Take Time to Understand

August 31, 2009
Colleen O'Leary

You would be hard pressed to pick up a newspaper or turn on the television or radio without hearing something about President Obama’s healthcare reform bill.

You would be hard pressed to pick up a newspaper or turn on the television or radio without hearing something about President Obama’s healthcare reform bill. It certainly has stirred up some lively debates and strong feelings. Regardless of your political leanings, as a healthcare professional I believe you have a responsibility to be informed about what is being proposed and what the debate is about the issues. You work with patients that are hearing the same things as you and they are in a much more vulnerable place regarding changes in healthcare. If you can be informed and present even a few unbiased answers to questions, it can go a long way.

The key is to be informed and try to base your reactions and thoughts on fact and not emotion. I work with another APN who, obviously, is against the proposed plan. I don’t know how she has tried to inform herself about the facts of the plan, but at almost every meeting we are in she makes some comment about how Obama care equates with less care and poor quality care. I’m certain she would never make a comment like that to a patient, but if she has such strong opinions about it, it certainly does have to come through in some way. And I wonder where did she get her information? Has she taken the time to read the proposal? Has she read things from healthcare analysts that can look at the issues logically? Or has she read and listened to politically influenced critiques?

Several changes have already been put into effect as a first step towards improving healthcare. These include instituting temporary provisions to make healthcare coverage available to those who have lost their jobs, increasing healthcare coverage for children, mandating computerized health records in five years, developing a more effective means of disseminating research findings to healthcare professionals, and investing in prevention and wellness.

A few of the key points in the healthcare reform act to be developed are to expand Medicaid eligibility to include a greater number of uninsured; mandate coverage for children; create a national exchange through which the uninsured could purchase a public or private policy; provide subsidies to lower-income individuals and small businesses to help defray the cost of purchasing insurance; and tax medium-to-large size firms that decline to provide their employees with health insurance. Anyone with insurance currently would see no change unless their employer chooses to no longer provide insurance coverage.

Some of the more controversial areas of concern are reducing Medicare overpayment to private insurers through competitive payments. If you talk to anyone who receives Medicare payments you will know that it is currently an inefficient system. Private insurers often base their reimbursement based on Medicare payment. There are currently overpayments for specific Medicare plans which increase premiums for those in the traditional plans. Reducing drug costs is another controversial effort. Everyone agrees that drug costs are out of control. The concern is how will this be achieved? Anyone who works in a hospital or clinic knows that another large focus is to decrease readmission rates. This part of the plan is crucial for hospitals. If a readmission is deemed avoidable the hospital will be paid much less.

Those are only some of the things that are being proposed and are causing controversy. I don’t think it’s the ideas of doing these things; it’s clearly how they will be carried out. We’ve heard about how the government will be deciding what type of care is reasonable, what tests and procedures are necessary, and how long someone will be allowed to be in the hospital. These things are causing very emotional responses. But what I don’t understand is where have these people been over the last 40 years? Medicare and Medicaid already do that. Private insurance does the same thing. Do you think that you can just go to a doctor and say you want a full body scan, you want weekly lab tests done and you want your appendix out just in case something would go wrong and it would all be paid for, regardless of your current insurance? Of course not. There are parameters. There is reasonability. That would surely continue. If you had to pay every penny of your healthcare out of your own pocket wouldn’t you be questioning if a test or procedure were really absolutely necessary? Or would you just trust that whatever was ordered is the most efficient use of your money while still providing for the best outcome? If we were getting our car fixed and told we needed certain things, we’d question whether there was a less expensive solution that would provide the same safety. But we get angry when it is suggested that we do the same with healthcare.

Regardless of what political party you support or what you’ve heard on the periphery, it is your responsibility as a healthcare provider, not to mention consumer, that you get the facts and get informed about healthcare reform. The bill is H.R. 3200. Take some time to educate yourself.