Posted by Metamorphoses Healthcare 12/23/11
“The Senate…met… to give its unanimous thumbs up to both the Medicare "doc fix" and other deal provisions… "With this brief reprieve from the massive 27 percent cut to Medicare payments, Congress now has to enact a real and fiscally responsible solution to this sorry cycle of scheduled cuts and short-term patches that compromises access to care for patients and drives up costs for tax payers," said the American Medical Association in a statement after last evening's eleventh-hour deal, worked out among House Republicans. The association continued: "Members of Congress need to use this time to work out in a bipartisan manner to provide stability for seniors, military families, and the physicians who care for them." Whether such "a real and fiscally sound solution" can be worked out by Congress …remains doubtful…revamping the much-reviled sustainable growth rate formula, which is the basis for the draconian Medicare pay cuts, remains among the thorniest. (Guglielmo 2011)
The following are interview excerpts from DAVID WINTER, PROFESSOR UNIVERSITY OF TEXAS at DALLAS (UTD). The excerpts from the interview with DAVID WINTER, MD can be viewed on the documentary website, http://www.emrdocumentary.net/transcripts.htm
IN: A medical economist we interviewed about health reform believes we can’t move forward effectively until we decide whether healthcare is an individual right or responsibility.
Given the strengths and weaknesses of private insurance as well as federal insurance programs such as Medicare and Medicaid, what are your recommendations to policymakers about best ways to manage runaway healthcare costs?
DW: Universal healthcare would solve a lot of problems.
Doctors struggle with Medicare and Medicaid criteria (reduced reimbursements, restricted use of treatments and tests, etc.). Overall, Medicare has been great for Americans. It’s brought healthcare to many who otherwise would have none.
Nonetheless, physicians find it easier to work with commercial payers than with the government, which lacks flexibility and makes changes slowly. Some have proposed merging private and federal coverage, but all the proposed solutions have problems.
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The case for private medicine in USA: healthcare as a personal responsibility
A private physician’s view of Medicare and Medicaid
The state of Kansas and 34 other states are submitting amendments to their states’ constitution, often called “the Healthcare Freedom Amendment”. The proponents of these amendments believe that “Medicaid [is] for the truly desperate situations” and “that private contracting was the way to bring down medical costs.” They also believe that “rationing, like charity, is best decided at the local level.”
This private medical model proposes the following tenets.
Patients should own their own health insurance not their employers. This is the economic model used for auto and life insurance. Patients, therefore, would not lose their insurance if they lost their job. Health insurance premiums should be tax deductible for both individuals and employers. Physicians who render charity care should be allowed tax deductions for the cost of that care. The author states that his groups “mission clinic” has done very well with this economic model. If the physicians contracts directly with each patient, tort reform is a less pressing issue.
The author gives an example of how he negotiated a refund of part of an unsatisfied patient’s bill.
The author goes on to say that physicians can move to independence by opting out of Medicare and Medicaid contracts.
This doctor’s patient said: "Medicare only paid the doctor 17 percent of his bill. How long will he be able to stay in business?" The physician went on to say that even if the percentage of your practice of Medicare (or BCBS) is 50% of his patients and you cancel your contract and lose 50 percent of those patients… If you are getting 17 percent of what you bill (as in the Medicare example above), you could set your new cash fees at 25 to 50 percent of your previous fees and be much better off. Years ago, 10 percent of my monthly revenue came from Medicaid. When I cancelled my contract with Medicaid, the very next month, I received twice as much revenue in the time slots that Medicaid had previously taken…What will another 21 percent cut in Medicare payments do to your bottom line? Or, How much will you get paid when the global payment goes to the hospital to be divided among the 'providers'?" (Watson 2010)
George R. Watson, D.O., practices family medicine in Park City, KS. Contact: drgeorge@watsonmedicalgroup.com. He serves as president of AAPS.
The case for government funded medicine in USA: healthcare as an individual right
In a 2002 survey of physicians, 49% supported government legislation to establish national health insurance (Ackermann and Carroll 2003). In a six year follow up survey, the same authors randomly sampled 5000 physicians from the American Medical Association Masterfile. They asked the physicians if they supported government legislation to establish national health insurance and if they supported introducing universal coverage through an incremental reform.
The response rate was 51%. The majority of physicians who responded to the survey (59%) supported legislation to establish national health insurance, 9% were neutral on the topic, and 32% opposed it.
Similarly, the majority of physicians (55%) supported incremental reform in order to achieve universal coverage, 21% were neutral on the topic, and 25% opposed it.
A minority of physicians (14%) opposed national health insurance but supported more incremental reforms.
Most (>50%) medical specialties supported national health insurance legislation. A minority of respondents opposed to this were from the procedural specialties: the surgical subspecialties, anesthesiologists, and radiologists.
There was a 10% increase in support for a national health insurance from 2002 to 2008 (49% to 59%) amongst physician respondents. Pediatric subspecialists were highly supported of such a program in both surveys. Support increased in every subspecialty between the two surveys time periods. (Carroll and Ackerman 2008)
In summary, we present two different models of healthcare from physicians’ viewpoints: The first model is based on the value that healthcare is an individual responsibility. Patients own their own health insurance policies, not employers, which would make job loss less onerous in regards to its impact on a patient’s access to continued healthcare. The premiums would be tax deductible. This model contains a pathway for those patients that do not have health insurance with tax deductible "charity" clinics. The second model is based on the value that healthcare is an individual right. This model reflects the opinions of physicians who participated in a survey. This model contains a national health insurance plan.
Ackermann, R. T. and A. E. Carroll (2003). "Support for national health insurance among U.S. physicians: a national survey." Ann Intern Med 139(10): 795-801.
Carroll, A. E. and R. T. Ackerman (2008). Support for National Health Insurance among U.S. Physicians: 5 Years Later, American College of Physicians. 148: 566-567.
Guglielmo, W. J. (2011) "House and Senate Give Nod to Medicare Pay Cut Postponement." Medscape Medical News 12/23/2011
Watson, G. R. (2010). "We can win the battle to maintain the practice of private medicine. Journal of American Physicians and Surgeons 15(1): 4.
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Metamorphoses Healthcare is a non-profit organization that advocates for the establishment of a national disease registry as an adjunct to the federally mandated purchase and installations of EMRs in all hospitals and physician practices by 2014.
The views presented in this organization’s documentary, “Electronic Medical Records and Health Reform”, focus on physicians' opinions about these issues. These physicians represent a diverse group. They are from a different background in regards to race, ethnic ancestry, religion, regions of the country, medical specialties, and political views (from conservative to liberal viewpoints).
The goal of this organization is to identify reforms that benefit the quality of patient care outcomes. We do not advocate a particular political point of view. That is we are a non-partisan organization.
A transcript of the full interview will be sent with the purchase of DVD of the documentary, ELECTRONIC MEDICAL RECORDS AND HEALTH REFORM. http://www.emr-ndr.net/index.html
Links to Facebook, twitter and our blog can be found on the website.
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