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December 17, 2009
Health Care Reform: Time to Stop Digging?
Health care reform leapt back into the spotlight this week when independent Senator Joe Lieberman announced that he wouldn’t support any proposal that includes an expansion of Medicare or a public insurance option. Lieberman agrees with the Republican line that an expansion of Medicare and tougher government controls on insurance providers would not only be inflationary, but analogous to a public insurance option which would potentially drive private insurance companies out of business. The American Medical Association (AMA) also opposes the expansion of Medicare, arguing:
Many physicians have been forced to stop accepting Medicare patients because of the program’s burdensome regulations and unstable payment system. Adding more patients to Medicare will force more physicians to make this difficult decision. Medicare payment rates have failed to keep pace with practice cost increases … Adding a new patient population to the program will only increase the cost shifting, raising premiums and health care costs for other Americans (2009).
Lieberman’s stance comes after the Democrats introduced a bill that attempted to break the current senate impasse by proposing a Medicare buy-in option for people aged 55 and over (currently 65+) and not covered by employer-provided health insurance, as well as a network of government supervised private insurance plans.
Lieberman’s opposition to the proposal deepens the political stalemate and threatens to dilute the reform. Meanwhile, the AMA’s position highlights the following conundrum: How will we, without increasing costs, extend coverage to more people (remember, nearly 46 million Americans are uninsured) while maintaining current health care practices?
One of the answers might lie in eliminating unnecessary waste. The existing health system encourages doctors to order expensive procedures and tests through financial incentives, a culture of defensive medicine, as well as patient pressure on physicians to be overly-thorough. A 2006 study that looked at 4,600 preventative health checkups found that 43 percent of them resulted in unwarranted urine, X-ray or electrocardiogram tests on asymptomatic people (Lagorio 2006). If every American were to undergo these tests at an annual checkup, the costs would run into hundreds of millions of dollars (Pho 2008).
There’s lots of talk about the cost of health reform, but what about the cost of not changing? According to the Urban Institute (2009), a nonpartisan research organization, if we make no major changes to the health system, the best case scenario is that by 2014—only five years from now—the number of uninsured Americans will reach 53 million. The worst case scenario is nearly 58 million. Insurance premiums, which have grown 131 percent in the last decade, will continue to grow. Poor affordability will necessitate an expansion of Medicare/Medicaid and further fragment health services.
What do they say about holes? If you find yourself in one, stop digging?
Robin Stone, M.D.
Insight Psychiatry
13123 Rosedale Hill Ave.
Huntersville, NC 28078
704-948-3810
Further reading:
American Medical Association 2009 Health system reform bulletin, December 9.
Holahan, J et al 2009 Health reform: the cost of failure, Urban Institute.
Lagorio, C 2006 Needless medical tests costly, CBS News.
Pho, K 2008 My take: just say no to unnecessary tests, KevinMD.com.
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