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The Unintended Consequences of Healthcare Reform

New America Media, Commentary, Dr. Elaina George Posted: Jul 31, 2009

The debate on healthcare reform is in full swing, but few are paying attention to the long- term effects.

I am for universal healthcare, in theory. As a physician, I believe that it is a fundamental right. Unfortunately, the way the debate and pending legislation have been crafted, the outcome will result in unintended consequences.

As a physician in solo practice, I am in a unique position to see the outcome of what is contained in House health care bill HR 3200.

1. A single payer system that pays the same rate as Medicare or, as the bill stipulates, 5% above Medicare, will lead to less choice. People are overlooking the fact that most private physicians are currently not accepting new Medicare patients because they cant afford to do so. There will no reason for this to change if the reimbursement scale is adopted.

Unintended consequence: The network of private physicians would be smaller and more patients will be placed in a system of fewer physicians, less choice and longer wait times to be seen. What is the point of universal healthcare if you dont have quality physicians to provide it?

2. The proposed healthcare bill sets up a bureaucracy run by a national health insurance commissioner and sets up an insurance self regulatory agency made up of national insurers, national agencies and insurance producers. There are no physicians or patient advocates.

Unintended consequence: This works on the same model of the commercial insurance companies. It is at the heart of what is intrinsically wrong with the system because doctor recommended care and patient rights are not represented.

3. Commercial insurance companies will follow the rules of the public option plan in
order to compete. They will use those reimbursement rates as their guide, and that
will lead to providers leaving the system and setting up a parallel system
and, by default, a two-tier system. Those with money will simply opt out, while
those in the system will likely be subject to more restrictions and longer wait
time for their care.

The goal of private insurance companies is to increase profits, while the goal of the government is to save money, but the end result is the same. There will be a limiting of access and a rationing of care. The government will have no competition that can stop it from continuing to lower the bar -- in both reimbursements to providers and hospitals, and covered services for patients.

Unintended consequence: Taken to its logical extension, patient care will be driven by a faceless government entity that runs healthcare on algorithms (e.g., how long it should take to treat a sinus infection and what drugs should be used; whether or not surgery will be allowed under the guise of evidence-based medicine. The art of medicine will be lost along with the innovations provided by physicians who are able to think outside of the box, and the practice of medicine will be irreversibly changed. The best and the brightest will choose a profession that doesnt sap their spirit.

It is time to turn the debate to the real culprit in the rise in health care costs: a private insurance industry that profits by excluding the sickest and limits care for its members; a pharmaceutical industry that reaps windfall profits by setting up pharmacy benefit management middlemen, who keep prices artificially high while driving the medical formulary; and a hospital system that is charging astronomical prices under the guise of recouping costs incurred by treating the uninsured, when in fact they get money from the government to do just that.

We have the power to revamp our health care system by removing and regulating those entities that profit from disease. This will require the guts to stand up to the lobbyists and corporations and tell them there has to be a limit to their greed.

It will also require the American people to take a hard look at the choices they make that contribute to chronic disease such as smoking, leading a sedentary lifestyle and eating an unhealthy diet.

It can be done.

Dr. Elaina George is an Ear, Nose and Throat physician in Atlanta.

Related Articles:

Will Health Care Reform Harm Ethnic Minorities?

Latinos Have a Stake in Health Care Reform

Blacks, Hispanics Biggest Losers if Health Care Reform Flops

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