One of the reasons that the healthcare debate has degenerated into arguments among extreme camps is because the plan lacks legitimacy to many of the providers who must deliver the care. In the beginning it was made clear to physicians that tort reform would not be considered a part of healthcare reform. It is clear that any legitimate reform aimed at decreasing the cost of healthcare would address the costs associated with defensive medicine. In our litigious environment if a matter of medical judgment could result in a potential lawsuit, no matter how low the likelihood, physicians will err on the side of caution.

 

Physicians will order tests and make referrals to shield themselves from potentially catastrophic financial judgments. Failure by Congress and the President to address this issue, as well as the realistic expectation that many physicians will see their incomes decrease make physicians unwilling participants in reform. Though this current proposal may have other problematic components, the lack of meaningful tort reform has shifted many physicians from the side of willing advocates to unwilling detractors. I implore the administration to bring physicians' concerns to the table and we will in turn bring our patients to the table as well.

 

First, I am concerned about the millions without health insurance - every month my group sees patients and operates on many of them for free for the Church Health Center - if all physicians would see some "charity" patients it would help the burden of the uninsured. This is a great local resource but depends on donation of time and money. The patients are usually those who are working in positions that do not provide/nor can they afford healthcare insurance.

 

I'm not completely convinced people who continue to abuse their bodies through alcohol or drug abuse for instance, should be entitled to the same benefits as those who are actively working and contributing to society. Emergency care is always available - there is not an emergency room in Memphis that would turn a patient away for the inability to pay.

 

Second, I am very concerned about the government entering the patient/physician relationship. I already struggle with insurance companies not covering ultrasound during high risk pregnancies or special diagnostic mammograms for breast lumps. Medicare patients are only covered to see their gynecologist for an "annual" exam every 2 years – although a breast/pelvic exam is recommended by every organization every year. So I am already seeing the conflict between what I recommend as a patient's physician and what the government will pay for. I fear the government entering the decision-making will lead to longer wait times. In Canada if a woman feels a breast mass it can be months before a mammogram is done – even longer before actual surgery – I don't think most Americans are ready for this type of rationing. There are so many exciting new technologies in my field, such as robotic surgery for hysterectomy. These patients do phenomenally in their recovery compared to the traditional way of doing surgery, but with health care rationing I fear I will no longer be able to offer this.

 

 Thirdly, there must be attention paid to malpractice. There are numerous areas even here in Tennessee where physicians have stopped delivering babies due to the escalated costs of their insurance. As a result of this we have many patients drive over 2 hours to deliver here in Memphis. Physicians are quitting obstetrics at earlier ages – and fewer American physicians choose my specialty year after year. I have concerns over who will be there to take care of me or my children much less the 40-50 million currently without insurance. The increase to the physician population increases by only 1 percent now each year – not enough to keep up with the overall population growth – certainly not enough to take care of all the uninsured. Without tort reform fewer people choose medicine as a career and with more government oversight this will be made worse. It takes years to train new doctors between medical school and residency – physician and nursing shortages are already common in many rural areas. Adding more patients without providing incentives for students to enter medicine will increase these shortages.   

 

Most of the debate concerning healthcare reform is being focused on the implications for healthcare recipients, specifically options, regulations, and controls.

 

Unfortunately, virtually nothing has been said about the implications for business owners in the healthcare arena and ultimately for their patients and clients. While the various bills under consideration all deal, ostensibly, with controlling costs, few seem concerned about who will be burdened with these added costs.

 

In the "pay or play" mandate under consideration, employers, other than those deemed "small," must pay the majority of healthcare premiums for all their employees and their families. The government model naively fails to realize that its criteria penalize companies that hire a large, flexible workforce of low-wage earners. This includes non-medical, in-home care companies that provide caregivers to older adults, many of whom are homebound.

 

Under this proposed play-or-pay mandate, numerous firms currently providing caregivers will be forced to lay off workers, and in some cases, actually will be forced out of business. The sheer weight of premium coverage will prove impossible for all but the strongest of these companies.

 

Moreover, this burden extends to all categories in healthcare, as the cost of doing business will challenge or invalidate current business models.

 

The results would not be limited to a dramatic increase in unemployment with a corresponding rise in unemployment insurance. It will yield poorer service because of the decreased number of companies and service personnel.

 

Lastly, it will cause inflation to skyrocket. Every non-exempt company in healthcare will raise prices to offset this new expense. Every citizen will end up paying the price for healthcare reform.

 

 

The need for affordable, broadly covering, widely available health insurance is as important as clean drinking water and safe schools. The proposed legislation of a public health option gives the government plan an unfair advantage and would bankrupt the hospitals and physicians, eliminating millions of good American jobs that largely cannot be shipped overseas. Meanwhile, another idea in congress allows the government nearly full control of the healthcare system. Interestingly, two U.S. senators are currently receiving therapy for cancer that no 5 member panel could ever rightfully claim is cost-effective for the government or beneficial to society as a whole. Government should never be allowed to make these choices for patients.

 

To allow government full control over healthcare is a real step backwards and a tragedy for the American people. True reform, in my opinion, would involve the extreme regulation of private insurance companies, eliminating waste in current systems, rewriting bankruptcy laws, tort reform, and increasing private insurance competition fairly and on an equal playing field, resulting in lower costs to individuals and families, a stable healthcare revenue to protect healthcare jobs and our economy, and a furthering of the most advanced and finest healthcare system in the world.