The currently pending health care bill in Congress is a complete disaster. It should be called the Health Insurers' & Doctor Prosecution Bill. The bill does nothing to reform health care, and everything to line the pockets of Health Insurance Companies. Congress needs to tear the bill up and start over.
As a physician, I feel obligated to comment on health care reform, as well as the current health care bill in Congress. Unlike other areas of the political arena, this is an area where I'm straddling the fence—at least on the pending legislation. Though I'm an advocate of health care reform, and support some of the general concepts alluded to in the current legislation (like a public option), I do not support the bill. In fact, I'll go one step further. I think the bill is a complete disaster as it currently stands.
Despite claims to the contrary, reforming the health care system is not that complicated. It only becomes complicated when every special interest group parasitizing the medical system gets a seat at the table. It's difficult to understand why health insurers should have any input whatsoever. It's a given that health insurance companies are profit-driven entities, whose overriding interest in health care reform is how to increase their already-exorbitant profits, or at least preserve them.
Since premiums are the only source of income for health insurers, increases in premiums increase profits. Reducing payouts for providing medical care also increases profits. Thus, health insurers can further their profit-increasing endeavors by either increasing premiums, reducing medical care, or both.
Thus, what health insurers bring to Obama's big table is their own profit motive—to charge more and provide less care. Do we really want this motive to be a major driving force in health care reform? I certainly don't. And I suspect most Americans don't either.
Upon reading the current bill, it becomes clear it was not written by physicians, nor was physician input even a major consideration. In fact, it's difficult to even find evidence of patient input--especially from those who've had problems with their insurance companies.
In contrast, the heavy hand of the health insurance industry is overwhelmingly evident.
Though I haven't read the entire 1000+ page bill, I've scanned the bulk of it, and read certain parts carefully. And despite it's legalistic "attorney-speak" language, some points can be gleaned. And most of them are bad.
I finally had to stop reading at page 810. It was so bad I just couldn't go any further.
It's a complete disaster in every way, shape, and form.
Obviously I can't cover everything in the bill here. But certain points did stand out.
First, the bill allows health insurers to cancel your insurance for a pre-existing condition if they can claim you weren't 100% truthful on the application. (This is the so-called "rescission" discussed in Congressional testimony. Another term for it is post-claim underwriting. This testimoney made clear the kind of inconsequential, unintentional errors the insurance companies will use to rescind policies, and keep profits high.) Though the bill's supporters claim that the bill forbids rescission, it provides a loophole 100 miles wide. It allows an exception to the ban on rescission in the case of enrollee "fraud" when filling out the initial application.
The wording used says that insurers can't rescind your insurance, unless fraud was committed. And what is the definition of "fraud"? Anything a court or attorney wants to claim is fraud. There is no hard-fast definition of fraud, which means there is no hard-fast ban on rescissions. This segment of the legislation appears to have been written by the insurance companies, and inserted into the bill, in a deliberate attempt to deceive the public. In fact, this part of the legislation is "fraudulent" in and of itself.
This piece of the legislation means insurance companies can rescind anyone's insurance at any time, by falsely claiming fraud was committed.
And the fraud exception directly contradicts the banning of pre-existing condition exclusions. If there are no exclusions for pre-existing conditions, what difference does it make if enrollees don't reveal a pre-existing medical problem, when they fill out their initial enrollment application? If they can't be rejected for a pre-existing condition when they enroll, what difference does it make if they later admit to having one? In fact, the rescission loophole provides a way to circumvent the ban on denying enrollment for pre-existing conditions.
But the worst of it, in my own view, is the Obamatocracy's war on doctors. Most of the proposed cost savings will come from denying payment to doctors, and by discouraging billing by doctors—through the threat of huge fines and CRIMINAL PROSECUTION of doctors for allegedly fraudulent billing.
The main cost-saving tool is physician intimidation—by discouraging bill submission by doctors through the threat of criminal and civil prosecution. The goal is to intimidate doctors into either not billing for services, under-billing for services, or simply to not providing services at all. Obviously patients will suffer when this happens.
There are multiple additions to existing health care fraud laws—laws which are already extensive (and which are challenging for even lawyers to interpret, and nearly impossible for doctors to understand.) Included is a new "conspiracy" charge, which requires less burden of proof for the prosecution to obtain a conviction, and which can be added to any other alleged charges. Thus, even if the other charges are proved false, a conviction for conspiracy may still be obtained, as a "conspiracy" conviction is easier to obtain.
There are somewhere between 100-200 pages of legislation devoted exclusively to enhanced prosecution of doctors. There are additional new charges that can be filed against doctors for incorrect information on Medicare applications themselves, which are already almost impossible to fill out correctly.
One example typifies this point. Physicians need to fill out a complicated application before they can bill Medicare. There's a place on the initial Medicare application labeled "location where you currently treat Medicare patients." Though this part might seem reasonable at 1st glance, it isn't. In fact, it's not only ludicrous, it is an impossible question to answer. The physician filling out the form is applying to Medicare to begin getting paid for treating Medicare patients. At the time of filling out the application, the physician cannot bill for Medicare patients by definition. That's why he's filling out the application--to begin getting paid for their treatment. If he currently isn't getting paid by Medicare for treating Medicare patients, it's not likely he's even treating Medicare patients. In most cases, the physician has just started working at a location, and may not even have any patients yet, much less Medicare patients. And if the physician doesn't put down an address where he is "currently treating Medicare patients," his application will be rejected. So how can the physician honestly answer the question, and still get a Medicare billing number?
He can't answer honestly. So he puts his current office location down, and hopes the application will be accepted, so that he can begin seeing Medicare patients and getting paid for them. There is really no other way to do it. But putting any false information on a Medicare application is a prosecutable, Federal, CRIMINAL offense. It actually says so right on the application. And District Attorneys have ALREADY charged and tried doctors in Federal court for violation of this very item.
So, you guessed it—one of the additions to prosecution of doctors is enhanced prosecution FOR WRONGLY FILLING OUT A MEDICARE APPLCATION! Really!
In addition, there are additional reporting requirements for doctors, and additional time-consuming (and non-reimbursed) mandates. And it just goes on and on. Given the already shrinking reimbursements for doctors, these changes will only push more doctors out of Medicine, thus reducing patient access to care. (Such reduced access to care will, however, reduce the cost of medical care, which may be the underlying goal anyway.)
It is now VERY clear where Obama plans to get the savings with his new health care plan: from reducing the actual provision of medical care. Doctors will provide less care due to the threat of going to prison for making honest mistakes. Doctors won't be able to see as many patients, since they'll be spending more time filling out new forms—new fraud & waste compliance forms, forms to re-submit denied claims, forms to re-submit 2nd denials of claims, new forms explaining why physicians had to repay denied claims, etc.
The medical "savings" relies on either the denial of claims, or the intimidation of doctors into not treating patients at all—thus eliminating the submission of claims altogether.
This legislation should be called the
Health Insurers' Welfare and Physician Prosecution Bill
Health insurers have spent a great deal of time and money trying to give patients the impression it's doctors who make health care expensive. And they've done a good job of it.
The days of the Mercedes-driving doctor have long since disappeared. Don't be fooled into thinking that fixing health care is about reigning in doctors. It's not.
It's about taking power back from health insurers, and despite the claims, it fails miserably in that regard.
Though we need health care reform, this bill is awful. It's worse than nothing. It needs to be thrown in a paper shredder. And then incinerated.
Congress needs to start over from scratch, and include a public plan that is non-negotiable.