On Monday, June 15th 2009, President Obama delivered his healthcare reform plan to members of the American Medical Association meeting in Chicago to mixed reviews (click this link to see video and read transcript: President Obama Speech Before the AMA). I believe and many other experts agree his prescription is the wrong medicine for what ails the US healthcare system. His solution to our problem is wrong because his diagnosis is incorrect. Here are facts, provided by Federal sources, that indicate the the President has the wrong diagnosis. Read on and share your thoughts by adding your comments at the end of this article.
As physicians, if your diagnosis is wrong, your prescription will also be wrong.
We currently spend over $2 trillion a year in healthcare in the US which represents 1/6th or 17% of our US gross domestic product.
Last time I checked, a massive $870 billion, 1000+ page stimulus bill was passed with nary a member of Congress reading neither the bill nor the American people given the opportunity to review and debate the bill as promised by the President. Not to mention TARP, TALF, and other spending totaling over $2 trillion dollars. We’ve already come to learn that 15 – 20% of the monies spent on these programs were unaccounted for and wasted. Now our President proposes to overhaul the healthcare system and wants Congress to present him with a bill for him to sign before members of Congress leave for summer recess.
Crazy! Haven’t we learned anything about being hasty?
Now we’re about to embark on a plan estimated by President Obama to cost no more than $1 trillion over 10 years. No sooner did he state that that the non partisan Congressional Budget Office put out a cost estimate that the plan, incomplete as it is, will cost at least over $1.6 trillion over 10 years.
And besides when has a government program ever fallen within or under budget? Answer: Never.
That’s why we and our children’s children will be bankrupt. Currently the US is responsible for over $60 trillion in unfunded liabilities in entitlement programs: Medicare, Medicaid, and Social Security.
We currently cannot pay back these liabilities, but apparently are prepared to add another.
Who are the Uninsured and How Many Actually Cannot Afford Health Insurance?
You hear the constant drumbeat that over 47 million Americans are without health insurance. It’s a daunting number but misleading. Let’s look at the facts, as published by the US Census Bureau:
- According to the US Census Bureau, 17 million of those without health insurance live in households having over $50,000 in annual income. That’s 38% of the uninsured in America. These households can purchase large deductible catastrophic medical insurance but choose not to.
- 9 million Americans – 20% of the uninsured – reside in households pulling down more than $75K a year.
- …And then there are the young invincibles. According to the Bureau of Labor Statistics, over 18 million of the uninsured are between the ages of 18 and 34. They spend more than four times as much on alcohol, tobacco, entertainment and dining out as they do for out-of-pocket spending on health care. They represent 40% of the uninsured in America.
- …14 million people without health insurance are eligible for government health care programs like Medicaid and S-CHIP but choose not to enroll. They represent 31% - nearly a third one third - of the uninsured in America.
- …The U.S. has 12 million illegal immigrants who don’t buy health insurance but still get health care.
…So, how many are truly uninsured?… about eight million, or about 3% of the American population.
So 97% of Americans that are currently insured, are eligible for public healthcare, or choose not to obtain medical insurance may be forced to change their current care as part of a plan to address the needs of the 3% that are truly without access to health insurance.
That doesn’t make sense to me, and these are government statistics, NOT mine. So you need to take what you hear from our politicians with a grain of salt.
Saving Money by Eliminating “Unnecessary” Tests
One of the brilliant ideas put forth as a magic formula for funding the new program is to use all the money we’ll save by eliminating “unnecessary” tests. Show of hands everyone — how many costly and unnecessary tests do you order on a daily basis? Don’t you order tests that are necessary to confirm a patient’s diagnosis in order to prescribe proper treatment? I bet you do!
The only times I have found that physicians have ordered “unnecessary tests” were to either placate a difficult patient or family member rather than to confirm a diagnosis. And let’s not forget our legal brethren who are at the ready to take you to court for failure to do the “unnecessary tests.”
Is There Enough Competition to Control Costs?
And how about the false argument that healthcare reform is necessary because there isn’t enough competition to help keep costs down?
Currently there are over 1500 healthcare insurance plans to choose from. Will adding one more plan to the mix fix everything by ensuring competition? I don’t think so.
If the government enters the market and runs its program with premiums that are below everyone else, acts as a referee and dictates unsustainable terms to the other players, it will ensure that there is ZERO competition because it will eventually wipe out all the other players.
Mind you, I am not sympathetic to the private insurance companies, but this bogus argument has no merit.
Here’s what’ll happen: large employers will dump their insurance plans and will shift their workers to the government run “public” plan, private insurers will find it increasingly difficult to compete and generate a profit against a government run healthcare behemoth, and many will go under.
There will be no competition because the last man standing will be government run healthcare.
