A Doctor Talks About Health Insurance Reform

I recently sat down with a highly respected doctor who has a practice and also teaches medicine at a major university. I wanted to know his opinion of the health insurance reform bill signed into law in March. I was surprised by some of his answers.

Q. Were you a supporter of health care insurance reform before the debate began last year?

A. Yes, I have supported healthcare reform for at least twenty years.

Q. What is your concern?

A. In a word: costs. Healthcare costs are bankrupting American families. When I started out as a doctor in 1981, only 8 percent of bankruptcies were driven by medical costs. Twenty years later, in 2001, that figure had more than quintupled, to 46.2 percent of bankruptcies. But it didn’t level off. In 2007, almost two thirds—62.1 percent—of all bankruptcies were health related. The reason, of course, is not that families are making less, but that the cost of care is skyrocketing. In 1970, the amount of money spent on all facets of healthcare, known as the National Health Expenditure (NHE), was 7.2 percent of our gross domestic product (GDP). By 2005, the NHE had more than doubled to 16 percent of GDP. Estimates are that the figure will stand at 19.5 percent of GDP by 2016. This is a cost curve that cannot be sustained.

Q. Where did the president and congress go wrong with the bill that passed?

A. The main deficiency is the absence of any tort reform. For physicians in the United States, the threat of a malpractice lawsuit is real. Without legislative relief, ‘defensive medicine’ will continue to take a significant chunk out of healthcare dollars. Estimates suggest that savings accrued from tort reform could account for 20-25% of the NHE and may be prudently used to reduce the healthcare costs. When President Obama addressed the American Medical Association in June 2009, the first thing out of his mouth was that tort reform was off the table. At that point, the AMA members should have gotten up and walked out of the room.

Q. Were the Republicans right to oppose the law?

A. No. They should have demanded changes in the law, rather than making political hay out of it. During the debate, they argued that the outcome of such legislation would be the rationing of care and “death panels” that would decide who receives care at the end of life. The truth is, we already have soft rationing of care. We need an honest discussion of what the priorities are for us as a nation. How important is it to screen new born for all the genetic disorders? How important is it to employ all available technological advances at the end of life? How important is it to provide all possible reproductive services for infertility? How important is it to have instant surgery or advanced testing irrespective of the cost and the specificity? We can not afford instant health care for every Americans every time. Educating public so that they do not have undue expectations is as important as the launch of healthcare reform itself.