What’s the Latest?
December 2009

Health Care Reform or Government Reform?
Bernard F. Hearon, M.D.

During this quarter, the health care reform debate has continued in Congress. On November 7, 2009, the House of Representatives passed HR3962, Affordable Health Care for America Act, by the narrow margin of 220 to 215 over the strident objections of many Americans. The bill did not have bipartisan support and many conservative Democrats voted against the bill.

On December 24, 2009, while most Americans were focused on last-minute preparations for Christmas, the Senate passed their 2500-page health care reform bill HR3590, Patient Protection and Affordable Care Act of 2009, by a 60-39 majority along strict party lines. The significant differences in these bills will have to be reconciled in congressional conference committee in January before a final bill can be signed into law by President Obama.

While the Senate bill does not contain the “public option” as a health care insurance alternative, if enacted, the bill would result in government control over the health care industry. Providing 31 million uninsured Americans with health care insurance will be an expensive proposition. The bill’s provisions specify who will bear the cost of this new entitlement.

Since the new legislation will prohibit insurance companies from denying coverage for pre-existing medical conditions and from charging higher premiums to those patients, the relatively higher cost for coverage of these higher-risk patients will be spread out among all policy holders. Therefore, those who have health insurance now will see their insurance premiums substantially increase.

The Senate bill also mandates that all citizens have health insurance and imposes fines on those who do not have coverage. Some argue that those presently uninsured would rather pay the nominal government fine than pay for expensive health insurance. Therefore, the legislation would essentially impose a tax on these uninsured individuals who would ultimately still be without health care insurance.

Among the most controversial provisions of HR3590 are those that effect existing health care entitlement programs. Medicare funding will be cut $470 billion over the first ten years with the initial cuts taking effect in 2010. Federal funding for the Medicare Advantage program upon which many seniors rely will be gutted. Thus, the new health insurance entitlement will be paid for in part by cutting Medicare. Since the Senate bill also expands Medicaid eligibility, it is projected to increase Medicaid enrollment. Increased Medicaid costs will be borne in part by the states with the likely result being higher state taxes for all citizens.

Senate HR3590 does not provide transformational change to our health care system and is really little more than a wealth redistribution scheme. The Senate bill, like House bill HR3692, has encountered widespread opposition. Public opinion polls consistently show that Americans do not support this legislation by a margin of nearly two to one. Though the Obama Administration claims the proposal is endorsed by health care providers (the American Medical Association has supported the bill but with reservations), orthopaedic surgeons (see pdf1) and other surgical subspecialists (see pdf2) are on record as being firmly opposed to HR3590.

For the most part, physicians and issues important to physicians have been excluded from the debate on health care reform. Notably absent from the proposed legislation is a provision for medical liability reform which experts acknowledge should be an integral part of meaningful health care reform (ref 1, 2). Medical liability reform could reduce the need for physicians to practice defensive medicine, eliminating some diagnostic tests which are now done primarily for medicolegal reasons and resulting in lower health care costs.

Many thoughtful physicians and politicians have proposed medical liability reform and have made other reasonable reform suggestions (see pdf3). However, for political reasons, these proposals have been largely ignored by the Democrat majority in Congress. The Center for Health Transformation has outlined six proposals (including medical liability reform) which, if implemented, would provide higher quality health care at lower cost (www.healthtransformation.net). While these proposals could certainly serve as a template for meaningful and effective health care reform, it is now clear that such health care reform will not occur during the 111th Congress.

Many Americans are now asking crucial questions about the legislative process they have witnessed and are demanding answers from their representatives.

• "How is it that the most important legislation of our lifetime, affecting the health care of every American and impacting one-sixth of our nation’s economy, can be written behind closed doors by a handful of representatives without input from all elected representatives and from physicians who provide health care?"
• "How it is that the Senate can pass a health care bill which is so complex and lengthy that few legislators have even bothered to read it?"
• "How is it that some of the 60 votes needed to pass the Senate bill were obtained in secret negotiations with senators whose votes were bought with tax payer dollars used as bribes?"
• "How is it that our Congress can commit tax payer dollars to health care reform legislation which the majority of tax papers don’t want and which our nation can’t afford?"

Satisfactory answers to these very serious questions about the proposed health care reform legislation in Congress have not been forthcoming.

Is this the representative democracy our founding fathers envisioned? Many Americans believe that it is time to return to the conservative principles upon which our republic was founded. The role of the federal government is to protect our rights to life, liberty and property. The founding fathers envisioned a limited role for the federal government to provide for the common defense, to protect our borders and to maintain sound and stable monetary policy. Some argue that guaranteeing health care insurance for all citizens is not a mandate of the federal government and may, in fact, be unconstitutional.

For certain, a universal health care entitlement would add to our growing national debt which is not sustainable. After years of unrestrained deficit spending, our national debt now exceeds $12 trillion dollars. Unfunded obligations to our existing entitlement programs (Social Security, Medicare and Medicaid) exceed $100 trillion. Another $9 trillion in cumulative deficits will be added over the next ten years. If HR3590 becomes law, the total federal deficit will easily exceed $125 trillion dollars.

Many financial analysts believe that this unfathomable debt can never be repaid and that the US government is insolvent. The Federal Reserve has responded to this debt crisis by rapidly expanding the monetary supply, debasing our currency so that the government can pay off our debts tomorrow with dollars that are worth less than they are today. The inevitable result of this monetary policy is hyperinflation and a global financial crisis which will rival or exceed that of the Great Depression. Devaluing the US dollar is an unconscionable policy because it effectively destroys the wealth of every American from all generations - present, past and future.

So what does all this have to do with you and your health care? The national debate on health care reform should be about improving the quality of your health care, decreasing the cost of your health insurance and improving the health care delivery system. In fact, the proposed legislation does none of these things. Instead, the issue of health care is being used as a means to control more federal tax dollars. The real crisis in our country is not as much about health care as it is about unrestrained government spending and the lack of political will to bring that spending under control.

Some politicians believe that a constitutional amendment mandating a balanced federal budget will be necessary to eliminate deficit spending. Others believe that strict spending limits as a function of Gross Domestic Product (GDP) or some other measure of productivity should be imposed on the federal government. Still others have called for a flat income tax, audit of the Federal Reserve and return to the gold standard. For certain, wasteful, unrestrained federal spending must stop - and soon.

Aristotle once said “Tolerance and apathy are the last virtues of a dying society.” This no time to tolerate the fiscally irresponsible policies of the federal government and no time to be apathetic about demanding that public policy reflect the will of the people. Now is the time for US citizens to email your representatives and let them know what you think.

Whatever your position may be on health care reform, remind your representatives that they represent you and your interests. Remind them that Congress must be fiscally responsible in discharging its duties. Remind your representatives too that they can’t expect to have meaningful health care reform when physicians don’t have a seat at the negotiating table.

1. Bernstein J, MacCourt D, Abramson BD. Topics in Medical Economics: Medical Malpractice. J Bone Joint Surg; 90A: 1777-82, August 2008.

2. Mello MM, Brennan TA. The Role of Medical Liability Reform in Federal Health Care Reform. N Engl J Med 361;1, NEJM.org, July 2, 2009.