I am compelled to write a rebuttal to Mr. Lawrence Harrington’s June 20 Letter to the Editor. I do feel sorry for him -- it must be difficult to live in Vermont surrounded by so many screaming liberals. He must feel a lot like General Custer at the Little Bighorn.
To summarize his letter, Mr. Harrington is not an Obamacare enthusiast. He cites the complexity of Medicare billing and its influence on whether a doctor will be able to stay in private practice or feel forced to become an employee of a larger institution. He tries to frighten us with a complex formula but does not define the terms. Somehow, he concludes that this formula is the invention of Obamacare.
In fact, for better or worse, this formula has been in use by Medicare, Medicaid, and virtually all other insurance companies since 1990. The main problem with this formula has been that it undervalues the work of the primary care doctor in comparison to the technically oriented specialist. The hospitals do their billing through another system (Diagnosis Related Groups) which was instituted in 1983. Obamacare has not changed this. There has been talk of replacing these old fee-for-service systems with a new system, but this is years down the road.
Doctors are not leaving their private practices because of Medicare billing or a formula. The formula remains the same wherever they go and it is used by all payers. The problem for doctors is that there are so many payers.
If doctors could get paid a fair amount from one reliable source, private practice would be a lot simpler to manage. As it stands now, each payer (insurance company) has its own unique set of rules and regulations which the doctor must follow. Mr. Harrington is correct when he points out that this requires a highly skilled staff. Besides billing problems, there are many other insurance "hassles" that face the doctor.
Is the doctor on the panel of preferred providers for that insurance company?
Will the doctor prescribe drug A but the insurance company insist on drug B, and what will it take to convince their clerk that drug A is more appropriate?
Will the insurance company allow the doctor to order a CT scan or an MRI, or will there be a need to obtain prior approval?
Who is the right person to talk to at the insurance company, and will that person put the doctor’s staff on hold for an hour? Hassles, unnecessary complexity, and increased overhead may drive the doctor to abandon private practice and sign on with a "big box" institution in the hopes that the institution can deal with the hassles and stabilize the doctor’s income.
Not all of our citizens have been as lucky as Mr. Harrington when it comes to health care. Before Obamacare there were nearly 50 million uninsured Americans. Because of lack of coverage, many delayed seeking care. It is estimated that about 40 thousand (0.08 percent) died as a result of lack of care in 2013.
Mr. Harrington says that his crystal ball predicts that more Americans will get less medical attention under Obamacare. Early reports indicate that he should abandon his crystal ball in favor of tarot cards. About 8 million people signed up for Obamacare in the initial enrollment period and about 60 percent of these had not had prior coverage. Considering the computer snafus, this was not a bad start. Coverage has been expanded, but little has been done to contain costs, and costs are out of control.
It seems odd to be defending Obamacare, as I don’t like it very much either. At present, with or without Obamacare, we have a failed healthcare system. It is twice as expensive as any other industrialized nation, and it does not deliver good care (on average) to our population.
It is estimated that when Obamacare is fully implemented there will still be 30 million uninsured Americans. The insurance companies have failed us; they get rich at the nation’s expense. Administrative costs consume 31 percent of our health care dollar. We could save enough on administrative expenses (if we ditched the insurance companies) to cover all of the uninsured.
What we need is improved Medicare for all. Birth to death. Everybody in, nobody out.
G. Richard Dundas, MD is a resident of Bennington.
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