By the way, if the government’s public program is as great as advertised, why then do all the proposed plans exempt members of Congress and union members (payback for helping elect the President) from participating in the government program?
Question…if it’s good for the goose, why not the gander?
How about introducing real competition by removing the shackles that prevent physicians from running their own hospitals, insurance companies, and other services? Why does your government feel you cannot be entrusted to serve your patients without oversight?
It certainly would introduce competition and help reduce costs. It always happens when you introduce real free market solutions that competition drives cost down. You see it every day when you shop.
I’m sick and tired of hearing from the President that because we entered medicine to answer a higher calling that fair compensation and ability to earn a living should be sacrificed for the greater good.
When I started practicing medicine in the early 1990s I received more payment for services rendered than I am currently receiving now.
This has happened despite everything around me going up in costs: running a practice, increasing malpractice premiums, staff salaries, rents, professional fees, license fees, DEA fees, and the cost associated with complying with every regulatory city, state, and federal mandate.
Let me ask you a question, what other profession has seen its fees reduced over the past twenty years? NONE!
A couple of other arguments need clarifying and I will defer to economist and retired business executive George Newman who wrote “Parsing the Health Reform Arguments” in the July 1, 2009 Wall Street Journal Opinion section. Consider the following excerpts from his article:
…You hear that the American people favor healthcare reform, but survey after survey show that the public is generally satisfied with their healthcare coverage. If that were not the case, why would the President insist “if you like what you currently have you can keep it?”
…The cost of healthcare is rising faster than inflation, but the improvements in healthcare have been more profound when you consider the costs [that] are associated with these improvements have prolonged life, reduced pain, require less surgeries, and produce miracle drugs.
…Healthcare does represent a rising proportion of your income… and it should. Quality healthcare is a discretionary, income-elastic expense – the richer a society, the larger the proportion spent on it. Would you feel better if you skimped on your family’s healthcare and spent it on alcohol, gambling, night clubs or a third television set?
I suggest you read the full article for its enlightening commentary.
There’s so much more to say but I’ll stop here and let you take it in for a bit. This is an ongoing debate with much more to be said. I’ll stay on top of it and hope you really give some critical thought to a proposal that I believe is misguided.
Stay tuned for more…
As always, I welcome your comments and feedback and thank Drs. Khan, Pike, Shah, and Andresen for their feedback. Note that comments are moderated to maintain the professional tone of this web site so if your comment does not appear immediately it is because it is waiting to be manually reviewed.
To your continued success,
Jose M. DeJesus, MD, MBA
{ 8 comments… read them below or add one }
BRAVO, BRAVO, BRAVO! Very well put, Jose. My question is, however, what can we do? The American people used to have clout with their elected officials. But now the political class has become deaf and totally unresponsive to their constituents, not just on this but on the multitude of issues this administration is ramming through against the will, I believe, of the vast majority. How can this blatant hijacking of democracy be dealt with?
I appreciate all your comments on the subject. I believe now more than any other time in the past we must ban together across specialties to fight this take over of medicine. I feel that many people don’t have all the facts when they discuss this on TV, and I often wonder where is the physician on this panel??
I might also add that those of us just starting our careers in medicine after finishing residency have huge debts to pay back for our years of education. We are unable to pay those loans back during our residency because of the small amount of money we make during that time. I think many forget the how much physicians sacrifice to do what we do! And let’s not forget the liability we take on everyday even when we are doing our best to practice safe medicine.
Thank you for your comments, and my hope is that we can also change the public’s view on the healthcare plan…and what it REALLY means for their own healthcare (and their family’s) in the future. And that everyone will take more responsibility for buying their own health insurance (I appreciated your break down on who the uninsured REALLY are).
Thanks so much,
Amy Cabbabe
Medicare crowded out the private health care market completely for seniors (excluding the deductible). This will happen to to a similar degree with the so called public option.
Some predictions if the private option is enacted:
1. Many physicians will tilt their practices to provide non covered services as the self pay option. For example acupuncture, prolotherapy are not covered. Some procedures may be covered for some indications and not others.
2. Some physicians, clinics will go out of business or retire early because of additional expenses and reduced reimbursements.
3. Offshore clinics, medical tourism-Bermuda, Bahamas.
4. Black/gray market medicine.
5. More physicians opting for salaried positions. This will result in unionization of doctors and other HC providers. Unions will result in reduced productivity-more coffee breaks, less call, lighter schedules. I’m sure that SEIU and ASFME are licking their chops.
6. Difficult patients will be shunned. If the diagnoses is difficult or the patient’s personality is difficult, good luck in finding a doctor. In Canada, it’s relatively easy to get care if the problem is small.
