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A physician's thoughts on the health-care reform bill

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By The Staff

Anyone reading this has surely heard by now that health-care reform has become reality. Some of you have likely heard plenty of arguments for and against this bill. I, like many of you, had questions about what exactly was in it. I also wanted to know how it would impact me as a family physician and health-insurance consumer.

I didn't have time to read all 2,409 pages, nor did most of our legislators who voted on it. So I found the best sources I could find (not MSNBC, Fox News or CNN) to give me a summary of what was in the bill. I could then draw my own conclusions about the implications of these new regulations, drawing on my own training and experience in family medicine, and as a small-business owner myself.

What I found is that while the bill does make some needed changes to how health insurance works in the United States, I have some big concerns as to how it is all paid for, liberties that are taken away from ordinary citizens, potential negative impact on job creation, and I believe, an increase rather than decrease in health-care spending in this country.

There are certainly good things within this bill, many of which physicians have been advocating for a long time. It bars insurance companies from denying coverage based on pre-existing conditions starting first with children this year, and phasing in for adults in 2014.

Within six months, insurance companies will also be prohibited from dropping their insured clients when they become sick. Lifetime limits on how much money insurance companies have to pay for an individual's health care will also be banned within six months.

While these are all good things for patients, it will lead to some increased costs which will likely be passed on to the consumer - dyou and me.

The bill also creates insurance exchanges in all 50 states where individuals and small businesses can group together to lower costs on insurance premiums. This is a very good thing that shouldn't increase costs at all, and is something pretty much all of us can agree on.

Now let me go through some of the worst parts of this law, as I see them. First, the president said over and over again that if you like the doctor you have, you will be able to keep them.

That is not entirely true. Some programs, such as the Healthy Indiana Plan that covers lower-income individuals, will go away as a result of this legislation. Most of those patients will now be enrolled in Medicaid, as this bill increased the top income eligibility limits for Medicaid. If you are currently enrolled in HIP but your doctor is not a Medicaid provider, you will lose your doctor.

Patients can also expect to have a harder time getting to their physician after these regulations take full effect. The country was already experiencing a shortage of primary-care physicians. Add 32 million people that were only getting care when absolutely necessary to an already strained system and you have more problems. There are incentives for medical students to go into primary care, but this will take at least a decade to start having an impact. This will likely lead to more emergency-room overcrowding for the foreseeable future, not less.

The bill also leads to more government involvement in day-to-day operations of many businesses. It dictates how insurance companies have to spend their money.

While I have experienced firsthand many insurance abuses in the past, I am a little uncomfortable with the government telling a private company how it has to spend its money. The bill also imposes penalties on businesses with more than 50 employees (more than five if they are a construction company with payroll of greater than $250,000) if they do not provide insurance coverage for their employees starting in 2014. This adds more costs to businesses at a time when jobs are in short supply.

Another provision in the bill provides incentives to smaller businesses should they choose to offer health insurance through the exchanges. That is not necessarily a bad thing. However, the incentives are structured so that the help a business receives decreases and eventually goes completely away, as employees' average salaries increase. This basically discourages a small business from increasing wages for its employees if they are doing a good job, because doing so would cost the employer the government insurance incentive.

Part of the way this bill is paid for is by taxing medical device manufacturers and pharmaceutical companies. This one is particularly concerning to me as a physician. These companies provide innovative devices that save lives and improve the quality of life for millions of Americans.

Nearly every family in the U.S. has benefited in some way because of our innovative medical-device and pharmaceutical manufacturers. How many of you know someone with a pacemaker, defibrillator, knee or hip replacement, lens implant or insulin pump?

Now, to "reward" these companies for bettering the lives of countless Americans and daring to make a profit while doing so, the federal government is going to further tax them. Proponents of the tax say that these companies stand to benefit from the 32 million more Americans that will now have insurance and be able to pay for their devices.

I would argue that a very large proportion of those 32 million are young and fairly healthy individuals who will not need these devices in large numbers.

Any extra sales these companies make are likely to be more than offset by the large increase in taxes they are being forced to pay. More job losses, with jobs possibly moving overseas, will result.

The primary reason health-care costs in this country have been steadily increasing is simply increased health care spending. There is very little in this bill to discourage further increases in health-care spending.

True, there is the tax on so-called "Cadillac" plans that have low co-pays for pretty much any care a patient receives. However, increasing the percentage of the population on Medicaid, where there is either a very small co-pay, or none at all, for pretty much any office visit, test or drug prescribed will lead to a sharp increase in health-care spending. What is needed is more patient accountability for how their health care dollars are spent.

When patients share in the financial costs of their health care, they are more informed health-care consumers. Often unnecessary tests are avoided. Many physicians are often reluctant to try and convince a patient they do not need a particular medication or test for fear of either losing the patient to another provider, or being sued.

The lack of any type of meaningful tort reform in this bill is also disappointing. Tort reform, coupled with increased patient responsibility for health care expenses, would go a long way to reducing unnecessary health-care spending.

Finally, there is the requirement that every U.S. citizen purchase some type of government-approved health insurance or face a tax. This has been put in place to lower the average premium for everyone since many of those currently not purchasing health insurance are young and healthy.

Once they are forced to buy insurance that they likely will not use very much, their premiums can help subsidize the older, sicker Americans whose health insurance would otherwise be too expensive for them to purchase.

I have no doubts it will lower premiums for those with pre-existing conditions, I just do not think that the federal government has the authority to require its citizens to purchase anything. This is the primary reason many states, including Indiana, have chosen to file suit, attempting to block the implementation of this provision which they insist tramples on states' rights.

Many people certainly stand to benefit from the passage of this bill into law. I am not saying that they are undeserving of proper health care. But I feel that significant health-care reforms could have been accomplished with a much smaller bill that did not kill job creation, encouraged more patient involvement in health care spending decisions, and allowed Americans to retain their liberty to spend their consumer dollars as they see fit, not as Uncle Sam sees fit.

Kleeman is a family-practice physician in Tell City. He resides in Santa Claus.