Tuesday, February 22, 2011

Re-bamacare: Is health care reform now a problem for Republicans?

The public relations nightmare for the Obama administration's health care plan last year now seems to be a problem for the Republicans.

Republican lawmakers have long wanted more intense reforms of insurance laws that purport to stream line the system, lower cost, and cut out redundancy.

Of course the concern for patients is that the only sure fire way to lower health care costs is to restrict access and therefore lower utilization.

Patient advocates have long been skeptical of Republican promoted health care (read: insurance reforms) because below the surface the bills seem to be reminiscent of old war style cronyism: pandering to the insurance companies and corporate medicine.

True or not, that's not the purpose of my discussion today. This is more about the table turning anti-Obamacare public sentiment that is now being carefully redirected toward these Republican proposals.

Particularly in state legislatures where lawmakers are now struggling to balance state budges with escalating deficits, every possible revenue source or cost cutting move is being critically examined.

On the surface many of these ideas seem plausible -- directly employee physicians so that their prescribing and ordering habits can be controlled.

Given that the most expensive piece of medical equipment in America right now is the pen, this would seem to be on target.

Limit tests or procedures, force the use of quality guidelines and metrics, cross share lab to prevent redundancy, and put physicians smack in the middle of a care management team to increase quality and value for patients.

And to make more money for the corporate entities involved.

The problem is not whether something like these rules need to be implemented -- they do -- the problem is that absent proper oversight and restraint the slippery slope of profits and revenue would suggest that patients might get the short end of the stick.

Just imagine if your physician was told to use a certain drug, a certain provider for a procedure or diagnostic test, a particular institution for your surgery -- your choice would be gone as would that of the physician.

Now certainly we are all going to have give up some health care decision freedom as we move to limit the exponential rise in health care expenditures.

But patients and physicians need the opportunity for some autonomy in the doctor-patient relationship.

Whether it is contractural protections against wrongful termination, protections against adverse hospital decisions, prohibitions against forced admissions, or whistleblower protections, physicians need to maintain some degree of separation from the unintended consequences of corporate America.

Patients need this as well.

What's been fascinating to watch is that in multiple states where Republicans are using the budget shortfall as a steam roller to clear a path for any proposal that seems to save money, the health care changes related to employment and insurance reform seem to be hitting a snag.

Dubbed "____-bamacare" depending on the lawmaker in question, use of this phrase immediately conjures up negative sentiment not only among the public but also among fellow Republicans who might not be so forward educated on the benefits at stake.

This is particularly evident in Texas where Lieutenant Governor David Dewhurst is seeing push back on his proposals to expand corporate control of health care.

From visiting with hundreds of patients its clear that monkeying with anything to do with a patient's health care choices, particularly now in this post-Obamacare sensitivity, is a risky move.

It is likely that good proposals will also potentially fall on the sword with our President's plan.

Patients seem to be tired of government intervention in health care. They recognize the need for changes in the cost, but they are still not convinced that government or big business is in the best position to make these decisions.

They are probably right.

- Posted using BlogPress from my iPad

Location:Jacksonville, Florida

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