H.R. 3962-It's Just Wrong

November 12, 2009
Jeff Kaplan

The pundits are going to have their field day with this one. "The danger [with this Bill] is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we've tried health reform and it didn't work. But the real problem will be that we didn't really try it.

The pundits are going to have their field day with this one. "The danger [with this Bill] is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we've tried health reform and it didn't work. But the real problem will be that we didn't really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right."

"Is the House Health Care Bill Better than Nothing?" by Marcia Angell, MD

Douglas or "Wrong Way" Corrigan was a highly skilled mechanic, even modifying his own plane for a transatlantic flight that had been disapproved. (His flight plan was CA → NY → CA; instead, he landed in Ireland). His "navigational error" was obviously deliberate, much in the same way as the H.R. 3962 has been bastardized—both off-course a insidious reasons.

According to Dr. Angell, this Bill isn't real reform because...

1. It puts the interests of the investor-owned insurance industry before patients.

2. Although it expands Medicaid and adds regulation to the insurance industry, the latter can still raise their premiums and squeeze the sick.

3. Perverse Incentives: Doctors will still "Over-treat the well-insured."

4. The public option will not be an eye-opener for the insurance industry; rather it will be a "dumping ground for a small number of people whom private insurers would rather not have to cover anyway."

5. As healthcare costs continue to grow, "The response of payers -- government and employers -- will be to shrink benefits and increase deductibles and co-payments. Yes, more people will have insurance, but it will cover less and less, and be more expensive to use."

6. H.R. 3962 "does nothing to solve the problem of runaway inflation in the [healthcare] system as a whole. It's a shell game in which money is moved from one part of our fragmented system to another."

Rather, Dr. Angell suggests Congress consider:

A. Lowering the eligibility age for Medicare from 65 to 55 years, and over a period of several years, keep dropping it, "until everyone is covered."

B. Increasing Medicare fees for primary care practitioners and reducing them for "procedure-oriented specialists."

C. "Medicare should monitor doctors' practice patterns for evidence of excess, and gradually reduce fees of doctors who habitually order significantly more tests and procedures than the average for the specialty.

D. Subsidizing medical students who choose primary care, especially those who "practice in underserved areas of the country for at least two years."

E. Allowing Medicare to negotiate with drug companies in the interest of attaining lower prices.

What's missing, especially from "C," above? Outcome measurement and management—paying more when we achieve better results; paying less when we deviate from accepted standards and get less than optimal results.