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Dr. Daniel Palestrant Headshot

No Worries, Congress Says They'll Work Out All Those Pesky Details

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As summer winds down and family life becomes a whirl of new lunchboxes, haircuts and other timeless back to school rituals - close your eyes and imagine this scenario. What if your kid's teacher was just informed that her salary, benefits and pension were going to be completely overhauled before Halloween? She would likely have a new boss with lots of opinions about the curriculum, too. But hey, no worries, Congress says they will work out all of these pesky details in coming months. All you have to do is drop your precious child off at kindergarten and trust Junior will get the best education in the free world.

This ridiculous proposition is the essential message delivered to doctors and their patients via the current health care reform legislation.

While lawmakers and their special interest entourages take their heavyweight political boxing match on the road, doctors are hunkering down, caring for patients, and searching for clues to what the future might look like. Over the past few weeks I have met with key lawmakers in Washington and have poured over HR3200's 1000-plus dizzying pages. I assure you, the search for substantive, pragmatic answers feels a lot like Mission: Needle in a Haystack.

Let's rewind and focus on facts.

The healthcare reform effort is at a pivotal moment. Today, much of the debate is around the impact that creating an insurance alternative through "co-ops" or a "public option" could have in reducing costs. Listening to the bill's proponents, having these alternatives would seem to be the best of both worlds. Create a low cost alternative to put pressure on private insurance companies, while allowing those people who have insurance to keep it.

Too bad it is pure fiction. Calling the public plan an "option" is dressing up a wolf in sheep's clothes. The current reform doesn't work if the public option is an option at all. How can I be so sure? Sometimes you have to look beyond the legislation for clearer answers.

The Congressional Budget Office has come out and said that the current reform bill doesn't save money or address healthcare inflation so long as the public option is an.......option. Tell this to any doctor and I suspect they won't be surprised. 94% of the practicing physicians polled on Sermo.com do not believe the current attempts at reform are addressing the real sources of spiraling health care costs. Looking carefully at the bill, it would seem the authors recognized this as well. If you turn to page 16 of HR3200, it essentially says that private insurance will be phased out by 2013. So much for optional.

The latest twist is leaked information from the yet to be seen Senate Finance Committee bill which envisions a hybrid system which includes both a public option and healthcare "co-ops" (click here for link). The co-ops are a cheaper, weaker, state-run version of the "public option", designed to pool individuals and businesses together to purchase health insurance and services. Still up in the air is what a national co-op would look like. Would it be truly nationwide or would each state have its own? The bill provides remarkably little detail.

Meanwhile, lawmakers continue to spin the Wheel of Misfortune in the political blame game. Desperate for a reprieve from the public stoning at town hall meetings, members of Congress are suggesting the real problem is that doctors make too much money, and therefore, should become salaried employees of a public or semi-public system. Don't be fooled by this sideshow. Physician salaries have consistently dropped in recent years, and currently account for less than 5% of total healthcare costs. Furthermore, studies from other countries repeatedly conclude that patients lose when doctors go on salary. A recent Sermo.com poll echoes those findings - 82% of physicians believe being on salary will restrict patient's access to care. And let's not forget the big elephant in the room. If/when doctors become salaried employees, who will sign our paychecks? Current legislation suggests that perhaps the states could foot the bill. Note to all doctors and patients living in cash strapped states like California: be very concerned. Massachusetts and Hawaii nearly drowned when they dipped their toes into these waters.

Call it what you want-a "public option", a "semi-private option, a "co-op" or "exchange" - the common denominator of all of these plans is that the issues most important to the physician community and their patients are missing in action. If essential issues like malpractice and insurance reform, increased pricing transparency, the elimination waste and fraud, and an overhaul of the byzantine Medicare/Medicaid billing systems are not addressed in a meaningful way, the end result will be clear: 52% of practicing physicians say they that they simply will stop accepting insurance, Medicare or Medicaid if health care reform, as currently envisioned, becomes law.

As the ones who are on the front-lines of healthcare every day, physicians know what needs to be done to truly change things for the better, perhaps more than anyone else. The great irony here is that physicians are too busy treating patients to lobby for themselves. The only thing that can change this balance is for us doctors to demand that crucial issues currently not included in the legislation, are addressed and solved (doctors: speak up here). We can start by sharing our concerns with our patients and with each other. Physicians need to become active participants in the health care reform process, or else the future of medicine will be ambushed by a 1,000 page bill that raises more questions than answers.

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