California health care reform

California health care reform

Schwarzennegger and Health Care
Concentrate on healthcare…throw out the politics…(for a change)

As professionals, there is a routine that most physicians perform when dealing with our patients. First, we ask the patient to explain their problem(s) in detail. We ask questions to clarify their complaint and then we thoroughly examine the patient. This is generally followed by more testing to narrow the family of solutions and finally by a strategy or plan of action to cure the problem.
After reading the governors’ plan to come to a “healthy California”, I am concerned that the Governor didn’t do his homework and examine the problem thoroughly enough. I fear that his strategy can only end in the compromise of patients' lives and welfare.
I do remember a physician who once told me that one way to win a debate was to be so irrational that people stop listening and just agree with you to shut you up. But, this crisis is too critical and I am sure that the governor wanted the stakeholders to stick around for the dessert so I can’t believe that this plan is anything but a miscalculation. That said, physicians must be at the table and we must stay engaged in order to provide the governor with much needed guidance. I think it only fair to ask that the governor give physicians and our patients the respect of a workable plan, comprehensive but reasonable, legal and legitimate.
The governor fell prey to the health insurance and government fallacy that the access to care problem is an insurance problem. It is not. Moreover, in some instances, health insurance has proven to be a huge obstacle to good care. Ask a child who has MediCal insurance and suffers with intractable seizures about the year long waiting period to see a neurologist. Interview the patient with HMO insurance who had to quit their insurance in order to get the chemotherapy necessary to save their life. What we NEED to do is find the means to allow our patients access to the care they NEED when they NEED it.
Let me just elaborate on a couple of points in the “plan” itself. Most are familiar with the anti-trust constraints that prohibit physicians from negotiating fees, leaving doctors without a means of passing any tax or unfunded mandate on to any patient who has insurance including Medicare. That 2% tax will come right out of the back pocket of every treating physician in this state. A 2% tax on total revenue could mean a real tax as high as 40% on net revenue for oncologists who purchase the drugs they administer to their patients. It was the governor, himself, who rendered an Executive Order prohibiting physicians from Balance Billing their patients. Any thought of passing this tax on to our patients is erroneous. It can’t be done legally here in California.
As for the increase in MediCal dollars: those dollars will only enrich the intermediaries and health plans. There are few physicians who remain in the MediCal fee-for-service marketplace. Most MediCal doctors have already been forced into managed care by the state and those few physician specialists who remain outside the HMO purview will be forced out of MediCal fee-for-service by the new regulations coming from the federal government. Ergo…… none of those increased reimbursements are going to land in the office of doctors practicing medicine. As for the pay for performance criteria strapped on for good measure, I will refer the governor to the latest Journal of the American Medical Association (JAMA) that demonstrates that these measures prove nothing, do not show any improvement in outcomes, and are a total waste of time and money.
As for the medical loss ratios that are intended (I believe) to minimize administrative fees, look at the financials of the health plans operating in California. The real administrative cost of care is upwards of 60-70%. Most of these administrative costs are hidden in the sub-corps that the health plans have implemented.
One thing is clear and that is that the quagmire we call health care is complicated and makes little sense. The solution, however, is not found by ignoring reality or by insulting those of us who work hard to promote legitimate and good care.
If the governor is serious about providing better care to more people, I would advise that he open up the market place and make things more transparent. Many patients stay away from emergency rooms when they should be seen because of the potential cost or because of the misperception that they must have insurance to be seen. If it were known that a visit to the ER for an earache is $75, many parents would see that their children are cared for long before the earache keeps them out of school for 2 weeks. As it is, the threat of a $2500 bill for an MRI is a huge deterrent to care. If the real cost of $300 (approx) were known and advertised, I would imagine many would have that knee looked at and fixed and be back to work rather than remain on welfare complaining of chronic pain.
As for all the unfunded mandates and all the new pay for performance measures, these have been proved to be of little consequence so far as better care. Giving doctors 2-3 years to revise our peer review process and minimize medical errors would dramatically improve the quality of care. This is a much healthier means of engaging physicians than taxing us, threatening us with more regulations or asking us to do unnecessary tests just to get paid.
These two changes (no money added) would go further than all the measures in the governor’s plan. No one gets angry or feels compromised; more people get better care; the cost of care goes down; and the State of California once again may stand proudly as the first state to step up to the plate and deal with health care without wasting money or making any one stakeholder richer or more powerful. In the meantime, the State can help make health savings accounts more available and follow the federal government when it comes to their deductibility. This would lower the cost of premiums across the state.
I would implore the governor to not make this only about healthcare financing. This reform should be only about meeting the genuine needs of our patients in an open marketplace where patients have “real” informed consent and doctors have the opportunity to offer choices that are not based on “what’s covered”. Healthcare will only be affordable when our patients can invest in themselves, not in a “government mandated purchasing pool”. Insurance must remain an actuarial bet available to purchase at a reasonable rate, not a 1.6 billion dollar stock option for a CEO.
Our healthcare delivery system is in crisis. I believe that the citizens of this state are deserving of the serious consideration of a plan that has their interests at heart, where politics is removed from the discussion, and where stakeholders don’t have to go to anger management class to participate in the conversation.