What About Health Care Reform?

President Obama mishandled the important topic of health care reform during his State of the Union speech on Wednesday night.

He spent little time discussing the issue, but when he did, he showed no sign of changing his method or learning from his opponents, insisting once again, "Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan." But where is the evidence of this? Both major bills before Congress include clauses which dictate exactly the kind of insurance you can have and what you can't.
And where is the incentive for doctors to keep accepting this insurance? More than 50% of practicing doctors already don't accept Medicaid, according to a 2005 survey, and the Medicare Payment Advisory Commission determined in 2008 that 28% of Medicare patients were unable to find primary care doctors. The yearly doctor dropout rate in private insurance exceeds 10% in many places, including New York.

President Obama went on to state that the health reforms would "reduce costs and premiums for millions of families and businesses," but how so? In Massachusetts, for example, insurance premiums went up when companies were compelled to cover pre-existing conditions and not drop anyone when they were sick. Noble ideals, but costly. And the rate of unnecessary ER admissions has remained steady at 15% even after universal health coverage passed in the bay state. "Patients will be denied the care they need" if health reform doesn't pass, the president reiterated last night, but there is no proof that increasing coverage expands access to health care. In Canada and Europe, the opposite is true.

The American public is no longer accepting the same tired platitudes, as evidenced by the Massachusetts election and the current climate around the country.

There are crucial problems not being addressed by health reform: First, there is a big shortage of doctors throughout the country, which will interfere with access to health care no matter your insurance coverage. The Association of American Medical Colleges estimates a shortage of 150,000 doctors by 2025.

Second, a one-size-fits-all HMO-style insurance is expensive and easily overused. It lacks the built-in disincentive for overuse of cheaper, higher-deductible insurance. Extending low-deductible insurance (a central principle of all the health reform bills) will lead to higher premiums, especially without portability to promote competition.

Third, even if you already have insurance it will be choked by government regulations and oversight under the new health insurance system, and it isn't likely to cover the high tech solutions you need. Lastly, doctors are already overwhelmed with too many patients. With no tort reform and decreasing reimbursements, they are likely to quit or at least quit taking insurance.

By not acknowledging America's concerns about health reform Wednesday night, the president appeared inflexible and incapable of real compromise. And by not spending much time on a topic that was front and center just a few weeks ago, he looked more like a politician than a leader.

Marc Siegel, MD