Sunday, March 21, 2010

A Knife's View on Health Care Reform

I expect the Health Care and Education Affordability Reconciliation Act of 2010 to pass the House very soon, with barely a vote to spare. Maybe even tonight. I have been involved in the debate, writing letters and the like for the good part of a year, even though my friends and family are probably sick of it.

This is because the legislation affects so many aspects of my personal and professional life.

As A Texan, I live in the MOST uninsured state of the Union. We also have 1.5 million children without insurance. During my days as an orderly at Parkland Hospital's emergency room, I was astounded at the entire "Third World" that existed in the heart of Dallas at the time. For a white kid from the 'burbs working down there, it was a real eye-opener. So I am for anything to change and improve the dismal state of health care for the poor. Congressman Henry Cuellar, who represents the most uninsured districts in Texas, has come out in support of the bill because his constituents need it. I applaud his efforts and wish all of our representatives would vote according to what their constituents want !

Those of us who complain about overcrowding in the emergency rooms and rising insurance premiums need to consider that uninsured visits for non-emergency problems cause huge problems. We all pay for that with longer ER wait times, insanely inflated hospital bills, and higher insurance premiums. Just like how auto insurance works for all drivers, so should health insurance for all citizens, provided everyone is required to have it.

As a Physician, my patients and I are frustrated with the paperwork, delay, and denials of the insurance companies. On many occasions, I have held a letter of approval for surgery in one hand, and a payment denial after surgery in the other. My only recourse was to go through a long appeal process or bill the patient, which I have rarely, if ever, have done.

I want a system that clearly states what is covered for my patients and then promptly reimburses physicians fairly, given our long educational commitments and high overhead.

I am saddened that the Congress cannot do anything except delay for a month at a time the planned 22% cut in physician payments under Medicare. If they want to increases access for patients, this must be fixed. New doctors will not accept Medicare patients, and existing ones may well opt-out of Medicare if this pay cut stands.

I also want a system that does not leave me open to a lawsuit even if the standards of care were clearly met, and one that makes me immune from lawsuits when doing charity work or rendering emergency care. How about arbitration panels that avoid the expense and pain of a long, drawn-out lawsuit ? The current bill sadly falls short on those goals, which would save money according to the Congressional Budget Office.

When similar reforms were enacted here in Texas several years ago, we had an immediate influx of new doctors who wanted to practice here. Thousands of them, in fact. Hospitals saved millions in liability costs, and several opened new community clinics. Lawsuit reform helps patients, lowers costs, and lets doctors do their job without practicing "defensive medicine." Remember my blog about the millions of CT scans that are done yearly, and how many people (23,000 per year) will develop cancers a result ?

As a surgeon, I use the latest drugs and have access to the best technology. During my plastic surgery training, I played a small part in developing AlloDerm, a skin substitute for burn victims. It now helps patients with at least a dozen other health conditions, including breast cancer and burns. That company lost money for years, and I knew how expensive it was for them to keep operating. Yes, those companies may make out sized profits in many cases, but as long as the U.S. continues to lead the way in researching and developing new medicines and devices, I say leave them alone. I am outraged at the mega-billions the banks wasted in their investment scams that put us in this financial crises, but am unaware of a similar crisis in the drug or medical device manufacturing realm.

As a small-business owner, the bill is a no-brainer for me. I have 6 employees, some with pre-existing conditions, and I want fair and complete coverage for all of them. Period. I want to be able to "shop" plans as part of an insurance co-op so they can have a true choice between plans. For years, we have been limited in our choices to 2 or 3 plans only.

As a head of household and taxpayer, I like the idea of my kids being covered until age 26. I would like being able to compare plans with more freedom, across state lines, and end the essential monopoly of the insurers. Yes, I may be in a tax bracket that will cause my taxes to go up, including the taxes on any investments and losing some benefits from my charitable donations, but I am willing to accept that.

The nation is truly divided on health care reform, and a look at our own Congress men's votes here in Texas reflect that. The House phones lines were getting 100,000 calls an hour ! Americans have a dismal job-approval rating for Congress (like 20%.)

I personally have developed a distaste for the way our President has obsessively made this a "too big to fail" issue for his administration, instead of focusing on jobs like he promised in his State of the Union Address. The current system is broken, and it's getting worse. I would have preferred a more step-by step approach to reform instead of this giant pill we are supposed to swallow. But it's time to fix this broken car before it breaks down on the side of the road, leaving us all in an even bigger mess.

After that, those in Congress who voted against the will of their constituents can go back home and face the music.