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admin posted on January 05, 2010 11:00
Midnight votes and backroom bargaining paved the way for a hastened passage of the U.S. Senate's health care bill as we were awakening on Christmas Eve morning. Now, as the House and Senate are combining their bills into one, it is important to understand what these bills mean for our patients and our practices. Although the end product is still morphing and as yet unknown, there are select areas where one can comment with a degree of certainty.
Medicare, which has attracted a significant spotlight due to its future fiscal status and the breaking wave of baby boomers, will be cut $438 billion over the next decade to pay for the Senate version of the health care bill. The House version cuts Medicare around $450 billion over the same time period. Absent from these staggering numbers is the $238 billion cut to physicians over the next ten years if SGR is not fixed. Without the SGR fix the $450 billion cut to Medicare becomes almost $700 billion. This $700 billion cut is the only way Congress has been able to make the legislation reduce the federal deficit.
What started out as a call for reform to Medicare ended up being no reform at all. Faced with the challenging task of improving Medicare, Congress has taken the easy road and simply cut providers. Although physicians have been repeatedly assured the expected 21% cut will be addressed with a permanent SGR fix, it is challenging at this point to determine whether such a fix is possible in the current fiscal environment. Even with a temporary or permanent fix, we can expect the new Medicare Independent Payment Advisory Board, which is tasked with reducing payments to providers, to fulfill their mission and cut provider payments even further.
The Senate proposal, which will likely be the working document as the House and Senate wrangle over a final bill, pays for the trillion-plus dollar insurance subsidies and Medicaid expansion by combining anticipated Medicare savings with new taxes. Several problems readily surface with the Senate's proposed payment for history's largest government expansion in health care. First, the needed SGR fix takes $238 billion off the table. Second, the remaining $438 billion in Medicare savings, estimated by the Congressional Budget Office (CBO), is being double counted and cannot possibly fully materialize. Additionally, CMS's Chief Actuary predicts that the $438 billion in provider cuts are unlikely to be sustainable and the anticipated savings will be less than projected.
The question to be asked and answered is—what does all this mean? It means one of three things. First, it could mean these unrealistic and devastating cuts will actually become a reality, which would result in the closing of provider practices across the country and cause harmful access issues for seniors. Second, it could mean providers don't suffer severe pay cuts, but rather large scale rationing will begin to occur. Third, it could mean the greatest income tax increase in our nation's history is on the horizon. These alternatives are not acceptable. It is time for Congress to go back to the drawing board and come up with reform that is real reform, the right reform, and not the rushed reform that will devastate not just the health care delivery system but our national economy.
In the coming weeks, we encourage you to stay informed and to stay active. This letter is the first in a series that will be sent to you as the SCMA continues to analyze both the pros and the cons of the current health care reform bill.
Sincerely,
kcrosby posted on December 24, 2009 09:25
The State Newspaper - December 24, 2009
By VINCENT J. DEGENHART - Guest Columnist
The U.S. Senate is feverishly debating health care reform, and there are more than 2,000 pages of proposed legislation that could dramatically and permanently change the delivery of health care in this country. Most Americans can agree that changes are needed in our health care system, that costs are high and access to care is limited. We all want a healthier America, but the right reform does not lie within the legislation that stands before Congress.
America still has the best health care in the world. We live in a country with the best survival rates for almost all types of cancer, a country with a health care industry that continually offers the latest advances in technology and research and a country with minimal waits to receive optimum care. This is sharply contrasted by countries with socialized medicine such as Canada and England, where it is common to wait long periods of time before receiving necessary, critical care.
The original goals for health care reform were to reduce costs and improve access to care. Those are lofty goals, but they have been poorly addressed thus far.
It can't be done through legislation with a price tag of more than $1 trillion. It will cost every American more; insurance premiums paid by employers will be taxed, income taxes will be raised to counterbalance the cost, physicians will be charged user fees for programs such as Medicare, and state budgets will be burdened with expanding Medicaid programs.
It is estimated that there are 45 million uninsured Americans. Let's examine the numbers. Approximately one third, 15 million, are citizens who qualify for Medicare, Medicaid, VA or state benefits but are either unable or incapable of accessing the system. The government could ultimately rescue these citizens merely by ushering them through these programs. Another third are Americans aged 21-35 who choose not to purchase health insurance, yet have the means to do so, and approximately 8 million to 10 million are illegal aliens.
Finally, there are approximately 8 million to 10 million who truly do not have access to health insurance, do not qualify for Medicaid, Medicare, other government or private health benefits. It is these 8 million to 10 million who need to be identified and cared for, which can be done for less than a trillion dollars.
It's not too late to get health care reform right. Currently, this debate is completely partisan. In spite of repeated efforts for bipartisan input, House and Senate leadership have accepted no input from the minority (Republicans). Our very own senator, Jim DeMint, has introduced several bills and amendments, yet they have not seen the light of day. Even Dr. Don Palmisano, past president of the American Medical Association and an accomplished surgeon, attorney and professor of law and medicine in New Orleans, believes we can and should start over.
