The State - August 18, 2009

U.S. Rep. Joe Wilson said protests at town hall meetings across the country have altered the shape health care legislation will take in Congress this fall, and he urged South Carolina residents to keep up the pressure.

“What we need for all of you to do is read ... and call your neighbors,” the Republican said Monday in Columbia. “Contact family members in other states. You have changed the course of this bill already.”

In the first of a series of town halls scheduled in the state this week, Wilson told roughly 1,700 people who turned out at Keenan High School they may have turned back “big government’s” move into their health care.

“I was so happy to hear that as a result of your outcry, (the Obama administration) has removed the public option,” Wilson said to loud applause.

It is unclear whether Congress ultimately will pass the so-called public option portion of health care legislation, which supporters say will compete with private insurance companies to help lower skyrocketing premium and service costs.

Wilson touted the Republican alternative, H.R. 3400, over another House bill, H.R. 3200, which has raised the ire of some people at previously held town halls around the country.

Congress has not acted on any health care bill yet but is expected to take up several measures when members return to Washington after their summer break ends after Labor Day.

While there were a few instances of shouting back and forth between audience members, the meeting was calm.

“It’s not a bad bill,” one female attendee shouted to Wilson, favoring H.R. 3200. “I don’t have a problem with government (in my health care).”

Jim Hanks, a Lexington resident, brandished a sign reading “Get Government out of Medecine.” Hanks said he receives both Medicare and Social Security but wants the government to extend tax deductions to individuals for their health care coverage, as it does for businesses. He also said he wants medical schools to stop holding down enrollment for general practitioners.

“I’m not for abolishing anything right away,” said Hanks, who said he is a member of talk show host Glenn Beck’s “9-12” camp, which he described as a libertarian group that yearns for the kind of national unity that gripped the country after the Sept. 11 terrorist attacks.

“I’m not for putting anybody on the streets,” Hanks said.

President Barack Obama is pushing an overhaul of health care as his main domestic policy agenda item. But the movement has sparked protests and charges of false information being spread to scuttle reform.

Peter Kremlick, 74, of Columbia, said he came to the town hall to urge Wilson to diversify his focus from health care reform to include other issues, such as gun control and illegal immigration.

“I’m concerned that while the right hand is working health care, the left hand is screwing in your pocket (to take away your other constitutional rights)” Kremlick said.

Kremlick said he, too, gets Medicare and Social Security but thinks uncovering fraud in Medicare would produce enough money to cover health care deficits.

John Black, a West Columbia physician and president of the S.C. Medical Association, said medical care is good in the United States, but “there are things wrong with it,” and “it’s not sustainable.”

Jameson Taylor, a policy researcher at the South Carolina Policy Council, drew opposition and applause from the audience by warning of the “rationing of health care” and of long “waiting periods” to get care.

Wilson said bipartisanship is the key to reforming health care.

“I give a speech every day on the floor (of Congress) about how Democrats and Republicans should be working together to reform health care,” Wilson said.

Forbes Magazine - August 17, 2009

James Klemis, an interventional cardiologist who practices in Memphis, was at a lake house on a Saturday earlier this month when he got a text message from a friend about a health care town meeting that evening. He jumped in his car and drove 45 minutes to an inner-city auditorium. There he met up with 15 of his doctor colleagues, who all showed up to give their congressman, Steve Cohen, an earful.

"It's a very poorly crafted plan that's being rushed through," Klemis says, who spoke out against what he called socialized medicine at the event.

Doctors like Klemis are organizing against ObamaCare all over the country. Yet it's without the support of the biggest national doctors lobby, the American Medical Association. Within two days of the House passing its health bill through the Energy and Commerce Committee in late July, the AMA gave the President a rare bit of good news by endorsing the bill.

It was a shock to many of the group's 250,000 doctor members. The bill contains a vigorous new public health plan for people under the age of 65. The Lewin Group, a research organization owned by UnitedHealth ( UNH - news - people ), estimates that the legislation would cause somewhere between 34 million and 85 million people to go from having private to government insurance and would pay doctors on average 14% less than private HMOs. This weekend, there were reports that the White House is floating the idea of reform without a public plan, though all the bills that have made it through committee contain one.

Just like the AARP has had to backtrack in its support of ObamaCare since it became clear that many older people fear they will lose Medicare benefits, the AMA has also begun to backtrack some, saying that it expects the final bill to look different. Says AMA President James Rohack in a statement: "We're at the beginning of the process, and we'll stay engaged to improve the final bill."

