Health Reform: Public Plan Options

re: Health Reform: Public Plan Options

Ethan Kass DO — Mon, 22 Jun 2009 00:19:05 GMT

I never met Dr. Patricia Rupero but I love her statement, "would not trust the government to be the standard provider for all Americans". Why, oh why would anyone want the government more involved in healthcare delievery than it already is? Are the Medicare and Medicaid programs so impressive that we want more of it? Despite the low reimbursement for physicians (especially psychiatrists) and hospitals, Medicare and Medicaid costs have spiraled out of control. The only government response to that problem is to further cut back on reimbursement. And least we forget about HMOs, another government brainchild (see HMO Act of 1973 - a Ted Kennedy special). How many out there are happy with HMOs? I'm willing to bet out of the 50,000+ headshrinkers out there I won't use up all my fingers in that head count. Back in the day of the dinosaurs, when psychoanalysts ruled, there was something about working through a problem called "repetition compulsion". Maybe we can resurrect some of those discarded ideas to help us see through this obvious bad plan (public option). Yes, a little psychoanalysis to help us work through our delusion of a non-political, efficient, wise, all-knowing government with nothing but our best interests at heart. Lets see if we can promote a little self-reliance and rid ourselves of governmental dependency. Just a little reality check, the Public Option is estimated to cost $1.6 trillion over ten years (take that medicare!) and according to the Lewin Group group, probably kill private options within a few years, and the most outrageous part...there will likely still be over 30 million Americans uninsured.

I see some people still advocate for a single payor program as the solution to our healthcare problems. Thats another unrealistic socialistic utopian fantasy, best treated with Zyprexa. Oops, I forgot, Zyprexa is probably not on single payor plan drug formulary. Ok lets prescribe Haloperidol ( a good case of tardive dyskinesia is acceptable for people who want others to wait on waiting lists). Seriously, the arguement against such a system is too vast to summarize here. But I will accept anybody's challenge to debate it. I think the U.S.'s favorite mayor, Rudolph Guiliani said it best. Let me paraphrase, "If America adopts a single healthcare payor program for its citizens, where will all the Canadians go for their healthcare needs?"

re: Health Reform: Public Plan Options

Fred Miley, MD — Sat, 20 Jun 2009 04:27:19 GMT

This yes-or-no question deserves a "No" answer because I and many colleagues would refuse to accept a public plan that is tied to Medicare rates and would opt out of Medicare and similar plans. The competitive marketplace, not the government, should tell you what your services are worth. Value given for value received (TANSTAAFL).

re: Health Reform: Public Plan Options

charles Huffine — Fri, 19 Jun 2009 05:12:53 GMT

The only solution to addressing quality, fair pay for physicians and universal access is a single payer program. It demands that the private insurance industry pack up and move on as it contributes nothing to health care in our country except costs. All ciiizens need to be in the plan. No Medicare, No Medicaid - both deal with high cost populations and the complaints about their reimbursement to physicians are directly tied to their being costly programs which can't afford to pay what it costs to provide the services people demand. When ordinary workers with the plans they like are forced to accept the government sponsored plans all of our "premiums" will be in the form of a fair health care tax add on based on vulnerable and maximally healthy populations. Thus the costs will be shared and costs will reflect the highest possible "n" that includes lower cost populations. Citizens will then be empowered through their representatives in gov't to demand and get full coverage for their care - like every other western country and many in Asia and elsewhere.

If the design of the benefits are to be adequate and cover essentially all medically necessary expenses the cost of paying for all citizens will obviously go up. So where will the money come from to pay for these expenses necessary to give our citizens the care they deserve? SAVINGS ON ADMIN COSTS!!!! duh!. These have been estimated to be 35-40 % of our health care budget. Simply having a public option in the current proposed reforms will not free up that money. Hospitals and doctors offices with have to spend the time, and incur the expenses, of sorting out benefits and reporting requirements for an even more complex multi-plan system. Keep in mind a hospital in Vancouver B.C can have 2 employees do what 41 can barely do in a comparable size hospital in Portland OR. Ben Crocker is right, the only advantage of adding the public option now is to have it fail quickly so we can proceed to do as Winston Church said of Americans: They always do the right thing only after they have tried everything else.

re: Health Reform: Public Plan Options

Kenneth Sakauye, MD — Thu, 18 Jun 2009 17:08:03 GMT

Medicare approved rates already appear to be the standard from which Insurance fees are set. I have seen few plans that pay more or less than 10% of this fee schedule except for Medicaid which often pays far less. The co-pay issue is a different problem.

I support the above plan if there is also a limit to how much Medicaid and co-pay portions can be discounted below Medicare approved rates.

re: Health Reform: Public Plan Options

John M. Ackerman, M.D. — Thu, 18 Jun 2009 16:47:42 GMT

Yes, absolutely, there should be a Public Option. When I was still in clinical practice (retired in May, 2007), I dropped out of Medicare and, by Federal Law, established a private contract with my Medicare patients. I was comfortabkle with any fee that they were comfortable with. It saved much time and overhead expense. If a Public Option is tied to Medicare, so should the private contract be tied to the Public Option.

re: Health Reform: Public Plan Options

Selby Jacobs — Thu, 18 Jun 2009 13:28:30 GMT

A public plan is essential to introduce competition and better performance into the insurance industry, which has done an abysmal job in dealing with uninsured. A public plan will also put pressure on commercial plans to be more efficient, spending less on admnistration, which can amount to 30S% in some cases of the health care dollar. A public plan must reimburse at Medicare rates or better of physicians will not participate. SGR for Medicare must be rescinded and not be introduced into a public plan.

