The debate surrounding the passage of the health-care reform finally comes to an end. Now that it has passed, let's take a look at how the bill will affect the average patient. The stated goals of reform were to insure more Americans while reducing the costs of the delivery of health care. Does it do so?
Will it insure more Americans? It certainly accomplishes this goal, as thirty-two million Americans will gain insurance, giving them "access to care." Half of these patients will receive new coverage through Medicaid, the other half through private insurance. Additionally, insurance companies will be barred from refusing coverage on the basis of pre-existing conditions. The value for these newly insured people will be substantial, as such insurance will provide a safety net, making them much less likely to be driven into bankruptcy by becoming ill.
But will it be easier to see a doctor? Not necessarily. One of the touted benefits of the bill is that having insurance will enable patients to see doctors for preventive care. This will presumably treat diseases early before they become more advanced, when they are more difficult, and expensive, to treat. However, Medicaid reimbursement to doctors is currently so low that doctors actually lose money by seeing Medicaid patients. Because of this, very few doctors will agree to see Medicaid patients, making it is quite difficult for such patients to see a doctor. Adding 16 million more Medicaid patients without improving reimbursement will simply make this problem worse, as more patients will be competing for the scarce doctors' time. To further worsen the problem, reimbursements to doctors for Medicare patients (over age 65) just went down by 21 percent. If Congress does not fix this reduction, doctors will begin to start refusing to take Medicare patients, just like they have with Medicaid. Just because patients are insured doesn't necessarily mean that they will be able to see a doctor in a timely manner.
Will this affect the quality of care that patients receive? Probably. As more doctors are forced to refuse Medicare and Medicaid patients, these patients will lose their ability to choose their doctor. Traditionally, the first doctors to opt out of Medicare and Medicaid are the best doctors, those that patients are willing to pay out-of-pocket to see. This could conceivably turn the U.S. health care system into a two-tiered system, where only the rich are able to see the best doctors.
Will this plan reduce the cost of health care? Potentially. If patients are able to receive the preventive care discussed earlier, it could keep them healthier. Of course this is a long term vision but short term you may run the risk of patients coming in to doctors or emergency rooms without a real urgent medical issue and exhaust the system. With preventive medicine and Screening one can argue that it would improve their health and quality of life while also preventing expensive emergency room visits and hospitalizations. But a great opportunity for savings was lost by the failure to include tort reform in the bill. Many unneeded (and expensive) diagnostic tests, such as CT scans and MRIs, are ordered not out of medical necessity, but rather out of fear of litigation. Without meaningful reform of the broken medical malpractice system, this "defensive medicine" will continue to waste billions of healthcare dollars.
In summary, the health care bill may offer some meaningful advantages for some of the 30 million Americans who will gain medical insurance. However, several needed reforms were notably absent from the bill. To truly fix the health care system, more changes are necessary, most urgently tort reform and the Medicare reimbursement problem.
David B. Samadi, MD is the Chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City. As a board-certified urologist and an oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer, and prostate cancer, he also specializes in many advanced minimally invasive treatments for prostate cancer, including laparoscopic radical prostatectomy and laparoscopic robotic radical prostatectomy. His Web site, Robotic Oncology, has been translated into six different languages and is one of the most popular urology sites on the Internet.