Saturday, January 2, 2010

Health Care Reform - where we are now

I am reproducing a letter by Dr. Thomas Lagrelius, which I received today. It represents what I think of our present state of health care reform, I could not have said it better. I may add that the most important two issues of Health Care reform for me personally have NOT been addressed in this reform.

My absolute "must include" reform issues are

1. Tort reform. We should have something analogous to "Workman's Comp". It could be named "Patient's Comp". Patients who suffer an injury during medical care would apply, be examined by an expert committee and compensated according to preset tables. Fair, fast and feasible. Why? Defensive medicine costs 100-200 billions (yes, with a B) each year! Want to reduce costs? Start here.

2. Balance Billing for physicians everywhere for all patients. Not for hospitals. This is the only way physicians will be able to survive the downgrading of our income that seems to an obligatory part or at least result of any kind of "reform". We are independent professional, we have worked very hard to get where we are, we have paid our dues, and we most definitely have earned the right to bill what we consider adequate for our time and experience. We need balance billing. And until then, I recommend to opt out of any contract that does not allow you this basic professional freedom.

Here is the copy of the letter. Emphasis was added by me.

Begin quote:

"Dear Hal:

You are correct about it being far from over! There is still a chance that some Senator will balk after getting an ear full from his constituents over the holiday break so we should keep the pressure up on them.

Even if it passes, this is my take. The single payer advocate Left in Congress built a straw man, the insurance company based guaranteed issue, community rated, insurance exchange thing with all kinds of rules and regs knowing it would be very expensive and entirely unworkable, and intentionally so. They expected to have the "public option" also in the bill. They rightly assumed that straw man would collapse and all would flow into the public option, i.e. "single payer". They got the bill through only by bribing lots of Congress members making Obama, Reid and Pelosi look like the worst smoke filled back room politicians since Mayor Daley or Tammany Hall.

But the Senate screwed them and took out the public option! We can thank Lieberman for that I guess. (I always did like Lieberman and he could still change his mind on the final vote.)

So they are left with the straw man with nothing to default to when it fails.

Everyone knows it sucks. Howard Dean and John McCain both agree for different reasons that the bill should be scrapped and they should start over again. Sixty percent of Americans don't like it while only 30% approve of it in the polls. Insurance will now cost much more, at least double, and most of the uninsured will still be uninsured because there are no teeth in the individual insurance mandate and the bill does not include half the uninsured anyway. In the end nobody will bet better care, nobody will save money and nobody will be happy.

And where are the doctors to do primary care on which the whole thing depends? No place. They are quiting. Even the Mayo Clinic is testing opting out of Medicare in some of its locations while direct practice continues to grow exponentially and students shun primary in droves. Taxes will go way up immediately while the "benefits" if there are any won't start for years under the front loading provisions pretending to make it look cost neutral at first. The voters will feel the pain immediately and get nothing out of it now or later.

Thousands of doctors will quit the AMA and seniors will quit AARP in even greater numbers. Current projections are that the Dems will lose this year's congressional election worse than they did in 1994 so the public option is dead along with the Dem. majority. Obama approval rating is now minus 18% down from plus 35% when he took office (strong approval minus strong disapproval on Rasmussen likely voters. Check the graph:

What a mess for Obama who sits in the sun in Hawaii looking remote and inept. He is seen as soft on terrorism, ineffective on the economy and inadequate to the job. The bloom is definitely off the Obama rose.

Laws have been repealed in the past before they went into effect. In 1989 the Medicare Catastrophic Coverage Act was repealed in less than one year and before taking effect due to a senior revolt.

It could happen again. Let's make it happen! We should throw our support behind the non-conflicted organizations that support physician and patient freedom, like Docs 4 Patient Care, SIMPD and AAPS, pull our support from conflicted ones like the AMA and AARP and make it happen for doctors and patients seeking freedom.

Tom LaGrelius, MD, FAAFP"

End of Quote

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