Washington Post,10 Things I Hate About Health-Care Reform, September 6, 2009
As a cardiologist and the administrator of a large practice that includes general internists and specialists, I spend much of my time trying to figure out how to provide care for a growing number of uninsured or underinsured patients. I also have to battle billion-dollar private insurance companies that don’t adequately cover patients with preexisting illnesses and often deny coverage for necessary treatments.
Here are 10 major reasons why I — and doctors like me — worry that the legislation on the table will leave us worse off.
1. Private insurance companies escape real regulation.
2. We urgently need tort reform, but it’s nowhere to be seen.
Without fixing these spiraling insurance costs and the legal environment that allows large payments in unjust suits, physicians will continue to practice expensive “defensive” medicine or simply leave states that do not enact tort reform.
3. “Prevention” won’t magically make costs go down.
in general, prevention adds to costs instead of reducing them. That’s because it often means medication for hypertension and elevated cholesterol, and screening and early treatment for cancer. No amount of “prevention” will put a dent in the cost of keeping Americans healthy.
4. Reform efforts don’t address our critical shortage of health-care workers.
Many people believe that the fix for our physician deficit is simple: expand class sizes at existing medical schools and create new ones. Sorry, it’s not that easy. There is a cap on the number of federally funded training positions for newly minted M.D.s. It hasn’t changed since 1996. If the number of graduates of U.S. medical schools increases but the number of post-graduate training positions remains the same, we won’t have fixed the problem — we’ll have created a different one.
5. We need more primary-care physicians — but we also need specialists.
Everyone is worried about the dwindling ranks of primary-care physicians. But we need more specialists, too. There are impending shortages in fields such as oncology, cardiology, general surgery and gastroenterology. Few Americans will tolerate not having access to a specialist in an emergency or having care rationed because of a limited number of skilled physicians.
6. We have to streamline drug development and shake up the Food and Drug Administration.
Creating and producing new drug therapies in the United States is a nightmare. Regulatory hurdles, disorganization and a lack of leadership at the FDA, as well as burdensome conflict-of-interest policies, have made the drug-approval process grindingly slow. At the same time, development costs are close to $1 billion per drug.
7. We can’t fund health-care reform by cutting payments to doctors.
The Centers for Medicare and Medicaid Services has proposed increasing payments to primary-care physicians by approximately 6 percent while lowering payments for many specialists, including cardiologists and oncologists, by as much as 20 to 40 percent. The American College of Cardiology estimates that 40 percent of the cardiology practices in Florida will go bankrupt.
8. We can’t forget about research.
Every modern treatment for human disease is related in some way to research at U.S. academic medical centers. However, decreased federal funding for research over the past six years has threatened to decimate a generation of young scientists and the cures they could discover.
9. Cutting reimbursements could shut some hospitals down.
It is unlikely that the homeless, the mentally ill, the substance abusers or the illegal immigrants who now receive their care in “safety net” hospitals will carry any form of health insurance.
10. We need to improve the quality of care.
The Institute of Medicine has pointed out, poor quality of care can be divided into three types: underuse of care, misuse of care and overuse of care. While eliminating misuse and overuse will decrease the cost of care, correcting problems from underuse will actually increase costs.
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I want my patients to have insurance that will pay for their care, and I want to be able to offer new medications and the most sophisticated treatment. I want to be able to give preventive care as well as to monitor patients effectively if they develop diseases. I want to be able care for my patients in their homes, and I want to offer palliative care if it becomes necessary. I want them to be able to afford all this.
In short, I want to see major reforms in health care — I just don’t want what is on the table.
Full article:
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/04/AR2009090402274.html
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