7. Continued more volume, less time, more extenders. Patients will fill out their own records on computerized kiosks. Granny better bring a computer savvy kid.
8. Defensive medicine will continue. Additional consents will have to say that if the insurance company denies a therapeutic or diagnostic intervention, the physician is not responsible. If the patient wants an MRI for a new onset headache the government insurance may not pay-too bad.
9. Time to short health care companies, especially the smaller ones.
I’d like to know what other unintended consequences you could think of as a result of the public option/universal health care.
I agree. Furthermore, this is a pig in a poke.
The details of what will be covered are left to one person to be appointed as Commissioner. This person will decide what “mental health coverage for all” will include– in addition to marital and family counseling which is specifically included, might not anxiety syndromes, neuroses, the broad spectrum of “autism”, etc., etc. How about IVF, chiropracty, acupressure, faith healing, etc. All the practice and compensation of anything called “health care” will be defined as covered or not covered by this one commisioner.
Although there are some good things in the bill, like prohibition of exclusion of pre-existing conditions and transferability, and support of primary care practitioners, these are far outweighed by the room for mischief. This bill is not in keeping with our tenets of “first do no harm”, and “anything worth doing in government is worth doing slowly”. Unfortunately, President Obama’s m.o. is falling into a pattern of oversized goals with the details left to other politicians– consider the stimulus package, the cap and trade bill, and the health care bills. All of these are characterized by wrong diagnosis followed by massive, overly expensive, too quick bills with our representatives never even reading, let alone thoughtfully discussing them prior to voting. This needs to stop before it is too late.
Yes. This plan, if enacted, will be the beginning of the end of healthcare as we knew it. After VA “Healthcare” and HMOs promising to save money this is the next BIG LIE.
Although some good points are made in the article, especially the break down of the uninsured, I don’t agree that we can maintain the status quo. The arguements for change on a macro level are compelling and the proposed cost increases per year compared to what we spend annually on health care is less than 10% or to use our GNP the increased cost would be less than 2%. We have the most expensive health care in the world as compared to other industrialized countries, yet we lag in many measure of “health” including life expectancy at birth (worst), medical errors (worst or second worst), diabetes care (worst) as some of the examples (see recent Commonwealth fund report for details-www.commonwealthfund.org). In addition, we have huge variations in regional spending per patient without seeing an increase in quality as a result of that spending (go to http://www.gawande.com for the article “The Cost Conundrum”). And yes, I have seen much inappropriate testing ordered. As a small example, two surgeons doing same type of surgeries. One orders every preop lab test while the other uses hospital based protocol ordering. They have similar risk patients and same outcomes. The first spends $20K more per year. Granted, not a lot of money but multiplied across the US comes out to big dollars. For too long, physicians have resisted changes like standardization, reduction in variability of care, and applying new evidence into clinical practice. For this we are now going to pay the price. The question is not how we can resist change, but how can we keep our seat at the table, embrace, and lead the change needed to fix our health care system.
Dr. DeJesus replies:
Thank you, Dr. Kander, for taking the time to contribute your thoughts on this important topic. While I agree that there are plenty of opportunities for improvement, outliers for utilization and cost variability (e.g. Miami), I am unhappy with the idea of having healthcare dealt with the same way that this country implemented TARP - by ramming an unread bill through Congress that ends up making radical changes in the funding and practice of medicine without adequate participation by those who utilize medical care, those who provide medical care, and those who will pay for it. We have read reports in the news about how President Obama has met from leaders of pharmas and other industry stakeholders and reported how he has received promises for billions of dollars of savings (again without mentioning where those savings would come from). Of course I am going to take a more partisan viewpoint because my job here is to look out for the legitimate interests of you and my other fellow physicians. I’ll be writing and publishing more actionable articles in the coming days and weeks on this and other topics of interest to our community.
Quite coincidentally, a friend shared this video with me which I just happened to watch last night. I believe it answers my question about why our elected officials are so unresponsive.
Watch it for free here:
http://video.google.com/videoplay?docid=7535755025025800195
Or, buy the DVD with extras here
http://www.obamadeception.net/
Everybody needs to know this information.
I totally agree.However,nothing mentioned about the claim that preventive medicine will result in great savings. Does that mean we should refuse treating those who suffer the results of not stopping smoking ,excercising or refuse dieting or injury protections etc. ?? Ofcourse, this won’t happen, but if prevention of major illnesses would require every minor complaint be fully investigated early to avoid further complications later,I can’t imagine the cost of this prevention method. Would some one explain what Preventive Medicine means and how it applies in our practice and the savings it supposed to generate ?
Another question ; have those pushing for reform that will inevitably leed to government control of health care looked at what happened to the quality and cost of health care in other far less populous countries, or states?? Please, let me know..
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