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Health-care 'reform' raises serious issues

Saturday, July 18, 2009

Friday, July 17, 2009
By H.L. Schneider Jr. 
Here are excerpts from a letter sent July 11 to U.S. Rep. Jo Ann Emerson regarding health care reform:
Please. I beg you and your fellow representatives to take your time and give due diligence with respect to proposed health-care reform legislation. The decisions you make will have the potential to bankrupt the country and forever change the political landscape. A public option (son of Medicare) would have enormous consequences, not to mention the cost to taxpayers and the country. I fear many providers (physicians) might retire, productivity would drop and work satisfaction might be negatively affected. Make sure the cure is not worse than the disease.
What is really meant by "reform"? Is it the need to insure every American? The need to cut the per-capita expenditure for health care? Both? The 42 million to 50 million uninsured includes about 8 million illegal aliens. Some proposals do not cover this group. These individuals get care through the emergency medical system where they cannot be turned away.
I get the impression that emphasis is put on the coverage of all Americans and we'll worry about costs later. In reality, cost is the real problem.
If the government creates a Medicare clone, I fear it would eventually force private-sector companies out of business. There are more than 1,500 insurance plans available nationwide. Should we overhaul the system for the 15 percent who do not have health insurance, or is this a ruse so that eventually the U.S. moves to a national health-care system monitored and paid for by taxpayers?
The private sector competing with the government is like playing football and the opposing team is both player and referee. Government subsidies and tax credits will allow negotiation with suppliers not available to the private sector.
The government is great at hiding the true cost of running a business. The public option will not have to make a profit to stay in business, similar to the U.S. Postal Service or Amtrak.
Will our elected representatives and senators require the legislative, judicial and executive branches, as well as all federal employees, to use the public option before it is forced on the people they represent?
Medicine has never been a free-market enterprise. If you participate in the Medicare and Medicaid programs, balance billing is forbidden. What most people do not know is that the difference between the billed charges and the amount Medicare pays is the Medicare adjustment or write-off, not a loss or tax deduction for the physician. When I entered the field gastroenterology, the physician fee for a diagnostic upper endoscopy was reimbursed about $340 from Medicare. Today that same procedure is reimbursed at around $110. In my 20-plus years of medical practice my cost of keeping a clinic open has increased yearly, yet payment for services has not increased proportionately or in some cases has not increased at all due to contractual arrangements.
Cost is probably the meat on the chopping block. It is true that the U.S. spends more per capita on health care than any other country. With innovation and research come new medicines, new treatment guidelines and new equipment or devices. These improvements result in a longer life span, the ability to work and less pain and, in many cases, avoid surgery or allow for a less invasive form of surgery. Several nemeses play a significant role in medical cost, such as chronic illnesses for which there is no cure but improved treatment, the noncompliant patient and one's responsibility for self. A significant portion of health-care dollars are confined to four chronic conditions: diabetes, obesity, cancer and cardiovascular disease. How will reform address patient responsibility?
The current administration would like for you to believe there is significant waste within the health-care system. The operational nature of our current system accounts for a significant amount of U.S. health-care cost. The largest area for spending appears to be administration. Hospital care is also a significant expense. Technology can be a blessing or a problem. Technologies in some cases outpace our ability to evaluate them. Coverage for using these technologies normally is based on evidence that they work, not on cost-effectiveness criteria.
Ultimately, the goal is to spend less per capita, and I fear that one way this can occur is to ration care, control access and decrease availability of care. The other method is flat-out cost control across the board, or caps on total costs.
You cannot expand care for 40 million people plus improve quality and rein in costs. All Americans must remember one thing: The government that can give you everything is the government that can take everything -- and, with government-run health care, even your life.

H.L. Schneider Jr. is a Cape Girardeau gastroenterologist who has served on the Blue Cross Blue Shield adviser board for best practices and was a reviewer for the Texas Medical Foundation.


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