The Senate health insurance bill is on hold, as everyone in Washington and around the country hopes and prays for a speedy recovery for Senator John McCain, who reportedly underwent a procedure to remove a blood clot over his eye. Having reviewed his medical records back in 2008 I can tell you that the team at Mayo Clinic in Arizona does an excellent job.
The delay reminds us that the goal with health reform is not to improve and extend health insurance, but to provide quality health care itself as the senator is clearly receiving. Does the Senate bill, in its current form, do that?
Here’s a closer look from the point of view of a practicing internist – me.
As a practicing physician who deals with Medicaid on a daily basis I can tell you that it is an essential lifesaving coverage that is also loaded with waste and is too easy to overuse.
Removing the individual and business mandates as all the Republican proposals do is an essential first step, since it has never made philosophical sense to mandate a product that can’t guarantee you the actual care it is promising. Actual care depends, and will always depend, on doctor and nurse participation and availability, treatment and test approvals, and a patient’s ability to pay for both the prodigious premium and sometimes for the service directly until the large deductible is met.
But without the Cruz amendment - which essentially allows patients to choose a more personalized or catastrophic style insurance product provided that the insurer also continues to provide the full ObamaCare boat to those who want it - patients would be faced with the same all or none choice that they have now. From my point of view the a la carte menu is much better and more suited to the varying needs of my patients, and for those who are concerned that premiums will then skyrocket for my sick diabetics or those with emphysema, heart disease, or cancer, I applaud the addition of $70 billion to help stabilize premiums. More may be needed.
Returning choice to the doctor’s office may also make the decision to double Health Saving’s Accounts more meaningful, as a healthy patient can choose a more scaled down policy to fit his or her needs and then pay for elective treatments or tests out of pocket. Patients are already doing this under ObamaCare until their deductible is met, but now there would be a tax incentive. Plus, the more HSAs are used the more patients will become aware of the tremendous variability in prices for the same service, and they can negotiate for lower prices thereby lowering costs.
Medicaid is one area that clearly needs work for a bill to pass the Senate. The problem with changing the program from an open ended entitlement to a restricted one with state block grants (saving over $770 billion over ten years) is that states will necessarily tighten their belts and millions will lose the insurance they now have. It is this feature of both the House and now the Senate’s repeal and replace bills that have made the bills so unpopular. In fact at least five Republican moderate Senators in expansion states are not definite supporters because of the stark Medicaid reform.
As a practicing physician who deals with Medicaid on a daily basis I can tell you that it is an essential lifesaving coverage that is also loaded with waste and is too easy to overuse. But the solution is not a drastic alteration as both the Senate and House bills propose. There must be compromise, with a goal toward both efficiency as well as preserving coverage.
The fact that one senator’s surgical procedure has prompted Senator McConnell to push the pause button on health insurance reform is not in and of itself a good thing. On the other hand, if the time is used wisely, Republicans will consider blunting their Medicaid scalpel and perhaps attract a few Democrats in the process.