A physician’s view

Published 10:31 am Saturday, December 19, 2009

I would like to offer a unique perspective on the health-care debate in our nation’s capital.

I have observed the evolution of the American health-care system both indirectly through my family and directly through my career as a specialist in internal medicine, pulmonary and critical care. My grandfather was a country doctor in the mountains of Tennessee. My father was the first radiologist in eastern North Carolina and practiced in New Bern, introducing the area to diagnostic radiology, radiation therapy, nuclear medicine, angiography, diagnostic ultrasound, computed tomography and magnetic resonance imaging as these technologies became available.

My mother trained as a nurse. My brother and I studied medicine and surgery and have practiced in the New Bern community for more than 20 years. I have recently retired from my previous practice due to health reasons and continue to work on a part-time basis as a hospitalist at CarolinaEast Medical Center.

My grandfather began his career at a time when there was no health insurance and frequently accepted barter payment for his services, although insurance became more common as his career progressed. My father practiced for more than 40 years and saw the introduction of Medicare and Medicaid into medical practice. He also saw the development and implementation of progressively fantastic medical technologies within the context of increasingly common availability of medical insurance. He believed — as has been argued by many others — that the marked rise in health-care costs has mirrored the increased availability of health insurance and the eventual governmental guarantee for payment offered by Medicare and Medicaid.

When a third party provides payment for services, there is no incentive for the patient or the provider to limit costs, and when insurance payment is available, no one charges less than what is paid by insurance. My brother and I saw the start of the Diagnosis Related Grouping method of payment for in-hospital Medicare services early in our careers and have subsequently seen the institution of progressively more restrictive and punitive legislative efforts to rein in health-care costs. Obviously, these efforts have proved futile.

Clearly health-care reform is needed to provide access to care in appropriate settings (rather than going to the emergency room for non-emergency chronic health problems), to decrease denials for pre-existing conditions and to increase the portability of health insurance (such that insurance is not lost when someone loses their job). There is also a great need for the reduction in the cost of medical care and for more equitable distribution of medical care payments. These changes must occur under a fiscally sound policy and must be affordable to our nation. Also, it is imperative that these issues be addressed without a decrease in the quality of care.

Unfortunately, the proposals being discussed in our nation’s capital accomplish virtually none of these goals. Millions of uninsured and underinsured Americans will remain so despite passage of the proposed health-care reform. Any of the plans currently debated will lead to the creation of a vastly enlarged federal bureaucracy. The extreme cost of the changes would be felt in many direct and indirect ways.

Cuts in spending for Medicare services are proposed at nearly $500 billion. These cuts are to take place at a time when the number of elderly patients will continue to increase substantially with the aging of the Baby Boomer generation. Therefore, even if Medicare expenditures were held at current levels, the payments per person for health services would decrease considerably in the future. Including the proposed spending decreases would further reduce these per-person payments. These combined changes would, in fact, result in rationing of care, as you cannot provide the same services for more people with less money.

Access to care for Medicare and Medicaid patients would also decrease. There are already many physicians who will not see these patients, and many more are on the verge of limiting their practices in this way. Medicare pays less already than private insurance for medical services — and has aggressively pursued policies that make it much more difficult to work with to obtain appropriate reimbursement for care. Most medical practices have to hire several employees simply to deal with obtaining payment from Medicare, thereby driving up overhead costs. It is no wonder that Medicare patients are not popular with physicians, and with the massive cuts proposed to the system I am certain that many doctors will simply decide they cannot continue participation in this plan.

In conclusion, although the proposed health-care reform being debated would provide guarantees preventing denials of coverage for pre-existing conditions and would increase portability of health-care policies, coverage would still be unavailable for many millions of the currently uninsured Americans. The plan would certainly lead to rationing of medical services and decreased access to care under the Medicare program. Claims that the program will be “budget neutral” and will not add to the deficit can only be made when one ignores the cost-shifting and dishonest accounting discussed above.

There is no effort in the proposed reform to actually decrease the overall cost of health care in America. Many reasonable suggestions have been made by the conservative elements of our government, such as badly needed tort reform, allowing the purchase of insurance across state lines to increase true market competition and the use of health care savings accounts, but these suggestions have been summarily rejected by the majority party.

I hope you will discuss these issues further with your friends, family and elected officials. True health care reform is badly needed to address the real problems that exist regarding health insurance and the cost of care. However, the proposed legislation currently before Congress does not address these issues but instead leads to a whole new system of social engineering and entitlement that will clearly result in the rationing of care and decreased access to care under the Medicare system, worsen the delivery of quality medical care in America, increase taxes, increase the cost of health insurance premiums and stifle our economy.