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Archive for the ‘Health Care Reform’ Category

In a previous column, I explained the various components of the Affordable Health Care Act. Now, I would like to give my perspective on this politically controversial plan.

I’ve seen a lot of changes to health care during my 40 years of medical practice. Needless to say, we’ve come a long way, but we still have a long way to go.

The provision of health care today, as we know it, is not sustainable. It worked well for many decades but needs drastic changes beginning now and into the future. To not change the way health care is delivered will bankrupt our nation.

It is that realization that makes me able to accept the new health care act, even with potential faults and uncertainties. No alternative plan has been offered to the public, so I am hopeful that this act of Congress will be the beginning of a change that is so desperately needed for our health care delivery system.

I want to be clear that I strongly believe that we, as a compassionate and caring society, ought to make sure that every citizen has the right to health care. How we can actually provide it and pay for it will be the biggest of uncertainties.

 

A recap

Regarding the Affordable Care Act, I previously mentioned some changes in health insurance regulation that have already taken place and some that will occur by 2014 (“Many parts to federal health care law,” Page 10, Aug. 3).

These include the elimination of preexisting conditions as a barrier to obtaining insurance, allowing children of policy holders to be covered until they are 26 years old, covering more preventative care and eliminating lifetime limits on how much in benefits insurance will pay.

These great new concepts should have been implemented years ago.

 

Health insurance required

Under the new law, most Americans will be required to have health insurance by 2014. Low- and middle-income families will be eligible for tax credits and subsidies to help pay the insurance premiums, unless they are covered by affordable insurance through an employer.

A potential problem here is that under the provisions of the law, some working-class families could be unable to afford family coverage offered by their employers. I am hopeful that under the new law they will be eligible for government subsidies to purchase their own insurance through the newly-created insurance exchanges.

It is also possible that companies expecting increased insurance premium costs may raise their employees’ deductibles and co-payments. Small businesses will be eligible for tax credits to help cover their workers, and yet it is reported that some small companies are thinking of dropping health insurance altogether. However, if that were to happen, those affected employees could buy coverage through insurance exchanges.

 

Possible scarcity of doctors

Another problem is that about 30 million citizens will be newly covered by health insurance, and there won’t be enough doctors to meet their needs. The Association of American Medical Colleges estimates that in 2015, the country will have about 62,000 fewer physicians than it needs.

The new law will attempt to forgive medical students of burdensome loans and reimburse higher Medicare rates to doctors who work in underserved areas.

Initially, it may be very difficult for the newly insured to find primary-care doctors, causing long waiting lists and overused emergency rooms and possibly driving some people with insurance to forgo needed care.

I envision that more treatment of patients will have to be done by non-physician providers, such as nurses and nurse practitioners, certified assistants and home health care aides.

 

Medicaid expanded

The new law expands Medicaid, the government health insurance program for the poor, to cover about 16 million citizens who will be newly enrolled in the program.

Each state was given the option of whether to participate in this expansion of coverage for Medicaid patients. States that participate will receive full financing from the federal government to fund the newly insured. In states that don’t participate, there could remain a number of our nation’s poor without coverage.

Also, the reimbursement to health care providers from Medicaid is so low that many providers may not want to accept Medicaid patients.

On top of this, and not covered by the new law, all physicians face a 32 percent cut in Medicare rates at the end of this year.

 

Hospitals affected

Hospitals have major concerns, too. They are scheduled to receive decreased reimbursements from Medicare and Medicaid for the uncompensated care they provide. The federal government now spends $20 billion annually to hospitals to help cover costs of the uninsured and illegal immigrants, neither of whom, by law, can be turned away from the doors of a hospital.

Under the new law, eventually one half of that reimbursement to hospitals will cease. Hopefully, the number of uninsured patients will decrease in proportion so as not to further financially burden the hospitals.

 

Who will pay

Last is the concern for how the new law will be financed.

Mostly, there will be new taxes. Individuals who choose not to buy insurance and employers who don’t offer it will pay billions of dollars in penalty taxes. Individuals making more than $200,000 and couples making more than $250,000 will pay increased Medicare tax on wages and an additional 3.8 percent on investment income.

Tanning salons, insurance and drug companies, and medical device manufacturers will pay more taxes. Individual Flexible Spending Account contributions will be lowered and medical-dental income tax write-off thresholds will be increased.

Hopefully, these changes will be offset by new insurance policies that have lower deductible costs and cover more care than was previously provided, thus lessening out-of-pocket expenses.

In summary, my opinion of the Affordable Health Care Act is that it does offer many improvements in the delivery of health care in general and will offer this care to many who now lack it. But who provides the care, how much it will ultimately cost, how highly we will be taxed for it and how much new bureaucracy will be created to administer it are all questions that remain to be answered.

