What works and what doesn't

Art Caplan has written his two cents worth about the health care reform push. Dr. Caplan needs to read the current bills being hashed out in the Senate and the House. The House bill is over 1000 pages. (The expectation is that, like the last 3 Big Bills, the actual final version will appear in the wee hours of the morning, hours before the final vote.)

First, what President Obama is talking about is prepaid chronic care and catastrophic care. These should be addressed separately. Most people can pay for their own physical and for their own blood pressure medicine -- just ask the majority of the Medicare "covered" who saw their deductible go up this year and who hit the "donut hole."

Or ask the veteran who has a job that offers private insurance.

In the '90's, when I was in med school and doing my residency in Family Medicine, the VA was not the stellar government medicine that Art thinks it is today. And the requirements for coverage - who was "service connected" - were constantly being tightened. Men who should have been covered because of their service in WWII and Korea found that the only way to get care was to show up at the ER and wait their turn.

All of the paper work and regulatory hassles - especially the risk of "fraud and abuse," now "fraud, waste and abuse" - that I've faced in practice are the result of Federal laws interfering in normal practice: 1968 then 1974, on through the amendments to the Social Security Act in 1997.

I certainly hope that the powers that be will offer a "basic plan" that is really a basic plan. I know that it cost much less to insure and care for my family back when we had major medical insurance. However, I doubt that the various special interest groups will allow that. The bills mandate that pap smears, mammograms and "preventive services" will be provided at no cost to the patients. No copay, no coinsurance. No deductibles.

This means that we docs will be under pressure to do everything at "preventive visits." However, the House bill mandates qualifiers and diagnostic codes for all services.

Didn't that complicated chart originate from one of the Democratic proponents of health reform?

If you do ask your doctor about the paperwork and hassles, ask them whether they'd rather fight Medicare or United Health.

If Medicare truly has a lower administration cost, it's because laws and regulations shift the burden to your doctor and the hospital social services and patient advocates.

When I run up against a Blue Cross or Humana requirement that I disagree with, I can argue with the Medical Director or even drop their plan and see their patients outside of the plan for cash. However, if I disagree with a Medicare ruling that I can't admit my 82 year old who's falling, has a low potassium level, is running a fever, and has a bladder infection unless he's septic as defined by Medicare, there's no doctor to talk to. There's thousands of pages of regulations each year and that risk of "fraud and abuse."

Another difference - the government is not paying for those private insurance costs. If they will leave us alone, the insurance costs will either cut their growth or price themselves out of business. If the government increases its payment by the plans proposed in the House and the Senate, the costs will simply grow as they have.

These costs will be added to the 23 Trillion dollars our grandkids already owe.