The HIT Realist: What Effect Will Healthcare Reform Have on the Healthcare Crisis?

June 7, 2010
Alberto Borges, MD

MDNG Primary Care, May 2010, Volume 11, Issue 5

There are numerous reasons why the new healthcare reform laws will fail to improve our healthcare system.

The healthcare reform laws will increase the overall cost to our economy by much more than the Congressional Budget Office (CBO) projection of $1 trillion over 10 years. The CBO numbers do not take the big picture into account. For one, counting on the proposed half-billion-dollar cuts to Medicare to actually gain political support is unrealistic, because if history is any indicator, this will never happen. Just two years ago, President Bush was unable to push through cuts of $78 billion from Medicare over five years due to opposition from the very Democrats who now say we need a five-fold larger cut. Also, adding a large group of new Medicaid patients will overwhelm state budgets, which already cannot afford the current cost of providing care for the poor.

The ranks of physicians will diminish at the same time that the aging baby boomer population will produce an upsurge in the number of older patients who require care. It is projected that nearly half of currently practicing primary care physicians will reduce their patient workloads drastically or retire due to large cutbacks in their reimbursements, increased government bureaucracy, and the mandated use of costly unproven EMR technologies. The poorly funded “pay for performance” schemes that have been proposed will further add to physicians’ business overhead costs and interfere with the physician-patient relationship.

The power of “NO”

The new healthcare system will place more power in the hands of non-physician bureaucrats who will decide what care will be offered to patients. The dark realities that age and cost will be the deciding factors in the new healthcare system will come to pass, with a loss of autonomy in deciding our own healthcare choices. The belief that “more care is better care” will clash with the typical European/Canadian style of rationing (http://bit.ly/9DQ0Xd). Those who have the means to do so will have to pay for “extra” care out-ofpocket, while those in the middle class will have to comply with the “power of NO,” which is an apt phrase to describe the coming system in which denials of care will be even more frequent than they are now.

Tort reform and lobbying — follow the money

Under the recently passed healthcare reform laws, illegal immigrants are not explicitly entitled to healthcare, but since there is no method to reliably document a patient’s legal status, the number of illegal immigrants that end up being covered is expected to increase dramatically. Also, according to the Center for Immigration Studies, under immigration reform as much as $300 billion could be added to the new healthcare bill, rendering obsolete the promise by Democrats to keep the cost at $970 billion over 10 years.

Tort reform, which is a politically polarizing topic, was virtually ignored during the run-up to healthcare reform. Without controlling the costs that physicians have to endure due to out-of-control lawsuits‑‑which inevitably leads to high-cost malpractice insurance premiums‑‑and without controlling the high cost of “defensive medicine,” the cost of healthcare will continue its rapid rise. The CBO last October estimated that tort reform alone can save our healthcare system upwards of $54 billion over 10 years.

The cost of medications will continue to soar; the pharmaceutical industry spent millions of dollars on lobbying Congress in an effort to avoid a Canadian-style pharmaceutical program that would see many medications cost up to 90% less than their American counterparts. In the second quarter of 2009 alone, pharma spent upwards of $40 million in its total lobbying effort.

Don’t get me wrong—there are many good aspects of the newly enacted healthcare reform laws, but there are far more troublesome aspects that need to be improved if we want reform to be truly successful.


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