Part 2

If yesterday was "The Good," now it's on to "The Bad..."

1. A big issue I have is that most of the bills do not exactly address how this will all be paid for. One major idea is to cut future medicare/medicaid payments to doctors. Patients who only have medicare and medicaid already have a difficult time finding a doctor, and cutting the payments will only cause more and more doctors to not accept medicare and medicaid patients. Furthermore, this will hurt primary care doctors even more than sub-specialists, worsening the already fairly severe shortage of primary care doctors.

2. One of the BEST ways to save money would be to pass some sort of tort reform. Only ONE of the several bills says ANYTHING about tort reform, and the bill that does say something basically says it will "consider" implementing some sort of "pilot program" to test the idea out. (Meaning: a snowball's chance in hell this will ever come to pass) The CBO recently estimated that tort reform would save $54billion over the next 10 years. But since lawyers write the bills and other lawyers give big money to the lawyers that write the bills, they don't like this idea. But it's proven that doctors order more tests because they are afraid of being sued.

3. The house bill especially seems to create a LOT more bureaucracy. Bureaucracy usually means that you have non-doctors telling doctors what to do. We are the ones who went to medical school, so we should be the ones making decisions about our patients. Not, as is suggested by the house bill, Katherine Sebelius, who has been a politician for a long time and lobbied for... you guessed it... trial lawyers.

4. The big plan to encourage people to get insurance is to give them a tax credit. But there is no tax credit for people who are already getting insurance. Furthermore there will be some sort of penalty or additional tax if you don't buy insurance. But you can apply for a "hardship waiver." I think that many people who currently don't have insurance are unlikely to buy insurance, figuring they'd rather pay the fee. Plus, if something bad happens, they can just go to the ER, where care is "free." (This is unfortunately the perception of many people out there.)

5. The house bill also has this section that will set goals for primary care residencies. On the surface, this doesn't sound like a bad thing. However, we already have the GME (graduate medical education) that does this. Plus the goals are things like: "training to work in non-acute settings." Um.... I'm in our outpatient clinic (non-acute setting) 4 half days just this week, seeing 12-13 patients at a time. "Coordination of care" and "Understanding the cost and value of diagnostic options" - yes, so that is basically what I already do every day. I do not need the government to come in and create even more red tape and paperwork to tell my program to teach me what it already does.

6. Penalizing hospitals with high readmission rates - now certainly we shouldn't discharge people too soon. But certain hospitals, especially those in inner cities that serve the indigent have lots of patients who just don't take care of themselves. Or are actively doing things that harm themselves. We can't send people home and physically make them stop smoking or drinking. Or even get them to take their insulin. This one might be more of a neutral, since it is good to encourage hospitals to take good care of patients, but hospitals, especially those that have residents, likely will have a high incidence of readmission just because of the population we serve.

Again.... this is a non-exhaustive list of many of the problems I see. Tomorrow, or perhaps Thursday (since I'm on call tomorrow) I'll write a little about "The Ugly."


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