Tuesday, August 17, 2010

Physicians’ Health Reform Manifesto

In issuing this manifesto, I do not presume to speak for all physicians. But I believe what I say here represents the views of most physicians who practice in an environment dominated by third parties, such as Medicare and private health plans.

One, we are overwhelmingly for the right kind of reform, which allows patients access to care without fear of bankruptcy or substandard care.

• Two, parts of the new reform bill fit our concept of the the right kind of reform, covering the uninsured, those with pre-existing illnesses, young people up to age 26 under their parents’ plan, and those with expensive chronic diseases.

Three, But the right kind of reform should also include fair-minded, capped, equitable tort reform, which reimburses injured patients; consistent Medicare physician payment reform, predictable over time; and the right of doctors to contract to bill patients directly outside of Medicare.

Four, we believe the current health reform law favors top-down Medicare and Medicaid reform, and penalizes or excludes ground up market reforms. This constrains innovation and entrepreneurship.

Five, we should acknowledge that the U.S., in effect, already has a single-payer system, driven by government, which pays for ½ of costs and covers 1/3 of the population, and the Reimbursement Update Committee (RUC), which sets physicians’ fees.

Six, the most effective way to lower costs would be to remove third parties, i.e. Medicare, Medicaid, and health plans, from patient-doctor relationships, give patients vouchers to pay for their care, have patients pay for a portion of their care, make health costs deductible across the board, encourage patients to have health savings accounts with high deductibles and a catastrophic cap and to set aside tax-free money for retirement.

Seven, we are opposed to the wrong kind of reform, which ignores adverse consequences of the new law – higher costs, steeper national debt, higher premiums, higher taxes, and heavier patients loads on overworked and over-regulated physicians, already in short supply – and which decreases patient access and longer waits to see physicians, who simply will not be able to handle the flood of 30 to 34 million newly insured patients coming on board in 2014, and 5 million new Medicare patients becoming eligible each year in 2011 who may have false expectations of “free” government-sponsored and subsidized care.

Eight, we are skeptical about reforms that attribute shortfalls of the system to U.S. physicians alone rather than to our national culture, with its freedom to behave as one wishes. Many of our relatively poor national statistics are due to factors beyond the physician’s control – a faltering economy, poverty at home, violence in the streets, lack of familial coherence, failure to fill prescriptions, and personal health abusing behaviors.

Nine, we believe many of the deficiencies of our current system could be addressed through such successful programs a Project Health, which now exists in six major cities, and which allows physicians to team with college volunteers to help families address such critical health issues as poor housing, transportation to health facilities, help with food stamps, aid in understanding medical instructions, and assistance in finding job training and placement opportunities.

Ten, we believe the health law can and should be modified to more clearly represent the “the will of the people,” 60% of whom oppose the bill, who wish to retain their present health plans, including Medicare Advantage, and who desire freedoms to choose doctors, hospitals, other health facilities and providers, with access to the latest and best technologies, without fear of federal intervention.


怡靜怡靜怡靜怡雯 said...


Richard L. Reece, MD said...

English please. I would love to know what you are saying.