Response to Comments on My Blog Posted at KevinMd.Com

Preface: On March 20, Kevin Pho, MD, posted the following blog on his site, the most widely read medical blog in America. The blog has drawn 49 comments, some of them critical. Thirteen of these 49 comments are mine, I wrote to clarify my position on the health reform law. I did not intend to be inflammatory or partisan in my blog, but to state flaws, misconceptions, and unforeseen consequences inherent in the one year old health reform law.

In the interest of further clarity, I would like to clearly state where I stand on his vital national issue of health reform. My 12-point statement appears after the blog. You may read readers' comments and my responses by going to kevinmd.com. I have not included these comments here because of length constraints.

Huge Holes Exist in the Health Reform Law (as it appeared in Kevinmd.com)

49 comments

by Richard Reece, MD

Huge holes exist in the health reform law you can drive an 18-Wheeler through. These holes are not “devils in the details.” They are so obvious nobody talks about them. They are the proverbial elephants in the room. I suppose this makes sense. It takes an 18-wheeler to transport an elephant.

Here are my six candidates of the biggest health reform holes.

One, the government’s lack of leverage over health insurers. President Obama and Kathleen Sibelius can talk all they want about the evil health plans and how they are outrageously raising premiums, on average by 10% to 20%. But other than jawboning and demonizing, the Obama administration has little control over the rates. It is fine to say the health plans must cover those with pre-existing coverage, young people up to age 26 under their parents’ plans, and to remove caps on lifetime expenses, but the plans can ignore the government and set the rates to cover the increased expenses engendered by government mandates.

Two, the government’s lack of appreciation that the U.S. is center-right not a center-left nation. At its core, America is a middle-class country that believes in limited government, limited taxes, and limited intervention in private affairs and private behavior. Two particularly sore points are: one, the individual mandate, which requires everyone to pay at least $700 , or 2.5% of income, and two, the provision that every business must submit a 1099 for every $600 spent for supplies or deserves, whether or not related to health care. In both cases, the IRS may crack down and pursue non-compliance. These two things strike Americans as government meddling. These government actions, in my opinion, accounts for much of the lack of approval of the Obama agenda and for the rise of conservatism, the Tea Party movement, and the embrace of the GOP over Democrats. The public wants Washington to swing to the center.

Three, the government’s lack of price controls. Everybody but Washington seems to know you cannot expand coverage for the uninsured by 32 million(and Medicaid by 16 million) and save money while cutting Medicare by $575 billion. And you cannot save money when 78 million baby boomers, starting in 2011, will begin becoming eligible for Medicare. Saving money under these circumstances is simply counter-intuitive. Congress lacks the political will, and no combination of taxation, fines, penalties, and punitive savings imposed on the health industry will make up for the deficit.

Four, the government’s incompetence in containing fraud and abuse. Fraud and abuse costs Medicare an $60 billion a year, over 11% of its budget, and that may be an underestimate. Someone has calculated that Medicare fraud and abuse consumes 7 times more money than the combined profits of the 14 largest health insurers, who are largely free of rampant fraud and abuse characteristic of Medicare. Medicare is too tempting a target for criminals who can use stolen Medicare IDs, and who know that Medicare is obligated to pay claims in 30 days.

Five, the inability of the States to pay for millions of Medicaid recipients scheduled to join the state rolls in 2014. Millions more may enroll before then when patients with current plans learn their new plans must meet government mandates that require comprehensive coverage and higher premiums they cannot afford. About 70 million will be required to change plans, and many of them will switch to Medicaid. Few Americans appreciate the Medicaid burdens States must shoulder. In California, Medi-Cal, its Medicaid program, cover 1/3 of children and 1/10 of adults under 65, 2/3 Of nursing home residents, and 2/3 of expenses of public hospitals, while costing the State of California. $46 billion.

Six, the failure of government to act to correct the looming access problem to physicians. This access crisis is already being felt in Massachusetts, said to be the model for Obamacare. There patients now have the longest waiting times in the nation to see a doctor or to seen in emergency rooms, and half the primary care physicians in the state no longer accept new patients. This is primarily a supply-demand problem. There are not enough doctors to see the flood of new patients, and the reform law does virtually nothing to increase the supply of doctors.
Richard Reece is the author of Obama, Doctors, and Health Reform and blogs at medinnovationblog.

Twelve Points to Clarify My Position on Health Reform

1. I believe health reform is still badly needed, and physicians should actively participate in the reform process since they must deliver the care mandated in the law.

2. I believe the Patient Protection and Affordability Act is the law of the land, and its provisions must be followed until otherwise changed.

3. I believe in the checks and balances of divided government with administrative, legislative, and judicial branches.

4. I believe in a system with two major political parties that respond to will of the people, as expressed in voting in Congressional elections every two years and a presidential election every four years.

5. I believe the Patient Protection and Affordability Act should be re-debated because of its unpopularity among voters, because of its already apparent flaws, and because it was passed on March 23, 2010 in the face of unanimous Republican opposition, No other major piece of social legislation affecting every American has passed without at least one bipartisan vote.

6. I believe those who wrote the Patient Protection and Affordability Act did so with good , decent, and honorable intentions of covering more uninsured Americans, protecting other Americans, and with the underlying motive of making their stamp on history.

7. I believe the Patient Protection and Affordability Act was written in haste while the political iron was hot without carefully thinking through the political, economic, and social consequences on individuals, the currently insured, existing institutions, patient, and physicians.

8. I believe the final reform product, whatever it is, must have a place for both government to protect the poor and disenfranchised and for the market to provide and assure personal freedoms, choice, innovations, and medical excellence.

9. I believe the cost of a entitlement programs will continue to be a major contributor to the U.S. debt crisis and can be reined in by a combination of slowly advancing the age of Medicare entry to 70 over a period of five years, by means testing of Medicare recipients, by encouraging and making health saving accounts more widely available, and by extending patient choice of health plans across state lines, just as the Federal Employee Health Benefit Plan does.

10. I believe that the states should have a voice and the authority to experiment with innovative Medicaid programs that make those programs affordable and protect the states against bankruptcies.

11. I believe that the Supreme Court should decide the constitutionality of the individual mandate - and soon.

12. I believe the November 2010 elections had consequences and signaled that the U.S. will continue to be center-right nation with a unique health system blending government and the market mechanisms for providing the best and most equitable care for all Americans.

Richard L. Reece, MD, blogs at Medinnovation and has a website under construction. www.doctorreece.com. He is the author of three recent books, Obama, Doctors, and Health Reform (Iuniverse, 2009), Innovation Driven Health Care (Jones and Bartlett, 2007), and an E-book, Pros and Cons of Accountable Care Organizations (Practice Support Resources, 2011). He works with but does not speak for The Physicians Foundation, a 501C3 organization representing physicians in state medical societies. Opinions expressed in his blogs are his alone. He can be reached at rreece1500@aol.com and 1-860-395-1501.