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The single payer system in health care is what the current administration has been promoting since the beginning of the health care debates. However, it does not seem like circumstances will allow for a total government takeover in the form of a Canadian-like medical system “womb to tomb care”. This type system, regardless of employment status, would provide care to all citizens. Private insurance companies, obviously, are fighting to prevent this and will continue to muster all the lobbying and resources available to them to oppose it. One can only imagine the pressure Congress is under as well as the personal interest of some legislators.
As we have seen, the “status quo” is not sustainable either. Regulatory agencies are not taking action to reduce premiums and copayments for patients, nor are they doing anything to lower the skyrocketing cost of obtaining medical insurance. While patients and physicians are being squeezed, the government is not moving in the right direction, namely toward efficient control of insurance companies and addressing the issue of tort reform. Almost all of the insurance companies have been profitable despite the economic downturn in our country at this time. We do not see any sign of them investing money in patient care or in reducing premiums and copayments. Quite the contrary, they are challenging physician medical decisions and rationing care to the very detriment of health care.
What can we say about the alternative, that is, U.S. Government-managed health care? Well, we have to do more than tweak the system to achieve accountability and efficiency. After all, that is what managed care was supposed to do and we know how that has worked for patients and physicians. Can the government do it better? Will the current bureaucracy expand? Is the quality of service going to improve? Will we, in the practice of medicine, be submerged in mediocrity and forced to follow ideas by those who espouse utopia but who do not care about patients and instead push papers and manipulate statistics? If this is the case, we are in danger of having a false sense of security, injuring many citizens who may think they are aware of how the system is working but have no clue to the actual process involved.
Is the single payer system, a federal government system, and will we be protected like other agencies i.e., the Veteran’s Administration on liability issues? Will the President and the Congress acknowledge the need for tort reform? If not, we have gained very little. If on the other hand, they do embrace tort reform for physicians, this will be a significant change in the rules of practicing medicine as we know it, particularly, in regard to liability issues.
What of the Medical Home model? This idea identifies the primary care provider as the central coordinator of care – in effect, creating a “medical home” for the patient. This is supposed to bring about better coordination of care, a team approach and collective responsibility for outcomes. In concept this sounds good. As with the advent of managed care though, what may seem good in concept is not always good when implemented – especially with politics and government in the mix.
We cannot predict what will happen, for certain, because we don’t know what motivates legislators. This is a great deal to ponder and we, as physicians, should participate (for the right reasons) in those decisions that affect the American public, who are our patients.
What we do know is many of the components of the health care reform law won’t happen until 2014, if at all. Doctors need to plan a survival strategy now!
Medicare SGR Vote
As of this writing, thanks to the efforts of the DCMA, FMA and AMA – and of course your phone calls – the U.S. Congress has passed the “Medicare and Medicaid Extenders Act of 2010” which stabilizes Medicare physician payments at current rates for 12 months – through the end of 2011. It is now being sent to the White House for President Obama to sign into law. This is a clear sign that physicians – when we remain united – can have an impact on our future. Don’t let down your guard.
