Healthcare / Regulation / Uncategorized

To Give and To Be Taken From: Doctors in America Going Bankrupt

Perhaps the most controversial bill passed in the last 20 years was the Affordable Care Act (ACA).  On the coming of the bill’s second anniversary, the Center for American Progress (CAP) hosted a forum, aptly titled “Illustrating the Success of Health Care Reform”. Three major panelists, Jonathan Gruber, Liz Fowler, and Dr. Alice Chen all were present to express their views on why this bill’s costs outweighed it’s benefits. Also, the meeting served as a celebration of Gruber’s new book , Health Care Reform: What It Is, Why It’s Necessary, and How It Works. As an economist from Massachusetts Institute of Technology, his graphic novel basically explains the successes found in the ACA:

“[John] had served as an advisor for both the Massachusetts and national health care reform bills, teamed up with an illustrator to explain the mechanics and importance of the Affordable Care Act, or ACA, in graphic novel form. Gruber’s book, Health Care Reform: What It Is, Why It’s Necessary, and How It Works, breaks down the significant but undoubtedly complex policy into fun, easily digestible comic strips through characters such as Betty on Medicare and unlucky Carlos, who must purchase his own insurance.”1

Though an obvious unilateral critique (as witnessed in the title) of the ACA, the CAP event certainly attempted an unbiased approach to healthcare regulation changes undergone in the United States.

Gruber’s video on the ACA started the event, and  expression how nearly 40% of the economic income in this nation could be eventually spent on healthcare. He illustrated how this act can mitigate this issue in four mechanisms: 1) public insurance, 2) fix loopholes in the Medicare cost , 3) allowing competitive insurance with healthcare companies, and 4) reducing the deficient.  By reducing the uninsured by nearly 2/3, reducing the gaps in Medicare, and mandating that no one pay more than 8% of income to insurance. With the finale of the video, Gruber took the stage, and explained how his book has managed to increase knowledge of the ACA:  “only 45% actually like legislation when asked […] but this figure continues to increase as you explain the facts of what this legislation actually does.” He explained how his graphic novel illustrated these facts, and how the coverage in Massachusetts provided the basis for the ACA. In conjunction, he explained how inequality and discrimination were ended with the 2006 issuing of affordable healthcare, with over a 70% approval in Massachusetts.

This being said, Gruber did not address cost-control, other than stating that nothing we really do as a nation could impact this. He continued that by mitigating 1/3 regulatory red-tape on healthcare, it has allowed for a streamline of system, but yet Affordable Healthcare Phase 1 only crawled as opposed to walked toward nullification of inflationary healthcare problems.  He claims that a Phase 2 needs to include a more unified effort for initiating cost-control of the system. He claimed the spaghetti approach (in his words, the approach of throwing all ideas against the wall and seeing which ones actually stick) was used in Phase 1 of the Bill, and yet for Phase 2, a better understanding will be implemented in regards to spending mitigation techniques. Dr. Liz Fowler continued this tread, explaining how by reducing waste in medical spending, nearly 20 Billion in healthcare cost have been reduced, and through cost mitigation, nearly 234 billion in anti-fraud spending and approximately 1 trillion from the deceit (in the next 10 years) are being cut from the federal budget. She also explained how this bill is beginning to fill the donut hole of Medicare costs for the 40,000 serious medical patients enrolled in the government  program.  She ended expressing how overall, nearly 30 million Americans being protected under this provision causes for an overall savings in money. Strangely enough, she offered no figures or data to support this claim. The roundtable ended with Dr. Chen expressing a truly emotional tale of her 25-year-old screenwriter who managed to surmount over $100,000 over a 10-day hospital visit. Without the ACA, he would not have been covered by insurance, and his rare skin disease, would have persisted in his wallet for the rest of his life. She expressed how since more people have coverage, how this act really works on a daily basis, and how she fights for the rights of those that need it. A Q&A followed with a major discussion of Gruber’s graphic novel.

Pervading this meeting was the idea that Healthcare Reform did not go far enough. For a certain measure, I agree. Where is the regulation to protect physicians? Physician bankruptcy was not individually addressed at the seminar as a rising issue, and certainly demands more attention than a simple gloss-over. More than ever, physician bankruptcy is plaguing the nation:

“This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists. Industry watchers say the trend is worrisome. Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital health care resource.”2

This, in conjunction with the Medicare statistics are absolutely stifling to this nation’s  generation of healers.  Continues CNN: “Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat.” Though perhaps these costs have a net gain on the economy, the cut seems to be taken out of the pockets of doctors who engage in proper, preventative medical practice:

“recent steep 35% to 40% cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue. [Total] revenue was down about 9% last year compared to 2010 […] cuts have destabilized private cardiology practices […] A third of our patients are on Medicare. So these Medicare cuts are by far the biggest factor. Private insurers follow Medicare rates. So those reimbursements are going down as well.” 2

The problems with the new system are the costs being placed on to doctors. Without reform on those that give these services, soon a large chunk of doctors will be unable to offer services. Congress has proposed a 27.4% Medicare pay cut to doctors, which “Although Congress has blocked those cuts from happening 13 times over the past decade, most recently on Dec. 23 with a two-month temporary “patch,” this dilemma continues to haunt doctors every year.”2 This places costs in to the hands of doctors due to insurmountable pharmaceutical cost and high insurance premiums.

This crisis is really the reform needing to be addressed. Yes, we all have a right to life, liberty, and the pursuit of happiness. Without a doubt, this right to life involves some form of medicinal support. This being said, the doctors providing support should not be made to pick up costs. Doctors should not be plummeting in to bankruptcy due to high healthcare costs. More focus needs to be centered on the problems that doctors face in this country; more focus needs to be show who give as opposed to those who receive. In the wake of the holiday season, it only seems right.

1 – http://www.americanprogress.org/events/2012/01/HCRSuccess.html

2http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/

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