What should be included in legislation?
-Tort reform. It is estimated that $200 billion to $300 billion per year is wasted on defensive medicine and litigation. The present system is too expensive and does little to improve care; some victims receive no compensation, and some are overcompensated. Health courts could be an alternative.
-Portability. Americans should be able to buy health insurance across state lines like car or homeowners insurance, which would increase competition and help bring down costs.
-Market-based solutions. Not everyone needs the costliest coverage. A healthy 25-year-old, single man does not need obstetrical coverage. A woman does not need prostate screenings. People should be able to shop for health insurance that tailors to their specific needs, not what the company or government mandates.
-Health savings accounts. These accounts allow Americans to have some say and control over health care costs - and ultimately lead to wiser spending.
-Wellness promotion. The long-term effects of self-inflicted unhealthy lifestyles are devastating. There should be financial incentives for wellness, for maintaining an ideal body weight, for not smoking, for regular exercise. These habits need to be promoted in our schools, long before physicians start seeing the patient and the ravages of obesity, hypertension, diabetes and cancer have already taken a toll.
America, we can do better. We need to improve the delivery of our health care. Let's start over, look at all facets of this incredibly complex issue, and do it right. It may take years. That may seem too long to some. But we've spent the past 100 years building the best health care system in the world. Don't destroy it overnight.
Dr. Degenhart, a Columbia anesthesiologist, is a member of the board of trustees of the S.C. Medical Association.
kcrosby posted on December 18, 2009 11:06
LEGISLATIVE UPDATE:
Late Wednesday afternoon, the US House passed the Department of Defense Appropriations bill. Added to that legislation was a 2-month extension on the sustainable growth rate (SGR) formula. The extension would delay the scheduled 21.2% Medicare cut until March 1, 2010. After passage through the House, the Senate received the bill and immediately filed a cloture motion in order to complete action on the bill this weekend.
INSIDER PROSPECTIVES:
Congressman Gresham Barrett recently contacted the SCMA with his analysis of the extension; and the SCMA has also had recent conversations with Senators Jim DeMint and Lindsey Graham. Here’s what your South Carolina leaders had to say about the amendment:
“It is important that the people of South Carolina have access to affordable and quality healthcare. However, it is also important to ensure that our health care professionals will not leave their field due to low reimbursement rates,” said Congressman J. Gresham Barrett. “Therefore, I believe the passage of the temporary ‘doc fix’ provision will allow for a Medicare payment system that encourages doctors to provide quality care and, at the same time, prevent avoidable health care costs. I look forward to working with my colleagues to find a fiscally responsible long term solution to the Medicare physician payment system.”
“Senator DeMint believes there should be comprehensive physician payment reform that provides our nation’s doctors the peace of mind that their Medicare reimbursements won’t be slaughtered from year to year. However, the proposals put forth by the Democrat Majority will not help physicians – rather, they will only hurt the patient-doctor relationships in this country and decrease the number of physicians accepting Medicare over time,” said Wesley Denton, spokesman for Senator Jim DeMint.
TELL US YOUR STORY:
If this legislation is passes through the US Senate, it is only a temporary fix. That’s why we want to hear from you, our physicians, on how such a drastic pay cut will affect you, your practice, and your patients. As the largest physician organization in South Carolina, we have the power to share your voice with our state’s decision makers, but we need to hear it!
kcrosby posted on December 10, 2009 10:19
The Greenville News - December 7, 2009
Congress is on the precipice of overhauling our health-care system. Lay aside that an institution with a historically low public approval rating (Congress) is insistent on dismantling an institution with high approval ratings (most Americans rate their level of satisfaction with health care as high or very high).
Lay aside the ostensible impetuses behind such an overhaul are cost and the uninsured, and the pending legislation does little to address either. Lay aside that Congress’s proposed remedy will add trillions of dollars in debt, includes mandates of dubious constitutional propriety, and includes nothing to curb the practice of defensive medicine.
Managing the burgeoning costs of health-care delivery and insurance and addressing the uninsured can be done with free-market solutions coupled with common sense. Before we remake 17 percent of the economy and create another entitlement program which costs can’t be borne, consider applying the principles that built the economy in the first instance (free market) and incentivize characteristics necessary for our culture to flourish, such as personal responsibility, accountability to others and discipline.
Health-care costs are increasing at a higher rate than other areas of our economy. The reason for this isn’t a dearth of governmental involvement it is because of it. Government mandates, the inability to buy health insurance across state lines, the lack of transparency, the incentive to practice defensive medicine and the lack of personal responsibility all contribute to the costs of medical delivery and health insurance.
Recently I met a young woman in Greenville whose employer doesn’t provide health insurance. She wants a high deductible policy to cover catastrophic disease or injury. She’d rather pay for office visits out of pocket.
