FROM THE EDITOR’S DESK
What’s new in Washington? By Joseph S. Andresen, MD
Quote of the Day: “We have 900 billing clerks at Duke (medical system, 900-bed hospital). I’m not sure we have a nurse per (each) bed, but we have a billing clerk per bed…it’s obscene.” -Dr. Uwe Reinhardt, hearing on health care reform, U.S. Senate Finance Committee, November 19, 2008 What’s new in Washington? It’s less than 90 days until health care reform legislation is predicted to be on the President’s desk and ready to sign into law. There is a frenzy of lobbying and legislative activity taking place right now. The Senate and the House of Representatives are working on separate bills with the goals of providing universal coverage, affordable premiums, portability, and removal of limitations on pre-existing medical conditions. There is also recognition of the importance of preventative care and streamlining the flow of medical information for increased patient safety, efficiency, and cost saving. The most heated debate involves inclusion of a competing “public plan” that would be available for all citizens and offer an alternative to private insurance coverage. The insurance industry is lobbying heavily against this possibility, claiming that the government would be an unfair competitor because of its size, lower administrative costs, and ability to set pricing. Proponents for the “public plan” claim that the benefits include introducing competition to previously limited
markets, reducing costs, driving quality advancement and innovation, and serving as a benchmark for the insurance market. Where are physician organizations weighing in? The American College of Physicians has not yet taken a position until more details are available regarding the “public plan” option. Certainly the hesitation revolves around the fear of a “Medicare for all” system, where hospitals and physicians are further squeezed for cost reductions to meet annual budget deficits with reimbursement falling below the costs of providing care. We do know that private insurance companies spend 12% to 30% of their dollars on non-medical costs vs. Medicare that spends about 5%. So when one removes the cost of underwriting, marketing, and profits, there are more dollars to spend on medical care. The real question is whether the legislative architects are able to look beyond the flaws of our current Medicare system, a system that undervalues primary care, doesn’t cover most preventative services, rewards fragmentation and volume of services, and has a sustainable growth rate formula (SGR) that triggers physician payment cuts every year. This is remedied only with a last minute Congressional stop-gap measure that passes on the problem to the following year’s budget. Is it possible to design a “public plan” that will control costs, improve quality, and increase access that private insurance companies will be forced to emulate while continuing to attract the best and the brightest to our profession? The PAGE 6 | THE BULLETIN | MAY / JUNE 2009
Joseph Andresen, MD is the editor of The Bulletin. He is board certified in anesthesiology and is currently practicing in the Santa Clara valley area. answer is yes, but only with the guidance, shared wisdom, and experience of our physician community. In 1993, health care reform was attempted behind closed doors without significant physician or public input and failed. This time is different. Contact your medical organization and legislative representative today. Here are the key players. Now it’s your job to take action. Call or email them today! Senate Finance Committee Baucus, Max (D - MT) 511 Hart Senate Office Building, Washington DC 20510 (202) 224-2651 baucus.senate.gov/contact/emailForm. cfm?subj=issue Wyden, Ron (D - OR) 223 Dirksen Senate Office Building, Washington DC 20510 (202) 224-5244 wyden.senate.gov/contact/ Grassley, Chuck (R - IA) 135 Hart Senate Office Building, Washington DC 20510