Wednesday, January 5, 2011

What is the Physician’s Role in Health Reform and Possible Repeal?

The question posed is an intriguing one. How do physicians play a constructive role in health reform without appearing to be partisan and self-serving? This role will be a tricky balancing act.

To begin with, I believe we should be as nonpartisan as possible. This is not easy. About 60% of Americans oppose the new health plan as a whole, but they like parts of it. The percentage is similar for physicians, who approve of parts of the plan but who are dissatisfied with the failure of the health reform law to address tort reform, the doctor “fix,” and primary care shortages.

Other often talked about subjects among doctors are how to install and afford electronic health records, how to think about accountable care organizations, and how to deal with new regulations punishing noncompliance with federal regulations.

The Physicians Foundation, a 501C3 organization representing 700,000 physician belonging to state medical societies, has taken a sensible approach. The Foundation conducts national surveys of doctors, publishes white papers on issues that concern doctors, issues grants to physician organizations seeking to improve care and efficiencies, and helps physicians speak to the media with a unified voice on reform issues.

Among other things, these activities reveal discontent among doctors on the current status of health reform, fears that new compliance regulations and low reimbursements will force them out of practice, concerns over the burdens of caring for 32 million more uninsured patients, and a pervasive feeling that their input into the real reform issues has been sorely neglected.

Because of the combined effect of the reform law and other economic pressures, doctors are selling out to hospitals in record numbers, and private practice is in sharp decline. All of these things raise the specter of a massive access crisis down the line, particularly among new Medicare patients among 79 million baby boomers who are just starting to enter Medicare ranks at the rate of over 12,000 each day.

Adding to the uncertainties of the profession is the movement to repeal Obamacare. Of the new members of Congress, 87 of the 96 new representatives are Republicans, and 9 of the 10 new Senators are Republicans. Many of these new members of Congress were elected by promising to repeal, or at least modify the health reform bill, all at once or piece by piece.

To carry out this mandate of change will require that reform opponents replace the bill with politically popular reforms It will require they acknowledge that Medicare and Medicaid account for nearly all the growth of future government outlays. Yet these programs are popular, and one tampers with them at one’s own political risk. Medicare remains the third rail of politics, Nevertheless Medicare and must be modified, be it by increasing the age of entry, means testing, or vouchers.

Physicians participating in the reform effort recognize that certain aspects of the reform law – coverage of young adults up to 26 under their parents’ plans, pre-existing illness, and the uninsured, and discounts of brand drugs for seniors in the Donut Hole are popular.

In my opinion, physicians engaged in reform, should,

• campaign for more trust in patients to choose and control their own care rather than in trusting government experts to make those choices and exert that control,

• insure that a safety net exists for the needy and uninsured rather than for everyone regardless of need,

• stress physicians need more resources to enable them to spend more time with patients rather than squandering time on filling out forms or following protocols,

• emphasize that private-sector, market-based innovations to extend and prolong life are superior to government regulations that hamper innovations.

Over the next two years, I anticipate most repeal efforts will be piecemeal and will focus on,

• Repeal of requirements that all businesses submit a 1099 form for every $600 expense item, This is bureaucratic nuisance that will overwhelm small and large businesses alike.

• Repeal of the individual mandate, This will require too many IRS agents to enforce, is invasive and may be unconstitutional.

• Modify regulations like end-of-life counseling as the first wave of rationing,

• Slow health exchanges as too burdensome and expensive for already strained state budgets. These exchanges may bring states into default.

There may be some effort to “fix” the sustainable growth rate (SGR) for doctors, but I do not expect any permanent solution will be advanced nor am I optimistic about tort reform on a national level.

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