re: Health Reform: Public Plan Options

Roy — Thu, 18 Jun 2009 03:03:57 GMT

10% over MC is higher than many of our local plans in Maryland (eg, BCBS). So I'm okay with tying it to MC rates. I do NOT like the cram-down piece, where you must participate with both MC and the public plan, or neither. How does that provide choice?

re: Health Reform: Public Plan Options

Louise Buhrmann MD — Thu, 18 Jun 2009 01:39:19 GMT

I think they should be separate. This plan could loose Medicare doctors that it has already, in some areas we a scarce enough.

re: Health Reform: Public Plan Options

Kathleen M. Mogul — Thu, 18 Jun 2009 01:32:31 GMT

I want APA to be a strong supporter for a public plan, and I think physicians do have a social obligation and may need to make some sacrifices, though I suspect improved Medicare rates for cognitive and primary care specialties could be negotiated.

re: Health Reform: Public Plan Options

N.W. — Thu, 18 Jun 2009 01:23:23 GMT

While support of universal care is laudable, we would be foolish to let government attain more control of our practices in this way. The history of Medicare tells all about our likely fate under more government control: 1. Blaming of doctors for increasing medical expenses even though our fees (Medicare) haven't been increased at all in 8 years -- and in fact during much of this time our fees have been lowered. 2. Low reimbursement rates -- not increased over time. 3. Increased bureaucracy. 4. Increased paperwork demands. 5. Impractical, Rube Goldbergesque payment schemes such as the various pay for performance notions. Clearly, under Medicare and a public insurance option, we will be facing more and more of the same, and encompassing more and more of our patient percentages as more and more patients sign onto a cheaper, public insurance plan in part finances through savings by reduction of doctor's fees. Conceivably, over time virtually all patients we see could be in either Medicare or the public plan. I, for one, do not believe I could remain in practice if all of my patients were under these plans. My profit margin would be virtually nil. The APA and AMA should oppose the public plan option, and if it comes into fruition, should insist that doctors can become "out of network" providers in all insurance companies, including the public option and Medicare, and also that they can "balance bill" up to a fair and reasonable fee if insurance reimbursement is inadequate. Obviously, congress and the president would oppose this, but unless doctors right now stand up and refuse to treat patients under these conditions, there will be catastrophic consequences for American medicine. Good college students will no longer seek to be doctors. Physicians near retirement will leave medicine in droves creating a terrible shortage of all types of physicians. To deal with this, more and more health care provision in the U.S. will have to be by physician assistants and nurse practitioners, which creates another set of problems. To repeat: Doctors need to NOW stand up for themselves politically, and when necessary stop participating in insurance plans. Doctors also need to insist on massive regulation and "reform" of private insurance without diversion of patient premiums to insurance executives and administrators. Doctors also need to insist on reduction of paperwork requirements for documentation and payment. Patients who cannot afford private insurance should be able to purchase plans with government subsidy of insurance fees according to need. This type of plan is the answer, rather than a public insurance plan.

re: Health Reform: Public Plan Options

Ben Crocker, MD — Wed, 17 Jun 2009 21:46:55 GMT

Yes, I favor this, as I am an advocate of single payor. I don't think this will save money, but it will be one more failure to get out of the way on the way to single payor or regulated multipayor system.

re: Health Reform: Public Plan Options

Janis Chester, MD — Wed, 17 Jun 2009 21:23:05 GMT

government should limit its role in health insurance and medical care, it should not be expanded.

the role of the gov't should be regualtory (e.g. keeping private ins. companies in line, which they have not done at all) and facilitating charity care. gov't should give doctors and hospitals tax breaks for charity care.

re: Health Reform: Public Plan Options

Len Schmidt — Wed, 17 Jun 2009 20:13:35 GMT

No - not without parity nor at discouted rates that will not support true practice expenses.

re: Health Reform: Public Plan Options

Ted Goodman MD — Wed, 17 Jun 2009 20:10:12 GMT

My practice consists entirely of ECT. If my entire practice was converted to Medicare, or Medicare/Medicade, my income would be reduced somewhere between 80-90%. When I first began doing ECT about 20 years ago, Medicare reimbursed about $125, and my billed charge was $150. My charge has adjusted with inlation over the years, but Medicare had been reduced to about $80. In addition, I do medication management at the time of treatment, but am not allowed by Medicare to bill for the second service. Finally, if the patient is Medi/Medi, then I am reimbursed only $40. For a patient getting monthly maintenance ECT, I might have several phone converstations with the patient, call in one or two prescriptions between treatments, then discuss treatment and medications with the patient and family members, all for $40.

I feel this is discriminatory reimbursement, hurting the most seriously mentally ill, as it is making ECT increasingly less available.

I also feel the APA needs to advocate to address this inequity!

re: Health Reform: Public Plan Options

Patricia Recupero, MD — Wed, 17 Jun 2009 20:08:06 GMT

Medicare is one of the most discriminatory programs when it comes to coverage for mental health treatment. the 50% co-pay is slowly being phased out, but who could have thought that it was a good idea in the first place. There is a 180 day limit in free standing psychiatric hospital stays - Lifetime! The IMD/EMTALA bill has been pending for a long time. Medicaid had the discriminatory IMD exclusion. I do not think that psychiatry or our patients are treated fairly by government and would not trust government to be the standard provider for all Americans.