Dr. Elaina George, MD
Healthcare Reform: The Law of Unintended Consequences
October 13, 2009

The debate on healthcare reform is in full swing, but no one is paying attention to the long term effects.

I am for universal healthcare in theory. As a physician, I believe that it is a fundamental right. Unfortunately, the way the debate and pending legislation has been crafted, the outcome will result in unintended consequences.

As a physician in solo practice, I am in a unique position to see the outcome if we continue on the path that Congress is proposing in HR 3200.

1) A single payer system that pays the same rate as Medicare or as the bill stipulates (5% above Medicare) will lead to LESS choice. People are overlooking the fact that most private physicians are currently NOT accepting new Medicare patients because they can’t afford to do so and stay open. There will be no reason for this to change if the reimbursement scale adopted.

Unintended consequence: The network of private physicians would be smaller and more patients will be placed in a system of fewer physicians, less choice and longer waiting times to be seen. This would have the opposite effect – what is the point of universal healthcare if you don’t have quality physicians to provide it.

2) The proposed healthcare bill sets up a bureaucracy run by a National health insurance commissioner and sets up an insurance "self regulatory agency” – made up of national insurers, national agencies, and insurance producers. There are no physicians or patient advocates.

Unintended Consequences: This works on the same model of the commercial insurance companies and is at the heart of what is intrinsically wrong with the system because doctor recommended care and patient rights are not represented.

3) Commercial insurance companies will follow the rules of the public option plan in order to compete. They will use the reimbursement rates as their guide and that would lead to providers leaving the system thereby setting up a parallel system – and by default a two-tier system. Those with money will simply opt out while those in the system will likely be subject to more restrictions and longer waiting times for their care.

The goal of private insurance companies is to increase profits while the goal of the government is to save money, but the end result is the same. There will be a limiting of access and a rationing of care. The government will have no competition that can stop it from continuing to lower the bar – in both reimbursements to providers and hospitals, and covered services for patients.

Taken to its logical extension patient care will be driven by a faceless government entity that runs healthcare on algorithms (e.g., how long it should take to treat a sinus infection and what drugs should be used, whether or not surgery will be allowed under the guise of evidence-based medicine). The art of medicine will be lost along with the innovations provided by physicians who are able to think outside of the box, and the practice of medicine will be irreversibly changed. The best and the brightest will choose any other profession that doesn’t sap their spirit.

It is time to turn the debate to the real culprit in the rise in health care costs. A private insurance industry that profits by excluding the sickest and limits care for its members; a pharmaceutical industry that reaps windfall profits by setting up pharmacy benefit management middlemen who keep prices artificially high while driving the medical formulary; and a hospital system that is charging astronomical prices under the guise of recouping costs incurred by treating the uninsured, when in fact they get money from the government to do just that.

We have the power to revamp our health care system by removing and regulating those entities that profit from disease. This will require the guts to stand up to the lobbyists and corporations and say that there has to be a limit to their greed. It will also require the American people to really take a hard look at the choices they make that contribute to chronic disease such as smoking, leading sedentary lifestyle and eating an unhealthy diet.