If the AMA can't squelch this grassroots rebellion, it might be less able, in the future, to claim to represent doctors in public policy debates. Physicians had already been concerned over increased government control of health care and the Medicare-like price setting of a new government plan. In fact, AMA leadership had been speaking out against such a public plan all year, while promoting ways to reform the insurance market and other less controversial measures. At its June House of Delegates meeting in Chicago, the doctors there had deliberately avoided endorsing one, while voting for a list of other principles.

The bill that passed through the House in July also notably offered no relief from malpractice lawsuits, the top priority of the doctors' lobby for years. President Obama had promised to consider tort reform during a conciliatory speech at the same June meeting, though the bill has not turned out to have any. "We're irate," says Klemis, an AMA member.

The president made things worse by saying doctors choose to perform surgery on patients to make money when cheaper care would be better, citing tonsillectomies and foot amputations of diabetic patients as examples. The College of Surgeons, with 74,000 members, called Obama's statement about taking out kids' tonsils for money: "ill-informed and dangerous. We were dismayed at this characterization." The Florida Medical Association, with 19,000 members, also sent an angry letter.

Historically, the AMA aggressively pushed back attempts to centralize the health care industry. It successfully opposed Harry Truman's attempt to create a national health plan in 1948 and another attempt in 1962. Doctors made it clear, and the public seemed to agree, that they should not be government workers. The AMA tried again but failed to block Lyndon Johnson's creation of Medicare in 1965, but then assumed its usual role, joining other interest groups to help foil HillaryCare in 1993.

This time around it's different, the AMA says. It supports the House bill because it expands coverage to more people (33 million uninsured would be covered, according to Lewin) and forces insurance companies to take all comers, even those with preexisting conditions. The group also secured a promise--although one that's not so secure that it's included in the cost-scoring of the bill--that Medicare would start raising its reimbursement rates for physicians over the next 10 years. If it happens, it would mean $245 billion in increased Medicare doctor payments. "The status quo is unacceptable," the group's president, Dr. James Rohack, a Texas cardiologist, said at the time of the endorsement.

The move proved costly to the AMA. It unearthed longtime tensions with doctors who see $1 trillion being spent on health care but doubt it will trickle down to help their patients or make their practices more financially viable. Right now, Medicare pays an average of $54 for sometimes hour-long appointments, says John Slatosky, a family doctor in Randleman, N.C. To pay for the new public plan, he predicts, the government will have to cut benefits from Medicare. "The AMA has stomped on primary care doctors for years," says Slatosky, who claims he's had to borrow from a bank all year to keep afloat.

An online straw poll on the doctors-only Web site Sermo.com found that 94% of 10,500 physicians polled oppose the bill. While the sample isn't scientific, and may have attracted an anti-AMA crowd, it's gotten attention as a vote of confidence against the group. The head of Sermo, Daniel Palestrant, has been on an anti-AMA rampage all summer, appearing on cable news stations to say that doctors have been sold out. Doctors aren't the reason why costs have risen or people can't find insurance, he argues: "Overall health care spending has gone up while physician salaries have gone down."

Palestrant accuses the AMA of being more concerned with keeping its seat at the White House table so it can protect its various ancillary moneymakers, like its estimated $75 million business licensing procedure codes to HMOs. (The AMA says Palestrant is upset because it ended a partnership deal with Sermo in May. Palestrant says he let the deal expire because the AMA doesn't care about its members.)

Whatever may motivate Palestrant, the anti-AMA bandwagon has picked up speed. Seven state medical associations--including those in New Jersey, Texas and Georgia--took the highly unusual step of breaking with their parent to denounce the bill. Others big ones like Arkansas' have also expressed deep skepticism, without specifically breaking with the AMA.

Several groups of specialty doctors--neurosurgeons, plastic surgeons and general surgeons--have joined the anti-ObamaCare coalition and have even been joined by two physicians who recently served as presidents of the AMA.
"The AMA," says Gregory Tarasidis, a head and neck surgeon in Greenwood, S.C. who is currently president-elect of his state medical association, "came out too early and too strong."

The State - August 5, 2009

WAKARUSA, Ind. -- President Barack Obama promised Wednesday that there will be an overhaul of the health care system before the end of the year and said it doesn't have to be a bipartisan effort.

Visiting economically stressed Indiana to announce $2.4 billion in taxpayer grants for create electric cars and tens of thousands of jobs, Obama also pledged successful conclusion of an ambitious health care overhaul that he has argued would stabilize the nation's fiscal health.

