Dr. Pullen Hands Out Grades on Healthcare Reform


I have stayed away from saying much about the health care reform debate so far, but based on the healthcare reform plan passed yesterday, I'd have to say, "Gosh, that doesn't look too bad."

I have stayed away from saying much about the health care reform debate so far. My primary reason is that the whole political process has sickened me. It seemed like the whole process was all about political gain and had little to do with improving access, cost of, or quality of US Healthcare. Somehow after both major party candidates campaigned on the need to pass major health care reform, after the election a plan that looked more like the McCain plan than the Obama plan (after the public option was dropped) was unanimously and vigorously opposed by Republicans. This seemed not so much because of the plan itself, but as a way to try to gain political advantage. Shame on all of the senators and representatives who dragged the country through this partisan mudslinging mess.

That said, from what I can tell, if I had somehow been able to not read a newspaper, listen to the radio or TV news stations, and stay off the Internet for the last year, and just saw the plan passed yesterday, I’d have to say, “Gosh, that doesn’t look too bad.” Admittedly I was not able to read the 2,000+ page bill, and am relying on the news reports primarily for my information. From what I can tell:

• Almost immediately the prescription medication “donut hole” will be made smaller in Medicare Part D.

• In the next year patients will not be at risk of losing their insurance because they get sick, and kids will not be able to be denied insurance for preexisting conditions.

• In a few years, adults will also not be denied access to plans for preexisting condition, and most Americans will have to find a way to have at least basic health insurance or will be penalized for not having insurance. Insurance exchanges will be established and regulated to improve access to a plan for self-employed people and smaller business owners.

• Some taxes will be raised, and the federal deficit will not be increased to pay for this plan.

• Lots more Americans will have some sort of health insurance after this plan comes into effect than have insurance now. Although not all Americans will have coverage, the percent that do not have coverage will be greatly reduced.

The big fear of physicians that they would be left either accepting Medicare-like rates through a public option, which would become the default least expensive plan, or be left choosing to try to get by caring for only the minority of patients not choosing the Public option has been skirted for the time being. I really have no idea how this reform package is going to affect the cost of health care, the quality of health care, the federal deficit, taxes/fees on middle class and wealthier Americans, or on the health of Americans in general. That said here are my grades on health care reform so far:

• Process: F

• Product: B-

• Winners: Many of the currently uninsured

• Losers: All of the politicians of both parties who lost any credibility as public servants, and appear to be far more interested in their reelection prospects and damaging their opponents than in addressing a major American problem.

• Problem not addressed: There will still be a significant number of uninsured Americans.

• TBD: How will the economy respond? Will business see this as a positive measure? Will Americans feel freer to look for better jobs, to start businesses, and to compete in the global economy with this plan than they do now?

• TBD: How will this affect the various models of medical care practices? Will the private practice of medicine, especially for primary care, be viable, or will only large multispecialty integrated groups survive?

Ed Pullen, MD, is a board certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.

This article originally appeared online at DrPullen.com.

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