposable income to it. They will be forced to buy the insurance created by the government. Eliminating pre-existing conditions really means raising the cost of insurance for the young and the healthy - an approach called community rating. So a 30 year old health father of four will be required to buy insurance that is estimated to cost 75-95% more under the "reforms" than it does today. Today such a policy costs $12,800 for such a family. Helping one group of people buy artificially lowering their costs, necessarily increases the costs for many others.
"AMA: Recognizes that fundamental Medicare reforms, including repeal of the sustainable growth rate formula, are essential to the success of broader health system reforms;"
For many years, the government has paid doctors well under the cost of the services they provide to patients. By 2012, a 40% cut is projected to doctors - a fatal blow that will drive doctors out of Medicare leaving the elderly stranded without a doctor. Unfortunately, the method of fixing this problem is to set doctors pay based on how well they comply with cost-cutting (rationing) protocols. If doctors don't meet "government thresholds" for spending, they will be paid less. In current programs rewarding doctors to report how well they comply with these thresholds, doctors were still paid far less than the actual cost of reporting the data. In another example of funny math by the administration, doctors will be given $44,000 over five years to send their patients' medical data and their own report card data to the government. Unfortunately the actual cost of the system over five years is $120,000. Thus the government - which will be even further strapped with money - will always find ways to cut pay to doctors. In fact, the bill quite clearly states that the payment system will be completely restructured in this way.
"AMA: Encourages chronic disease management and car e coordination through additional funding for primary care services, without imposing offsetting payment reductions on specialty care; Includes prevention and wellness initiatives designed to keep Americans healthy;"
It is true that prevention and management of chronic disease will help lower costs. But as it turns out "prevention" doesn't really save money for the system since such care itself is costly. In addition, people still get cancer, heart attacks, infections and are still involved in accidents. We can't "prevent our way" out of spending money on health care. See below for more on impact on specialty services but the Center for Medicare and Medicaid Services is likely to arbitrarily stop paying "consultant" fees - lowering the payment to all specialists in one stroke to finance payment to primary care doctors.
"AMA: Addresses growing physician workforce concerns;"
A recent ruling from the Center from Medicare and Medicaid Services indicated that an increase in payment for primary care would come from cutting payments for things like caridiology (11%) and for tests like echocardiograms and EKG's. There are over $4 billion in cuts for imaging services that will lead to radiologists leaving medicine. In addition, doctors who don't comply with rationing and cookbook medicine protocols will be driven from practices by denial of "incentives", penalties and unfunded mandates. The physician shortage will worsen. This was proven in Massachusetts when it was demonstrated that primary care shortages have lead to very long wait times to see such doctors there. Allowing a 6-8% bonus to primary care while imposing double digit costs on those doctors will exacerbate this problem, not solve it.
"AMA: Strengthens the Medicaid program;"
Congress routinely pays doctors and hospitals well under cost of the services provided. In fact in Boston, such poor patients are paid so poorly under the model of Congressional reform - the Massachusetts mandate - that the Boston Medical Center just filed a lawsuit against the state for all the free care it is being forced to pay. If more free care is demanded, that hospital will have to close. This is another promise that Congress can't keep.
AMA: Requires individuals to have health insurance, and provides premium assistance to those who cannot afford it;
This mandate will impose a tax on Americans of 2.5%
of their income if they don't buy health insurance. They will be forced to buy
health insurance that will be over-priced. The insurance companies will enjoy
the mandated extra business and will generate unnaturally high profits. In
Massachusetts, this mandate is failing. The state now spends $1.5 billion on
health care to subsidize (through taxes) those who can't afford the mandate.
There are waiting lines to see doctors, there are rationing protocols being
imposed on doctors and hospitals. Few are satisfied with this program in the
state. There are better ways to ensure people buy insurance. Given them a tax
credit (a voucher) to buy insurance outside of work. Allow them to buy across
state lines - insurance in Utah has fewer mandated benefits than in a state like
Minnesota where the cost of insurance is driven up by mandated benefits like
Viagra and marriage counseling.
AMA: Makes needed improvements to the Physician Quality Reporting Initiative that will enable greater participation by physicians;
This program requires doctors to send their medical practice data to the government so the government can determine if that doctor is "good". That program already pays well under the cost for reporting. In addition, the government will use that doctors to penalize doctors who don't meet certain "efficiency" thresholds. This is used by insurance companies already. United Health Care directed patients away from my practice, and imposed costly administrative hassles on my staff because for fewer than 35% of patients on whom I did delicate spine surgery, I allowed $22,000 to be spent on their care rather than the goal of $17,000. That money was spent on the patient for hospital care, surgery, tests and physical therapy. The government and insurance companies seek to penalize doctors like me who spend too much of "their' money on patient care.
"AMA: Initiates significant payment and delivery reforms by encouraging participation in new models such as accountable care organizations and the patient-centered medical home."
Accountable Care Organizations will drive small and solo docs (75% of doctors) into group practices that will be forced to follow the rationing protocols or be paid less. There will be more bureaucracy for the patient and the doctors and less personalized care. The medical home is a great idea, but will come at the expense of specialty care that Americans still need as indicated above. Other payment reforms includes "pay for performance" where doctors are told how to practice medicine by a committee. Such medical practice has been shown to hurt patients, cause patients to get the wrong medical care so doctors can get a good "report card", lead to doctors to avoid costly and high risk patients and forces doctors to ration care in the name of "efficiency".
There are better ways to reform our health system. Congress needs to stop its overcharged rush to bad reform and allow true reform to the Medicare system. It needs to focus government money on the poor and encourage charities to help too. It needs massive change indeed - it should take power from the hands of government and insurance companies and place it in the hands of individuals. Then we will see a real change for the better as prices are driven down and doctors and hospitals are held more accountable directly to their patients.
Dr. McKalip is a private practice brain and spine surgeon in St. Petersburg, Florida. He is the President-elect of the Pinellas County Medical Association, President of the Florida Neurosurgical Society, serves on the Board of the Florida Medical Association (FMA) and is on the Florida Delegation to the AMA's key policy making body, the House of Delegates. He serves as the Chairman of the Council on Medical Economics for the FMA and lead the effort to write a health system reform plan for the FMA that focuses on individual financial empowerment of patients. Dr. McKalip founded Doctors for Patient Freedom and is working to ensure that individual savings, choice and competition create better and more affordable medical care for Americans. Dr. McKalip has written and spoken on the unintended consequences of expanded government and corporate control of health care financing and medical decision making including rationing, cookbook medicine, unsustainable economic models for government and unaffordable or unavailable private insurance products and financing options for patients.