Thursday, June 25, 2009

The Final Frontier---where no man has gone before



For those of you in the know, this week is a critical time in health care reform. The Sentate’s Health, Education, Labor, and Pension committee, chaired by Senator Ted Kennedy is analyzing and weighing the various bills being proposed in Washington, this week. NPR is carrying a good portion of the proceedings. There is a lot at stake. Not only will proposed changes make immediate impacts, but in the future these changes will have unintended consequences. This happened with Medicare, the HMO act of 1971, Congressional budget regulations regarding sustainability (SGR) adjustments each year, and others. The federal government is slow to act, and slower to re-act. Legislation cut in stone is often in the end counterproductive.

Some of the proposals lead to well intended false hopes and promises. A major flaw regarding a public health program is that it would stimulate competition in the private market. That is highly doubtful, based on common sense. It’s like the 800 pound gorilla competing with a 150 pound chimpanzee. The federal government has many built in advantages, such as contracting, freedom to set rates arbitrarily, sheer overwhelming market presence, and force. Will government competition include predatory premiums way below market values? Will payments be locked in, and will it be prohibited by providers to charge less than the public health program? These are serious questions, considering how CMS has acted in the past. Are we going to see more credentialing restrictions for providers? Will this open a door to a ‘federalized medical license’? (maybe that is a good thing)

Even though this appears to be a critical year in terms of interest and action hasty actions can and will lead to unintended consequences and disaster.

These are the members of the committee:


Democrats by Rank

Edward Kennedy (MA)
Christopher Dodd (CT)
Tom Harkin (IA)
Barbara A. Mikulski (MD)
Jeff Bingaman (NM)
Patty Murray (WA)
Jack Reed (RI)
Bernard Sanders (I) (VT)
Sherrod Brown (OH)
Robert P. Casey, Jr. (PA)
Kay Hagan (NC)
Jeff Merkley (OR)

Republicans by Rank

Michael B. Enzi (WY)
Judd Gregg (NH)
Lamar Alexander (TN)
Richard Burr (NC)
Johnny Isakson (GA)
John McCain (AZ)
Orrin G. Hatch (UT)
Lisa Murkowski (AK)
Tom Coburn, M.D. (OK)
Pat Roberts (KS)

There is one MD on the committee, Dr Tom Coburn of Oklahoma. Of note are also several ‘powerful deal makers on the committee, including Ted Kennedy (Chairman) Chris Dodd, Barbara Mikulski, Orin Hatch. There are also several ‘young senators’.

Will the ‘old wise men’ make the right decisions for the younger generation of Americans?

Now is the time to put in your two cents. Despite the overwhelming feeling amongst physicians of futility and despondence it is vital you make your voice(s) heard NOW. Without physician input and support any systemic changes will be hampered and doomed just as they have in the past 25 years.

During these committee hearings, NPR points out that looking around the room behind the cameras are the 268 seats filled with special interest lobbyists.

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