In other aspects of life she can shop nationwide, indeed worldwide, to find what she wants. Not so with health insurance. What she wants she can’t afford because it includes mandates she doesn’t want or need. She can’t compare policies offered in other states. If we rely on the market to control costs and improve competition in other aspects of our economy, why not health insurance?
Recently an OB/GYN from Spartanburg delivered the fourth child to a 17-year-old with no private insurance, and though eligible for Medicaid she didn’t sign up for it. He mentioned there was no disincentive in this patient coming as often as she wanted for visits, whether medically indicated or not. By knowing certain medico-legal buzz words, she wound up with more ultrasounds than a private insurance patient.
So, a responsible young woman who wants insurance can’t afford it. And a 17-year-old with four children who won’t sign up for government assistance winds up with better health care than her peers. The right conduct isn’t rewarded and there’s no disincentive for indolence.
Rather than decoupling health insurance from employment, Congress perpetuates this symbiotic connection to the detriment of employers and workers. As Charles Krauthammer argues, “getting health insurance through your employer is an accident of World War II wage and price controls.” It forces people to stay in jobs they don’t like for fear of losing coverage and imposes obligations on job creating small businesses.
Health insurance should be an individual decision buttressed by the ability to shop across state lines for policies that fit individual or family needs. Couple this with medical savings accounts and we have the ancillary benefit of increasing personal responsibility. There is incentive to become healthier because rates would decrease.
We all fear accidents or disease processes rendering us unemployed and the pre-existing condition rendering us subsequently uninsurable. Can the market address this? Imagine a health insurance policy that combines coverage for this year’s expenses with the right to future insurance at a set price. A “guaranteed renewable” individual insurance contract is the simplest way to deliver both. When you sign up, you have the option of keeping the policy for life or for the term of the contract, and your premiums remain constant.
The current health-care legislation doesn’t address defensive medicine. It expressly punishes states that seek tort reform. Eighty percent of doctors queried admitted they order tests and procedures solely to minimize malpractice exposure at a cost exceeding $150 billion annually.
Controlling health-care costs is overdue. Insuring the needy is economically advisable and morally laudable. Our country already provides care for the sick and needy, but in a cost inefficient fashion.
Surely an economy built on free market ideals should exhaust market solutions before embarking on a system of statist medicine proven inefficient and costly in other countries.
*Please note: The SCMA Health Care Forum does not reflect opinions of the South Carolina Medical Association.
kcrosby posted on October 27, 2009 09:26
The Greenville News
By Gary A. Delaney • October 23, 2009
We can all agree that health-care reform is needed. We can also all agree that any health-care reform should include universal coverage, improvement of the quality and delivery of care, as well as insurance reform that curbs the ever rising costs affecting both individuals and corporations across the United States. The truth of the matter is that this can be successful without government interference.
First, let me discuss some of the valid points made by Dr. Anne Graham Masters in a recent column.
While it may be true that other countries have incorporated universal health care, many of those countries’ health-care systems cannot compare to the caliber of health care in the United States. When you take examples such as England and Canada, it holds true that implementation of universal coverage and a government-run system is failing those countries and their citizens.
To bring the matter closer to home, states such as Tennessee have experimented with a government-run insurance plan, but the experiment nearly drove them into bankruptcy. A single payer system is not the right reform.
The statement was made that a public option would not interfere with market-based solutions. Yet, when a government-run program is instituted, it is nearly impossible for private competitors to truly compete. Not only will the government create their own program, but they will be the regulators of the market for all. Thereby, they become a player and the referee, making it nearly impossible to provide a level playing field for all the parties to compete. A public option is not the right reform.
Dr. Masters stated that we need a public option with “Medicare for all.” If Medicare were a solvent, financially sound government-run program, this assertion may be palatable. Yet it is not solvent or fiscally sound, and the current projections by the Medicare trustees are that it will be bankrupt by 2017. It is precisely at this time when it will be needed by our largest generation — the baby boomers. Medicare for all is not the right reform.
Implementing government frameworks may seem ideal, but when looking at examples such as the United States Postal Service, history has shown those programs to provide less than optimal service. While the USPS guarantees the delivery of your mail, not only are there faults, but the government subsidies to it are substantial. Many citizens eventually default to the private sector — to reliable enterprises such as FedEx.
Reform needs to guarantee the delivery of care, and contain costs. Unlike the mail, our health is too fragile to take the risks of an inefficient and cost prohibitive system. A government-run program is not the right reform.
So what is the right reform?
Reform is enacting nationwide tort reform that caps economic damages that will curb rising health-care costs. Reform is the elimination of pre-existing conditions. Reform is instituting market-based solutions so that fairness is instituted and access is instilled for our patients. Reform is allowing the patient to privately contract with the physician of their choice. Reform is trusting in the physician to determine the quality of care.
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