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I would like to offer my interpretation of the federal government’s Affordable Care Act, commonly called Obamacare.

First of all, insurance companies will be regulated. There will be coverage under the parent’s policy for children up to age 26. There will be no maximum limit on what an insurance company will pay for an individual’s lifetime of health care coverage, and preexisting illness cannot prevent one from obtaining health insurance.

Preventive care, such as mammograms, colonoscopies and other related services, will be covered by all insurance plans with no out-of-pocket expense.

A Prevention & Public Health Fund will be created to promote general health and wellness programs and initiatives to combat obesity and discourage tobacco use, alcohol and drug abuse and other unhealthy conditions.

Added taxes will be placed on pharmaceutical companies, medical device makers and the tanning booth industry.

The government will regulate and control reimbursement to health care providers — that is, physicians and hospitals.

A commission, acting independently of congressional control, will develop new ways of paying for medical care, with a move away from the fee-for-service model. One such new model is called the Accountable Care Organization. This would function somewhat like an HMO, except that ACO patients would not be required to stay within a network.

In addition, there is the “individual mandate” part of the act. This is a requirement that starting in 2014, all U.S. citizens will be required to purchase health insurance. It pertains mostly to the 30 million people who, for whatever reason, are without health insurance.

About half of these uninsured people have incomes high enough to buy health insurance through state-run health insurance exchanges. The others have incomes low enough that they will be covered by the existing state-run Medicaid programs.

For people who choose insurance through the exchange, premiums will be regulated by the government, which will also provide subsidies to help those who cannot afford to buy insurance. People who work for firms with 100 or fewer employees will also be able to purchase their own coverage through the exchanges. Undocumented immigrants will be barred from purchasing insurance through the exchanges.

There will be a penalty to individuals and companies who choose not to purchase health insurance. This penalty — which the law calls a tax — will top out at $695 per individual and $2,085 per family. There will be no criminal or civil action for refusing to pay the penalty; however, the IRS could withhold tax refunds from those who owe penalties.

In summary, the Affordable Care Act is an attempt by the federal government to help provide health insurance to the 30 million-plus citizens who have no coverage. It makes significant pro-consumer changes to existing health insurance regulations and makes an attempt at offering programs that could improve the health of most American citizens.

There are some major questions being asked about this law, such as: Will there be enough medical providers to care for the newly insured millions of Americans? Will there be enough money to finance this ambitious project, and where will it come from? What happens to states that don’t want to increase their Medicaid programs?

This is a large and complex law with many details that still needed to be worked out. In a future column, I will give my personal assessment of its major provisions.

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Now that the health care reform law has been passed, it’s time to get serious about tackling the problem of the cost of health care to our nation, which, if not controlled, will threaten to bankrupt our economy.

Since World War II, we have witnessed an unprecedented development of technology that has increased our life spans and helped conquer many life-threatening diseases. This improvement of health care has come at a tremendous financial cost and continues to grow.

Last year, spending for health care in the United States was $2.4 trillion. That total is about 17 percent of the gross domestic product and more than four times the amount spent on national defense. Health care costs are rising at more than two times the rate of inflation. Since 1999, employer-based health insurance premiums have increased 120 percent, while inflation has risen 43 percent and wages have risen 30 percent.

The way I see it, our health care system comprises the following groups: doctors, patients, hospitals, medical insurance companies, drug companies and the government. Every one of these groups will have to make some major sacrifices and adjustments to its status quo to help bring down costs. Their willingness to do so will be the key to success.

Here is my opinion of what each group needs to do.

Doctors: Health care providers need to change the way they are reimbursed. Fee-for-service compensation — that is, receiving payment for each patient seen or each procedure done — has worked well for many years, especially when costs were a fraction of what they are now. The medical profession is now developing evidence-based practices that provide guidelines for the best, as well as the most economical, treatment for patients. There also needs to be an emphasis on and compensation for a new focus on preventative care.

Patients: The people of the United States have, for the most part, been privileged to receive some of the best medical care in the world, without regard to price or value. There will need to be some form of sensible rationing of health care, and I’m not talking about the infamous “death panels.” As it is now, we function under a “blank check” mentality, where the doctor can provide any and all care possible, no matter what the cost. Patients have naturally come to accept and expect this system, which is all too expensive.

Also, billions of dollars could be saved if patients took more responsibility for their own health. Our existing insurance model does not encourage patients to take care of themselves. Doctors can only do so much, but often, patients choose to continue to smoke, drink too much alcohol, gain too much weight, exercise too little or just keep up an unhealthy lifestyle.

