Monday, August 03, 2009

Opponents of Health Care Reform go Cra-a-a-zy!

Alright, 1000 pages seems unwieldy for any government bill and that is what we have with the current House bill on health care reform. But on further perusal, it's double spaced and outline form, and actually not that difficult to navigate.

Watching Hannity* this weekend (I do this occasionally just to see the most extreme wackiness being proposed) and also reading a couple blogs, I have come up with some criticisms of the health care bill to answer.

The right wing has gone nuts finding all manner of complaint with the current House bill. Fleckman has gone point by point and page by page to give his commentary on the bill. I admire his completeness, the problem is that he has large gaps in his knowledge base and his views are peppered with outright anger over "government control". I'll address three points specifically.

1. "Government will tell grandma that she has to give up her right to care and just die." This is the anti-rationing argument and opponents reference page 425-430 of the bill for their ammo. The background on the legislation, however, is that currently Medicare does not pay physicians to sit down with patients to discuss end-of-life care. If the doctor makes time for this important discussion, like many things in Medicare, it's a freebie. Hospitals are now required to offer "advanced directives" for anybody being admitted either for a routine outpatient surgery, or life threatening emergency; patients can refuse to fill out the papers and they often do because of their lack of understanding. Wouldn't is be much better if that same patient who is now coming in with chest pain at 2:00 a.m. had already discussed all the interventions in a leisurely visit with their own physician in the office? That's all the legislation is saying: insurers must pay for the discussion once every 5 years, or if the patient's health changes significantly. Duh.

2. "Telemedicine is health care by telephone." (p 379-382) Again, Medicare and most private insurers do not currently pay for telephone calls by physicians to patients. As a consequence, for doctors to get paid for their time, it is required that patients come into the office to discuss routine lab and x-ray results in order that the visit can be billed. The problem is that many old and/or sick patients have difficulty making a special trip just to discuss things that can be done over the phone, so the compassionate doctor does it for free. This provision in the legislation would allow a fee to be billed for telephone calls. Better medicine, long overdue... just ask Thomas Edison. In addition, the current legislation adds a provision for a telemedivcine advisory board in order to monitor the progress and keep up with newer communication technologies.

3. "Government is being big brother by telling doctors they cannot own surgicenters, diagnostic centers and pharmacies." (p 316) Actually, these restrictions have been extant for a couple decades for Medicare providers and the legislation would just make it formalized for non-Medicare providers. The rationale is that many studies show that physicians who own such health care vendors tend to over-utilize their own facilities, i.e., they order more needless xrays and do more unnecessary surgery if they can double-dip on billing. Under the current legislation, physicians can still own such entities, they would just not be allowed to refer patients to their own facilities and bill for such services.

Of course, there are many more criticisms and I took these at random. These provisions are all common sense and really just formalize or clarify or update the status quo. Insurers will be required to cover certain things under comprehensive care, so women will know that Pap smears and mammograms are covered benefits, for example. No more will private insurers be able to game the system by calling their coverage comprehensive and then refusing certain well-accepted things, and don't tell me that doesn't happen-- it does.

Are there things missing from the bill that I would like to see? Sure. If we must have all these various private insurers, the least we could do is make all the forms the same. Currently, a typical doctor's office must be adept at filling out a couple dozen different forms to bill all the different insurers. There is no reason all the insurers could not use the same forms, which would cut down administrative costs and allow patients a better understanding. Also, the same payment for the same service would be beneficial, although I know this will never happen. It has always seemed strange to me that Insurance Co A may reimburse 20% more than Insurance Co B for the exact same service, but that's just a contracting issue with physician groups.

As you can see, health insurance is being treated more like the utility it is. Certain things must be covered, policies must be portable, pre-existing illnesses must be accepted... the insurers can no longer game the system by cherry-picking healthy and wealthy patients. So it begs the question, why do we even need health insurance companies... except to take their 15% or 20% profit off the top?

My take is admittedly extreme and I subscribe to the school that believes that private insurers have nothing of value to add to the health care product and we would be better off bypassing the for-profit insurance industry altogether. Patients have this delusion that they have a vast amount of choice in what can be done. They don't. Doctors by and large follow standards of care and insurers choose whether they want to cover it or not. The current health care bill is long overdue and is merely formalizing statutes that are long overdue. The talk of "rushing" through a bill all bullshit, too. Policymakers have been mulling these basic and necessary changes for 20 or 30 years, only now do we have the political will to make it happen.

*I lasted 5 minutes watching Hannity and had to change the station due to his complete lunacy about the issue. Every statement was punctuated with his "fear" of what might happen or that he is "scared" of all the potential "unintended consequences." Geez, what about the intended consequences of the insurance lobby's efforts to delay reform all these years? It's bankrupting us. Maybe we can add a special clause in the bill that pays for diapers for right-wing commentators so guys like Hannity don't have to wet their pants over every single news item. The fact that anybody is listening to him-- and a lot are-- is a sad testament to the notion of an informed electorate. (No wonder we had such broad support for the idiotic war in Iraq!)


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