"I promise you, we will pass reform by the end of this year because the American people need it," the president said.

That will take some doing; A handful of bills currently is circulating in the House and Senate amid at-times divisive policy arguments. The White House previously had said that it wanted Obama to be able to sign those changes into law by the end of the year.

In an interview after his speech, Obama said he is not wedded to a bill with Republican as well as Democratic support. He said he is encouraged that some in the GOP are negotiating with Democrats on the Senate Finance Committee, but signaled impatience with protracted talks that haven't yet produced legislation.

"Sometime in September we're going to have to make an assessment" about whether to keep trying to negotiate with Republicans, he told MSNBC.

Obama said he "would prefer Republicans working with us" but that getting his main priorities for a health care overhaul are more important.

*Please note: The SCMA Health Care Forum does not reflect opinions of the South Carolina Medical Association.

The State - July 29, 2009

There’s no question that our health system needs reform. But that’s not all that needs reform.

We also need reform of a legal system that takes up to $600 billion (over 10 years) out of our health system to pay lawyers and reward some patients with lottery-like winnings. This could protect doctors and hospitals from having to order unnecessary tests preparing for a possible lawsuit, saving our system up to another $1 trillion over 10 years.

We need reform of the private health insurance industry so that it cannot reduce a doctor’s reimbursement for work already done, or deny payment for patients after they get home from the hospital or deny people insurance because they have been sick in the past.

We need reform of our antitrust laws that prevent doctors and hospitals from working together to reduce costs but ignore allow the insurance companies to set fees together since they are exempt. Tort reform like that of California, Texas or South Carolina would save our health care system enough money over 10 years to almost pay for the changes President Obama wants.

But these important reforms are not part of the president’s package. Where are they?

Why aren’t important insurance reforms, antitrust reforms and tort reform part of the president’s proposals? And why the rush? Why not comprehensive reform?

Let’s slow down and get this thing right.

Unfortunately, the president’s proposals will cost our country at least 1 trillion and by some estimates as much as 10 trillion extra dollars over the next 10 years. Money that we do not have. And even then, they will cover fewer than half of the currently uninsured or underinsured. And I believe that the president’s proposals will inevitably move us all into a government-controlled health care system that then will have to confront these enormous costs.

Cost containment in government-managed health care systems around the world is achieved though rationing. Canada, for example, rations heath care by age (reduced care if you are 65-80), by time (queuing, or long waits, sometimes over six months for routine surgeries or tests) and by denial of access to testing or procedures. Ironically, in Canada, the provinces of Quebec and British Columbia are now allowing private contract medicine while we in the United States are moving toward preventing it.

I do argue for private insurance reform, but I believe we need a viable private health insurance market. The primary bills in Congress would by the year 2013 basically put the insurance companies out of business, by requiring all insurers to use a standard benefits package and prohibiting high deductibles or high co-pay policies.

The president will have his public option/public exchange insurance, but with the new restrictions, private insurance companies will not be able to compete with the government’s public option insurance on price. We will lose our health savings accounts. I fear that small businesses and individuals will move en masse to the public-option insurance; private insurance soon will not exist. The president says now that you can keep your private health insurance, if you like it; but I believe that after 2013 it will be unlikely that you will be able to buy it any more. Most people would call this shift national health insurance, or a single-payer system.

So why are we rushing into a very expensive new health care system that we cannot afford, and that will lead to nationalized health insurance and government control of all health care? Why are we rushing into a new system that does not control costs, that does not provide tort reform, that does not end defensive medicine, that does not provide antitrust relief for doctors and hospitals to work together to cut costs and waste, that ignores the real and proven ways to cut costs, that will eventually put private health insurance companies out of business as health insurers?

Why, indeed? Let’s slow down and get it right.

Let’s get true health system reform. Let’s get insurance for the uninsured. Let’s get tort reform. Let’s get antitrust reform. Let’s get insurance reform that allows insurance companies to stay in business and compete with the government. Let’s get doctors back to work. Let’s encourage our youth to go to medical school. We are the United States of America. We can do it.

But not the president’s way. Rather, the people’s way. We want power in the people, not in the government. We can make sure we can all have individually owned health insurance that works, that is priced right and that can be covered from the U.S. treasury for anybody unable to afford it. We have individual insurance for our cars; why not for ourselves? 

*Please note: The SCMA Health Care Forum does not reflect opinions of the South Carolina Medical Association.