Healthcare Reform

The Democratic controlled Congress has been successful in pushing through one of the largest government takeovers in history. To make matters worse, the process that got the Democratic leadership the votes to pass this bill left much to be desired. Deal making and arm twisting were seen by the American people and soured many opinions of Congress and this administration. However, the bill is now the law of the land. The ultimate goal should be to repeal the entire bill and replace it.

Until we repeal the bill, I believe that over the next two years we will need to work toward revising many sections of the bill that are detrimental to the healthcare system and the businesses most affected. The added taxation, unfunded mandates on the States, and Medicare cuts are a good place to start. I continue to believe that private sector solutions are the backbone of the American economy. Mandating private companies to spend a certain percentage of their dollars on services is a major overreach by the federal government.

These mandates will increase the cost of doing business, driving some companies out of business and decreasing competition. This could eventually lead to total control of the market by the largest companies and the government, hurting our small businesses. This scenario could lead to the larger fear of a government mandated single payer system. The free market should prevail.

The Obama Administration and the Democratic leadership in Congress used the healthcare legislation to take over student loan programs, to cut Medicare benefits, and raised taxes on American businesses to pay for this $1 trillion bill. How far will they go? Recent indications reveal that the bill will kill jobs in both small and large companies due to the onerous taxation and penalties. Nothing in the bill addresses the real problem which is the cost. In fact, many believe it will lead to out of control cost increases at the taxpayers’ expense. The assessment of the effects of the bill is ongoing.

As a physician, I have very serious concerns about the intended and unintended consequences of this bill as well as future access to quality medical services in the U.S. We will be heading towards a two-tiered system like in many countries that have government run healthcare. This legislation will set the stage for those who can afford private care while the rest of us will have long waits and experience rationing due to financial concerns of the government. The ongoing physician shortage is likely to continue and may worsen. The quality of physician services is likely to decrease. We need healthcare reform, but not the type of reform which has been put into law.

I believe that healthcare reform is necessary and that there are some commonsense reforms that can help get costs under control within this legislation. This being said, the approach being taken by the Democrat controlled Congress is the wrong solution. I firmly believe that government oversight and control are not necessary to advancing us toward the goal of healthcare reform. The private sector, with help of the Federal government, can begin to solve the problems with our healthcare system by adopting common sense healthcare reform. The following solutions will get us on the right track toward a more affordable system without compromising quality and access. Some of the following in are in the bill and should remain in the bill that replaces it.

1. Enacting real medical liability reform is essential to decrease the costs of defensive medicine and free our courts of frivolous lawsuits. As a beginning, we need to implement a national system of tort reform similar to what exists in Indiana today. This includes caps on noneconomic damages, restrictions on attorney contingency fees, statute of limitations on the filing of lawsuits. However, this is just a start. We still have problems with defensive medicine in Indiana. I believe a system of medical/legal review panels in each state will be required to solve the problem long term. This may require a constitutional amendment. Enacting legal reform will save the system as much as 100 billion dollars per year.
2. Insurance reform is required to prevent insurance companies from unlawfully cancelling health coverage just because you are sick. Insuring people with preexisting conditions must be required at a reasonable cost. Elimination of annual or lifetime spending caps will protect people with catastrophic or chronic disease by ensuring health plans meet their obligations.
3. Allow small businesses to pool together through Associated Health Plans (AHPs) to leverage lower cost insurance on behalf of their employees. This will make health insurance more affordable and accessible for small businesses.
4. We need to allow auto-enrollment into employer sponsored coverage, as long as employees are allowed to decline the coverage. Currently, almost 10 million people have access to employer sponsored insurance and do not enroll. This represents one third of the U.S. citizens who do not have health insurance.
5. Differences in state regulation of health insurance have resulted in significant variance in health insurance costs from state to state. We need to allow Americans to purchase licensed health insurance in any state. Insurance sold in a secondary state needs to still be subject to the consumer protections and fraud and abuse laws of the policy holder’s state of residence.
6. If a health insurance plan offers coverage to dependents, then the plan must cover dependents through their 26th birthday. This will significantly reduce the number of young people who currently do not have health insurance coverage.
7. Standardization of health care forms and transactions is essential to reducing the administrative costs of health care. Standard insurance application and claim forms need to be required. A universal system to enroll doctors into health insurance plans is needed to reduce the costs and time required to enroll in hundreds of different plans.
8. Expand the accessibility to Health Savings Accounts (HSAs)
9. Protect Medicare and Medicaid programs by creating a nongovernmental commission to find and suggest implementation of the changes required to ensure their long term viability. Clearly, some solutions will not be politically possible without nongovernmental intervention.
10. We need to find U.S. citizens who are already eligible for state or federal assistance and enroll them in the appropriate programs. This represents one third of the uninsured.
11. Require States to establish either a functioning high risk pool or a reinsurance program and provide federal funding to assist these programs. Insurance offered through these programs will ensure everyone has access to affordable health care regardless of their health status.

These practical solutions to a very complex problem will get us on the right track toward decreasing the costs and increasing the access to quality medical care. The solutions I offer are only a beginning. I don’t believe our health care system problems can be solved with one piece of legislation. It may take a decade or more to solve some of these complex and difficult issues. Private sector solutions with the help of government will be the answer.