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June 23rd, 2009

Taking the Scalpel to Health Care

health-care-reformWritten by Mariannette Miller-Meeks M.D.

It would come as no surprise that health care reform is URGENT, and that failure to make massive changes to our nation’s health care system will cost thousands of jobs and irreparable harm to our economy if not completed immediately.

This comment by President Obama at the American Medical Association (AMA) meeting a week ago Monday brought applause. In President Obama’s 55 minute speech to the AMA in Chicago, he was courteously welcomed, treated respectably, and applauded numerous times. The President was also booed once, deservedly so, when he catering to the trial attorney lobby.

To this physician, the President appeared at the AMA to convince, cajole and coerce our nation’s medical professionals in an effort to secure our endorsement for his public option alternative for health care reform. Some physicians were persuaded, some already advocate a universal single-payor health care system, but many physicians, myself included, look beyond the rhetoric and instead dissect the intent of going with a single-payor system, especially in light of his recent economic policies.

President Obama and the Democrats in Congress have learned a lot from the failed attempt by the Clinton Administration in the 1990’s. This time around, there is a since of urgency, promises of creating hundreds of thousands of jobs, pledges that you can keep your own doctor and insurance, dreams of a streamlined medical record system, and assurances that the new proposal is not mandatory, it’s just an option . President Obama’s line in his speech acknowledging that physicians merely want to be healers received the most applause, but his health care proposal falls short of that goal.

With the presidential campaign over, it is now easier to take the scalpel to the President’s healthcare proposal since we now have the benefit of looking at how his administration has dealt with other areas of the economy. Contrary to popular belief, President Obama doesn’t want socialized medicine…yet. Even Howard Fineman of Newsweek admitted this when he spoke to at the AMA luncheon last week. For President Obama to accomplish health care reform that will provide coverage for almost all Americans, he will have to incrementally march us in that direction.

President Obama’s “public option” will be subsidized by taxpayers, which means it will unfairly compete with private insurance options. Individuals will undoubtedly move to the lowest cost option, especially if they believe that they will be able to keep their own doctor. As we saw with the creation of HMO’s, initially the coverage will be extensive, but as the costs increase, the new public option will be forced to mandate reductions, meaning health care will be rationed.

With the existence of a public option, businesses will forego providing health care coverage to their workers. This will allow some businesses the ability to dramatically cut their costs, but it is unlikely that they will increase the wages for their workers. As more individuals move into the public option, private health insurance will be further constrained and premiums will increase with the subsequent loss of enrollees, which will basically eliminate any competition for Obama’s public option plan.

Another area in which the Obama Administration is advocating for massive change is in electronic medical records (EMR). The cost of electronic medical records will be tremendous and will not yield the cost savings most politicians profess. This was outlined in an article in the Des Moines Register on January 5, 2009. Electronic medical record keeping has not lead to any cost savings in the U.K. Instead, electronic medical records will actually decrease provider efficiency. Data entry errors may go uncorrected which could yield improper and erroneous care. Heath care may also be more impersonal and lead to further decaying the patient-physician relationship. Even more important is the question of who controls the electronic medical record. This question remains unanswered by the president.

I do not want any of my personal medical information going to a central government clearing house or common platform as stated by Senator Harkin at the White House Forum on Health Care Reform this past March in Des Moines. Private medical information belongs to the patient and his or her doctor, not the federal government. The EMR should be burned to a disc or an RFID chip or a chip placed on a medical bracelet or necklace that the patient brings with them. A provider within a system should be able to access information and share it with other providers with the consent of the patient. If the data is in a central repository, the federal government can mandate behavior and ration care, penalize providers and use information for political purposes.

Obama’s health care reform will not create hundreds of thousands of new jobs. I have extensive experience in military (i.e. government)medicine, and we never had too many people. In fact, as a nurse I preferred the military because we functioned at a much higher level given the doctor shortage. In January, the London Times revealed that 19 hospitals in England’s government healthcare system were closing. The closing of the 19 hospitals wasn’t due to a lack of demand or patients; it was lack of government money.

In his speech to the AMA, President Obama outlined where he will curtail spending and find cost savings opportunities to pay for his health care reform proposal, but that is for another article. I will say that for those of us in the medical profession, health care reform, even if entirely as a single payor universal system, will not reduce costs. The only way the government will be able to accomplish that is through rationing care. That is what occurred in Canada over 20 years ago, and it is what will happen here in the United States, but at a quicker pace. Last month alone, the Congressional Budget Office revealed that the Medicare program will become insolvent much earlier than predicted. If it had remained catastrophic insurance only, it would be solvent for decades to come.

Finally, on the issue of medical liability reform, President Obama offered little encouragement. It is a common tactic to identify a common enemy to engage and get the audience invested in your agenda. Obama could have done just that if he had spoken out against frivolous lawsuits, which have increased the cost of health care for all Americans. Unlike the rest of his health care reform agenda, he was short on the specifics other than the urgency with which it must be enacted. He obviously avoided the subject to prevent debate on the matter so that he can push his public option proposal while he is still personally popular. Former Senator Tom Daschle urged this tactic in his book where he cited the slow process as the reason for failure under the Clinton Administration.

Make no mistake; President Obama wants to continue the historic legacy he already owns by being the first African-American president. Presidents Truman, Kennedy, Carter and Clinton all failed to deliver universal health care. If President Obama is able to achieve what his predecessors have failed to do, it would cement his place in history. Obama has already achieved what these former presidents could not: creating the urgency to make massive changes to our nation’s health care system instead of dealing with the economics of the proposal.

Mariannette Miller-Meeks M.D. is the former President of the Iowa Medical Society, and was the Republican nominee for Congress in Iowa’s 2nd Congressional District. She and her husband Curt live in Ottumwa, Iowa.

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The Iowa Republican

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