I have gotten questions from several people about how I on the physician-side-of-things feel about the new Health Care Bill. Here was one of my responses:
Honestly, I am still trying to make sense of how this will affect doctors. In general, I do think there are some good things about it (which I am often very hesitant to say about liberal proposals in general), but there are still several things that need to be addressed if we hope to make any progress:
What I support in the bill:
1. I do agree with the requirement that everyone should have access to insurance regardless of medical background or job situation. I have seen too many sad situations regarding people without insurance, and I have felt the frustrations of people I care about who have been denied coverage for silly things, which only leads to the delay of proper health care, and more expenses later on when they end up in ED or develop problems that could have been prevented.
2. If they’re going to require that insurances companies accept all people, then it is only fair to insurance companies that they require everyone to purchase insurance. This is the only fair way to spread the risk. It is unfair for someone not to purchase insurance and to not contribute to the pool and then suddenly expect everyone to bail them out if they happen to get in a car accident or get sick and go to the ER (the ER cannot turn away people regardless of ability to pay). That is just not fair to the other tax payers/insurance purchasers. I have seen soooooo much money wasted in the ED. People who don’t have insurance go there for stupid things like a sore throat or a cold, because they know they’ll get treated. Hopefully this can be prevented or decreased in the future if everyone has access…However, practically speaking, this will likely not be the case, at least for awhile, given the shortage of physicians (see below). Some states are now arguing that requiring people to buy insurance is not constitutional, which I can understand the argument, but at the same time, we require people to buy insurance if they want to drive a car….
3. I also agree that there is no public option. That would place even MORE control in the hands of the government. I do not want them making health care decisions for me or others, and if there was a public plan, that would run the risk of putting the private companies out of business and leading to even more government control….bad, bad, bad.
4. I have not looked at the language, but from what I’ve heard in the news, I’m glad that no tax money is being funneled into abortions. I would NOT support having ANY of my money going to help carry out an abortion. That is my personal beliefs. I agree with the law regarding abortions and don’t believe it should be changed and made illegal (I have come to terms with this after separating my beliefs from what I believe the law should be), but just as I respect other people’s beliefs regarding that issue, I would hope they would understand mine and respect my wish to not contribute to it.
And now to answer the question about how it affects doctors, and thus some of the NEGATIVE aspects of the bill:
1. It does nothing to cut costs of healthcare in general, other than restrict the amount of money doctors get reimbursed for. Keep in mind that on paper it may appear that physician’s salaries are decent, but we (or at least I) have TONS of debt to repay. The average debt for medical students in the class of 2009, which was my class, is $156,456. My debt is above that…I am not kidding. Top that with the huge malpractice insurance fees I will likely be paying after residency….
2. It doesn’t address tort reform (unnecessary imaging is done ALL the time, which is expensive and exposes people to unnecessary radiation, partly because doctors are afraid of getting sued) which raises cost and energy directly by the ordering of unnecessary tests, and indirectly as a result of ridiculously expensive malpractice insurance and often unnecessary law suits (I am not saying ALL lawsuits are uncalled for. A negligent physician should be held accountable, but there a lot of lawsuits that should have never been allowed to waist anyone’s time and money…)
3. How are we going to give more people care when we already have a major shortage of physicians, particularly primary care, and particularly in Illinois (many people have left Illinois and other places such as Philadelphia because they cannot pay to keep their practice open because of malpractice insurance and other expenses)? Universal access does not equal universal care. Look at Massachusetts: Massachusetts required nearly all of its residents to purchase health care insurance in a bill signed in 2006. Today the waiting time to see a doctor is 42 days despite having more doctors per capita than any other state, and the cost of insurance is higher than in any other state (According to John Barrasso, GOP senator from Wyoming, interviewed on the Wall Street Journal podcast 3/34/10). Well Government, how are we going to encourage more bright people to go into medicine if we cut reimbursement rates even more and increase the workload per physician even more? Who is going to want to spend 8 years of their life after high school doing intense studying, spending tons of money for education (see cost listed above), and then do ANOTHER 3-6 years of residency with crappy hours and poor pay after medical school? That’s nearly 14 years of intense training AFTER high school! I don’t mean to sound self-righteous, and hopefully people are not going into medicine for the money, because that is clearly not a good reason to go into it, but it is definitely a long, long road, and medical school was not a particular fun 4 years for me….
That’s all I have for now. Please feel free to agree, disagree, correct, or add additional comments. I’m sure my opinions will be more clearly thought out and/or change as I read, hear, and learn more about it.