Orthopedic surgeons sound off on House and Senate health care reform proposals

Some warn that the public option could evolve into a single-payer system offering low reimbursements.

After a summer of heated town hall discussions and meetings with constituents, Congress will work on health care reform when it reconvenes this month.

Prior to the August recess, the Senate’s Health, Education, Labor and Pensions (HELP) Committee and three House committees passed versions of the American’s Affordable Health Choices Act of 2009. However, both the House and Senate recessed without meeting President Obama’s original deadline for submitting a final health care reform bill— a move many physicians say was for the best.

“It is fortunate they did not have time to vote,” Orthopedics Today Chief Medical Editor Douglas W. Jackson, MD, said. “This is too important to do in a shotgun and rushed manner. President Obama has left too much up to Congress to do rapidly and the special interests and specific legislators have too much influence.”

Too expensive

Orthopedics Today Editorial Board member, David A. Wong, MD, said that the delay forced government leaders to listen to concerns that Democratic proposals are too expensive.

“Despite the promises of transparency and discussions, clearly the administration wanted to ram the bill through just like they did the stimulus package and not have exactly what is happening now, where they have to listen to their constituents,” Wong said.

The plans

The Senate plan would create a health benefit gateway in each state to help qualified individuals and groups purchase health care. The plan also includes a community health insurance option, under which Health and Human Services (HHS) would negotiate provider reimbursements.

Also, the proposal calls for collecting quality measurement data, provides grants for programs to improve health, establishes a primary care extension program, and creates a center for health outcomes, research and evaluation.

David A. Wong

The House plan would establish a federal health insurance exchange for individuals who do not have adequate coverage. It also allows states to offer their own exchange or form an exchanges with other states.

The plan implements an 8% payroll tax for employers with annual payrolls between $250,000 and $400,000 who elect to not provide coverage for employees and enacts a health care tax on individuals and families with the highest annual incomes.

If enacted, the proposal would reform the sustainable growth rate (SGR) and provide physicians with a Medicare payment update in 2010. The bill also extends the Physician Quality Reporting Initiative, expands the geographic work floor and prohibits physician ownership of hospitals established on or after January 1, 2009.

A version of the bill passed by the House Committee on Energy and Commerce also includes: a public plan with payment rates negotiated by HHS; and a Consumer Operated and Oriented Plan (CO-OP) program to make grants and loans for not-for-profit, member-run health insurance cooperatives; a Centers for Medicare & Medicaid Payment Innovation within the Centers for Medicare & Medicaid Services (CMS) to test payment modes.

Both House and Senate plans require that individuals have at least minimal health care coverage, provide premium credits to families with the lowest incomes and prohibit denial of coverage based on pre-existing conditions.

Government officials said that the House proposals will be combined to create a final bill. In addition, the Senate HELP Committee’s proposal is expected to be merged with a bi-partisan bill from the Senate Finance Committee. At press time, the finance committee had not yet passed its bill.

Physicians are divided

Regardless of which bill is enacted, Jackson said that providing more coverage and attempting to contain health care costs would result in lower physician reimbursements. The plans could also lead to a single-payer system.

“None of the bills will rein in costs without increasing taxes and fees or rationing or both,” he said. “Physicians are divided. Some of the bills are designed to reduce procedures and favor office practice.”

The AMA has publically supported the House plan, but other medical groups warn that the plan could lead to long-term decreased reimbursements. Wong noted that as more businesses have more employees enrolled in the public option, a single-payer system could emerge. Under this option, physicians would be reimbursed Medicare plus 8%.

“The AMA has basically jumped onboard because they have promised a change in the SGR and that to a lot of people is short-sighted, especially if we get this snowball-effect from business.” Wong said.

He noted that none of the options offered by Democrats include tort or liability reform and said that comparative effectiveness provisions could negatively impact research and development.

One of the greatest public concerns regarding the House plan is the estimated $1 trillion price tag.

“Clearly health care reform is something that needs to be an issue in the country, but people are concerned about the tax and spend approach of the Democrats,” Wong said.

The face of meaningful reform

David R. Mauerhan

Orthopedics Today editorial board member, David R. Mauerhan, MD, said that it is crucial that Congress takes a thoughtful approach to reform.

“In my opinion, there is no need to rush this legislation even in this calendar year,” he told Orthopedics Today. “This legislation will represent 15% to 16% of our national GDP, so the government needs to spend the appropriate time to study this to get it right.”

However, failing to deliver on his campaign promise of health care reform this year could spell disaster for Obama’s administration.

“It may get to the point where clearly, politically, the president has to pass something,” Wong said. “If he takes a major defeat on this like the Clintons did, it is going to be politically damning.”

For more information:

• Douglas W. Jackson, MD, can be reached at Memorial Orthopedic Surgical Group, 2760 Atlantic Ave., Long Beach CA 90806; 562-6666; e-mail: jacksondw@aol.com.
• David A. Wong, MD, can be reached at Denver Spine Center, 1601 E. 19th Ave., Suite 4000, Denver, CO 80218; 303-860-1500; e-mail: ddaw@denverspine.com.
• David R. Mauerhan, MD, can be reached at Carolinas Medical Center-Ortho Surgery, 1000 Blythe Blvd., #503, P.O. Box 32861, Charlotte, NC 28232; 704-355-5982; e-mail: david.mauerhan@carolinashealthcare.org.