Monday, December 19, 2011

What Doctors Think about Health Reform

D.C. stands for Darkness and Confusion.


December 19, 2011- Lee Stillwell, an inside-the-Beltway health care consultant, writes a periodic Washington Report for the Physicians Foundation (, a non-profit 501C3 organization representing over 500,000 physicians in state medical societies.

In my opinion, Stillwell's reports accurately mirror attitudes, fears, and perceptions of the ACA (Accountable Care Act. aka, Obamacare). It has now been 21 months since the Act's March 23, 2010 passage. The nation's citizens, including its physicians, remain divided on the wisdom and consequnces of its passage.

We are about to end the year, much like it started. There has been a great deal of noise and few results toward the goal of creating a new healthcare system that has increased quality and value for the consumers and drastically reduced costs to government.

Repeal or retention of Obamacare and overhaul of Medicare/Medicaid as part of the need to control healthcare spending will remain a top priority of both Democrats and Republicans as we leave 2011 and head into 2012.

Even though the need to control healthcare spending grows by the minute, Congress will adjourn without addressing the problem.

An annual report from the Medicare Office of the Actuary estimates health care spending by 2020 will double and federal, state and local governments will pay half –50 percent—of the cost. The report indicates health care spending will average 20 percent--of the nation’s GDP in 2020, up from 17.6 percent in 2010.

Looking at those numbers in another way, health care spending will almost double to $4.6 trillion from $2.6 trillion in 2010. And, health care spending in 2020 will cost $13,710 for each man, woman, and child in America, up from a 2010 per capita cost of $8,327.

Surprisingly, the analysis concludes that President Obama’s health care law only plays a modest role in growing costs, even though it provides 30 million uninsured Americans with insurance coverage. Blamed are the increasing numbers of aging Americans and the high cost of medical innovations.

Obviously, such statistics and the mounting political rhetoric about the urgent need for drastic action have made the public very nervous. They rightly fear that medical care will cost more and their access and choices for treatment will be less. Consequently, health care and the economy will be defining issues in the upcoming Presidential primaries and next year’s November election.

Matter of fact, disenchantment with Obamacare—the Affordable Care Act (ACA) passed March 23, 2010-- continues to grow. A recent Associated Press poll shows support for his law has dropped to 29 percent with 49 percent opposing it. Also, only 15 percent believed that government should be able to force citizens to purchase health insurance while 84 percent say “not.” The U.S. Supreme Court will determine the fate of this individual mandate, which is part of the Obama bill, this coming year.

These polling numbers make the Republican political strategy for 2012 obvious. They plan to be very visible in their efforts to appeal the law. Remember, the GOP-controlled House’s first legislative effort this year was to pass a repeal of Obamacare, which went nowhere in the Democratic-controlled Senate.

Expect more of the same in 2012. Insiders say the GOP focus will be on repeal of two provisions in the Obama law—the Independent Payment Advisory Board (IPAB) and the CLASS Act.

The Obama Administration had put the CLASS Act, the health care law’s long-term care provision, on hold because staff at the Department of Health & Human Services (HHS) couldn’t find a way to make the program solvent. Therefore, the GOP contends it should be repealed and is moving legislatively forward to do so.

Republicans warn that the IPAB, a 15-member board, has too much power. The law authorizes it to make reductions in provider payments if they increase too fast. Congress could overrule the panel, but only with a super majority in the Senate, or by devising an alternate plan that saves the same amount.

A political solution for both of these provisions is possible, but there appears no likely outcome in 2011 for the greatest of the challenges facing the nation’s health care system: Medicare reform.

Political observers believe Medicare reform only comes from a bipartisan plan. Subsequently, there is a great stir in the capital over a development this past week that saw a bipartisan legislative proposal to revamp Medicare come from two unlikely individuals--Rep. Paul Ryan(R-Wis.) and Sen. Ron Wyden (D-Ore.).

Ryan, chairman of the House Budget Committee, was the chief sponsor last April of a budget resolution which passed the Republican-controlled House with a provision limiting the federal government’s Medicare spending while requiring seniors to pay for coverage and eliminated the traditional fee-for-service option.

The Senate ignored Ryan’s proposal, which upset many of the nation’s seniors. And, it should be noted, 34 percent of the seniors 60 or older regularly vote. And there now are 47 million Americans on Medicare.

The new Ryan-Widen plan expands choice by permitting private health plans to compete with the government for seniors. The new system, which would start in 2022, also would include a premium support system intended to lower the costs of private plans by comparing them to Medicare. Providers and drug companies would face reduced support if spending rose more than one percent GDP.

Reaction was predictable. House Speaker John Boehner(R-Ohio) called it a bipartisan idea worthy of consideration. House Minority Leader Nancy Pelosi (D-Calif.) charged that the plan shows the GOP want Medicare to “whither on the vine.” White House Press Secretary Jay Carney called the plan radical and GOP Presidential candidates Mitt Romney and Newt Gingrich praised the plan.

None of the comments appeared to deter Widen and Ryan from promoting their plan, which still lacks cost projections and other key details. The men don’t intend to introduce the legislation until after the November 2012 election, only putting the proposal out there now as a marker for discussion.

Their timetable makes sense. A divided Congress, and reelection-anxious President, seems destined to avoid a real solution in 2012-- until after November’s results. By then, spiraling deficits, threatening the nation’s economic wellbeing, will force all the politicians to address the matter. For better or worse, we finally can look into a crystal ball— in 2013 for sure--and see our health care system dramatically transformed and reshaped to meet budgetary challenges.

Retention or rejection of the health reform law preoccupies physicians. The law's fate remains uncertain.


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