Tuesday, June 23, 2009

The end of the road for health care reform? (Hardly)

Today, I am blogging from the end of the road - literally.

I write from the beautiful shores of Homer, Alaska, famously described by former resident and "All Things Considered" commentator Tom Bodett as being the "end of road." I am here because later this week I will be meeting with internists attending the annual ACP Alaska chapter meeting in Anchorage, and Homer, a little over 200 miles away on the Kenai Peninsula, is a nice side trip. (Each year, I try to attend as many as a dozen ACP chapter meetings across the country. This allows ACP members to hear my perspectives on what is going on in Washington, and in turn, I get an earful on what's on their minds, especially from notoriously independent Alaskan physicians!)

The end of the road might be an apt description of how some commentators now view President Obama's prospects to achieve lasting health care reform.

The Congressional Budget Office's report on the cost of health care reform, followed by the decision by the Senate Finance Committee to delay release of its draft plan, have led some to conclude that President Obama's push for health care reform is in deep trouble. Roll Call reports that the price tag and partisan bickering could "derail" Senate passage of health care reform.

After months of mostly upbeat reports, it's as if the press suddenly awakened to the fact that reforming health care won't be easy. But why? - all of the negatives from the past week were entirely predictable.

Health care reform will cost a lot of money? Well, yeah.

Republicans and Democrats will bicker? Duh.

Democrats will have difficulty reaching agreement amongst themselves? What else would you expect from a party that has made internal dissension a celebrated art form?

But amidst all of the gloomy reports, there actually was quite a bit of positive news for President Obama and his congressional allies.

First, the drug industry reached an agreement to reduce the costs of drugs paid for under the Medicare Part D program. This is important because the White House and Congress need savings and offsets that will not be fought by the affected stakeholders.

Second, House Democrats produced a draft bill that includes measures designed to win broad support among key constituencies - including doctors. It not only eliminates next year's 21 percent cut in Medicare's payment to doctors, but would also get rid of hundreds of billions of dollars in accumulated doctor pay cuts - a top priority of the medical profession. The bill includes scholarships, loan forgiveness, and payment reforms to support physicians in primary care. I will write more about the House proposal later this week, but I believe that there are enough positives in it to keep physicians at the table in a way that help move things forward.

Finally, despite all of the hand-wringing in Washington, a new poll shows that the public remains strongly in favor of health care reform. 85 percent of respondents said that health care must be completely rebuilt or fundamentally changed - with a strong majority favoring a greater government role in health care. The poll also showed strong support among Democrats, Independents, and even a majority of Republicans for a "public plan" option, one of the most controversial issues in Washington.

Instead of reaching an end of the road, health care reform continues to move forward - as it does, it will run into speed bumps, pot holes, and perilous turns along the way. The whole effort could yet crash and burn, but from where I sit, at the end of a road overlooking Kachemak Bay, the finish line remains very much in sight.

Today's question: Do you think health care reform is in deep trouble - or will it continue to move forward to enactment?


Jay Larson MD said...

Too much time and effort has been dedicated to health care reform to stop the process. Yes, health care reform will happen. The big question is... How much health care reform will be achieved?

Joseph W. Blackston, MD, JD said...

No, I respectfully disagree. The big question is, how much "healthcare reform" can we AFFORD??

I am in support of "reforming" the healthcare system. I would even support a LIMITED form of single payer coverage.

But Obama, in only a few months in office, has already spent more $ (on NOTHING related to healthcare, BTW) than ALL OF THE PAST US PRESIDENTS COMBINED.

Do we bankrupt our country just to achieve goals set by the ultra left wing? Who is going to pay for this "reform," and what is going to be "reformed"??

Unfortunately, "healthcare reform" means, to many in Washington, that everyone gets everything they want all the time, and its all FREE!!!!

Without limitations on ER abuses, medical malpractice reforms, "scooter store" payments by Medicare, and yes, limiting things like back surgery for simple mechanical pain, multiple cardiac stents for asymptomatic people, etc., we are doomed.

The people in the Soviet Union though their country was, to borrow a common phrase these days, "too big to fail." They were dead wrong. Soviet doctors were literally unemployable, and the result was to either leave the country or starve.

When the US economy completely fails due to massive overspending, worthless money, and staggering inflation, being an interventional radiologist or a board certified internist won't matter, because we will all be picking up aluminum cans on the side of the road.

Unknown said...

You just cannot expect everygood and great things to happen at once because the business interest and lobbying( legal bribery) is too powerful in Washiington. There is so much fraud and abuse and waste in at present medicare -medicaid system that it alone can save $250 billion per year. Whos is goin to make sytem better: Pharmaceutical Industry? HMOs? Hospital System? Doctors? Politicians( with thei pocket full of PAC money)? or a leader who has vision and power to make changes happen for greater good of americans.
We pay enough taxes that health care can be given to all americans only if the greed and abuse by poweful businesses were excluded.
Millions of people file for bankruptcy and millions of business die every year due to unaffordable healthc are cost.
My HMO agen came to deliver my new Plan and told me that premium will be up by 8% this year. For what?
I hardly use my it and my wife use it 1-2 times per year a dn so does my kids.how fair is this?
For Profit HMOs are not synonymous with better and affordable healthcare of americans.
Pankaj Karan,MD

Joseph W. Blackston, MD, JD said...

Dr. Karan makes many excellent points. There is much waste and much fraud in the present system, and much of this is related to Medicare and Medicaid, which is exactly the point.

These are GOVERNMENT run programs. Doctors are sick of dealing with the hassles of Medicare, and are insulted by the poor reimbursement of both. Do we really want MORE of the same??

I agree we pay huge taxes already - money which could reasonably allow all citizens BASIC healthcare in the form of preventive services, catastrophic illness protection, and perhaps limited emergency department access.

What we cannot afford is for our taxes to pay for every possible healthcare want, for every person (read, US citizens in addition to millions of illegal aliens).

Some wonderful, magical, charismatic "leader" is not going to fix this, no matter how great things sound when being read from a teleprompter.