Coming Health Reform Summer Storms

June 21 - This is the first day of summer. Health reform storm clouds, harbingers of political lightning strikes, loom on the horizon. How bad the storms will be and what form they will take is unknown, but here are thoughts on their shape and ferocity.

• Summer Storm One, the inevitable physician access crisis - Today USA Today described one coming storm on its first page “Doctors Limit New Medicare Patients: Surveys Point to Payment Concerns.” The U.S. now have 41 million seniors on Medicare. In 2015, it will be 50 million, in 2020 58 million. An AMA survey indicates 31% of primary care physicians restrict the number of Medicare patients they will see. The reason for this is basic: Medicare currently pays only 78% of what private plans pay. If Congress goes through with its 21% cut in doctor pay, or passes a temporary fix, the number of doctors closing their doors to Medicare patients will escalate. And there will be plenty of them. Seventy eight million will start to become Medicare eligible in 2011 at the rate of about 13,000 a day over the next 15 years. And beginning in 2014, 34 million Medicaid patients will come on board the federal entitlement train. At that point, and probably before, the Obama administration will have a genuine physician access crisis on its hands. What good is Medicare and Medicaid if you have too few doctors to care for you, or waiting times exceed two months, already the case in Massachusetts.

• Summer Storm Two, the possible November tsunami . In its Op-Ed page today, the Wall Street Journal warns of another approaching storm “Obamacare and the Independent Vote.” Its authors, three Stanford University Professors who are members of the Hoover Institute, after citing and analyzing multiple national polls, conclude, “Voter opposition hasn’t changed, and it could be decisive in November.” The president, they say, faces an uphill battle selling his health care bill, which is opposed by up to 70% of independent voters. Among voters who oppose the health bill, voters are 20% more likely to vote for the Republican than the Democrat candidate. Voters oppose more federal spending and fear for the future of their children and grandchildren because of the $13 trillion dollar federal debt, which will grow at $1 trillion a year for the foreseeable future.

• Summer Storm Three, confirmation hearing for Donald Berwick, MD, as head of the Centers of Medicare and Medicaid. CMS has not had an acting director for four years. Obama has nominated Dr. Berwick for the post. Berwick is a professor of pediatrics at Harvard Medical School and is the founder and president of the Institute of Health Care Improvement in Boston. Berwick is a charter member of the health care elite. According to the New York Times, “ He is a man with a mission, a preacher and a teacher who has been showing hospitals how they can save lives and money by zealously adhering to clinical protocols for the treatment of patients. “ Berwick might be called the Pious Pied Piper of liberals. He is four-square for a government-run health care, detests market-driven care, promotes government-imposed rationing, openly admires Britain’s National Health Service, and has a long paper trail of articles and speeches outlining and defining his position. Republicans will use well-known political positions to revive their arguments against the new health care law, which they see as a potent issue in this fall’s elections. Dr. Berwick has given them plenty of ammunition.

I do not know if these issues will be a passing lightning storm, or will evolve into political hurricanes, tornados, or even a tsunami. But I know storm clouds are gathering. They are not favorable to the health bill and challenge the nation that it will lead to a more affordable and more widely accessible system.