Hospitals: We’ve all heard horror stories of exorbitant hospital charges. Hospitals must contain costs. The new health law should help them cut costs, because most people will now have some form of insurance to pay for their care. Hospitals will no longer have to compensate for the money they lose on uninsured patients by charging more for those who are insured. Hospitals also need to consolidate services and resources to eliminate the wasteful duplication that often exists. Our medical centers must be run more efficiently.

Medical insurance companies: These companies spend a lot of money on administration, and they earn excessive profits from high premiums. If they cut back on their costs of operation, they could lower premiums.

Drug companies: This group has, over the years, been a key player in the tremendous improvement in our health over the past 70 years. The drugs they have developed have improved, prolonged and often saved our lives. However, non-generic drug prices have risen all too rapidly and need to be fairer and more competitive. Some patients in the United States have been forced to go to Mexico and other countries to buy drugs, because they are cheaper in those countries. Drug prices in the world should be equal, not higher in the U.S. Our government and insurance companies need to insist on lower drug prices.

Drug companies also must immediately stop direct advertising to patients. They are only promoting expensive new drugs, when equally effective alternatives are available at a fraction of the cost. Doctors are uniquely trained to determine which drugs are best for their patients.

Government: This entity must help and encourage doctors to find the most beneficial and yet cost-effective treatments for patients, without overstepping the doctor-patient relationship. Government must work with and not against the medical establishment.

Government must also help regulate the medical malpractice question. The existing system of multimillion-dollar awards, with windfall profits to attorneys and patients, must change. Too often, huge awards are given with no correlation to actual malpractice, while there are other instances of actual malpractice that result in no compensation for the patient. To keep from being sued, it is estimated that doctors spend up to $200 billion practicing defensive medicine. In place of the existing malpractice court system, I would recommend a mediation system, wherein trained judges and panels of experts in medical and legal issues would award just and adequate compensation to deserving patients who have suffered true malpractice.

With the suggestions listed above, and with doctors implementing effective cost-containing measures, I believe we can save our health care system without lowering the quality of care.

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I have been asked by numerous people about my view of the recently passed health care reform law.

First, as someone who tends to lean more to the conservative side, I have always been leery of a government-run health care system, because I feared that “big brother”’ would come between and interfere with the important concept of the doctor-patient relationship. I have very serious concerns about what could happen to the quality of medical care in such a system.

In reality, the government already provides health care for a significant percentage of the population in this country through Medicare, Medicaid and the Veterans Affairs health program. Whether these systems are the best they can possibly be is a matter of opinion.

Given the fact of the existing level of government-run insurance, I think the best scenario would be that the majority of us not covered by the government would continue to obtain private health insurance and that such insurance would be affordable and be made more competitive, compassionate and cooperative.

I am of the opinion that our health care system is one of the best in the world, but it has had its major problems.

One problem was that, although the majority of U. S. citizens had health care coverage, millions of people did not. This seems to have been remedied by the new law, which should really be called a “health insurance reform law,” because health insurance coverage was its main objective.

Another problem with our system is that the rate of national spending on health care is staggering and unsupportable. It cannot continue its pace without bankrupting our economy.

The new law has done nothing to lessen the rapidly increasing cost of health care — in fact, I fear it will increase spending, adding to the national deficit.

No political party until now has achieved this level of change in an attempt to improve our health care system, even when it was well-known that changes were necessary. I see this new bill as a step in the right direction, even with its flaws, because it will force us — patients, providers and government — to make important changes. Time will tell how well it works.

The things I like most about the new bill are:

• It provides expanded health insurance coverage for those who have none.

• It ends health insurance company abuses, such as denials based on pre-existing conditions or the ending of coverage after one becomes ill.

• People who are satisfied with their health insurance plans can keep them.

• It allows parents to continue coverage for their children up to age 26.

My concerns about the new bill are:

• The cost to implement this bill will be staggering and will be unable to be supported by increased taxes on the wealthy and the proposed “Medicare savings.” This will lead to increased taxes for all or a restriction of health care.

• Those who have health insurance, both private and Medicare, will pay higher premiums to cover the expanded care provided by the new bill.

• Although the law has provisions to increase the number of primary care doctors, there will not be enough providers for the millions of new patients seeking care.

• There is no provision to decrease the rapidly escalating cost of medical care, which, if not brought under control, could be disastrous for our economy.

The bottom line as I see it is that something needed to be done to shake up the health care system to provide for its long-term healthy existence. The new bill has major flaws, but it is a beginning to promote the necessary changes.

Now, what is absolutely imperative is to develop a plan to rein in the cost of health care. In my next column, I will share my thoughts on how to bring this about.

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