Discuss heathcare reform with Senator Tom Coburn, MD

Tom Coburn, MD
US Senator, Oklahoma (R)
View Senator Coburn’s website

From Sen. Coburn, MD: Your Input on Tort Reform

Posted on August 31, 2009

I recently met with several of your colleagues from the Sermo community. I enjoyed the chance to receive the signed Physicians’ Appeal and chat with fellow physicians.

Today I want to continue our dialogue. With President Obama’s recent address to Congress and Senator Baucus’ health bill being debated this week in the Senate Finance Committee, the discussion on health reform here in Washington has taken on new intensity. Much of the energy of the debate inside the Beltway has narrowed to focus on the issue of health insurance – and what happens to Americans with it or without it. I want to explain to you some of the current options on the table and see what you think such reforms could mean for physicians.

Most in Congress agree we need to fix our system so that Americans with a pre-existing medical condition can access affordable, quality care. Democrats and Republicans both want to reduce the number of the uninsured and there is bipartisan support for taking steps to hold insurers more accountable for their actions.

The particular reform goal of the President and Congressional Democrats is to use the federal government to expand health coverage to all Americans. There are several health bills in Congress which seek to achieve this goal (H.R. 3200, S. 1679, and Sen. Baucus’ bill). Each of these bills differs somewhat from the others, but they share significant similarities. Here is what the bills generally have in common:

• The current federal poverty level is $22,050 for a family of four. The bills would expand Medicaid eligibility to families earning an annual income up to 133% or 150% of the federal poverty level, or about $29,325 and $33,075 respectively.
• Create a new government-run health insurance program (co-op or otherwise) to "compete" with the 1,300 existing insurance companies in the U.S., which could mean American families who have private insurance could pay $3,000 to $4,000 more in health insurance premiums if it is arranged similarly to Medicare
• Make it illegal for Americans to go without health insurance and tax those who do not comply (an "individual mandate")
• Make it mandatory for businesses to offer federally-defined health insurance plans to all their full-time and part-time employees, or face a federal tax for noncompliance (a "employer mandate")
• Move the regulation of health insurance from the state level (where it is currently) to the federal level in Washington, DC.
• Allow an appointed (unelected) panel of individuals make decisions about reimbursement and coverage decisions for Medicare
• Allow federal appointees in Washington, DC to decide the details ("essential benefit package") about what would be included in the federally-required health insurance each American would have to buy.
• Levy new taxes on insurers, medical device companies, businesses, or Americans to pay for federal subsidies to Americans under certain income levels, to help them purchase health insurance

So far, no bills being considered in Congress address the issue of low reimbursement to physicians under Medicare — which is a cost-shift that adds about $1,800 to the cost of health insurance for each family. And, so far, no bill provides any med malpractice reform or addresses the practice of defensive medicine, which adds an estimated $1,700 or so to the price of insurance per family each year.

While we do need major health reform we have to be careful to do no harm to the positive aspects of our system. America has the best physicians, hospitals and medical innovation in the world. Getting reform wrong could undermine the parts of the system that are working well.

I’d like to hear from you about what you consider to be sensible and constructive steps toward real reform. What do you think of the current policies being considered in Congress? What would be the impact of these reforms above for you, your medical practice, and your patients?

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