Most Americans agree that health care reform is needed – but what shape that reform takes is an ongoing debate. And how that reform will affect chronic pain patients is rarely mentioned.
Personally I have a lot to gain from a health care reform policy that provides coverage for everyone because right now no one will insure me at any price. In spite of that, I find myself with serious reservations about the plan currently under consideration.
Let me say upfront that I haven't read the whole plan, so anything I refer to as being in the bill is something I've heard or read in news reports. Actually, I'm not sure anyone has read the entire bill. It's still being debated and amended, so I don't think it has been published online – at least I haven't been able to find it. From what I hear, it's well over 1,000 pages of legalese – not exactly bedtime reading. (I did find a 615-page version submitted by Senator Kennedy about six weeks ago, but that has since undergone many changes.)
Charting the Plan
Although I couldn't find a copy of the entire bill, I did find a chart depicting how the proposed plan would work:
If you'd like to see a larger, readable version of the chart, click here. I don't know about you, but to me this looks like a nightmare of bureaucracy. I have no idea where I would fit into this plan, but it scares me to think of how nuch red tape would potentially stand between me and my doctor's ability to provide the care I need.
While there are many aspects of this bill that bother me, five specific issues cause me grave concern:
1.) The administration insists that this is not a plan for universal health care, private insurance companies will still be able to operate, and if you have a private insurance policy you like, you can keep it. Technically, that's true. What they don't tell you, though, is that as the bill is currently written, if you don't have a private insurance policy in place when the bill takes effect, you will not be allowed to get one. You will be forced to take the government policy.
How long do you think private insurance companies will be able to continue if they can't get new customers? And even though the company you work for may have a private insurance policy now, if the government offers a less expensive policy, how long do you think they will keep offering the private insurance? In my opinion, even though this may not start out as universal coverage, within a few years it will be.
2.) The administration also says that you will be able to keep your current doctor. Again, that is true – at least for the time being. What they don't tell you is that the care your doctor is allowed to give you will be regulated and rationed. Some cost-cutting features already written into the bill include:
• Limiting MRIs, CAT scans and other diagnostic tools
• Significantly limiting Cesarean sections
• Limiting the use of antibiotics
• Cutting back on surgeries and other treatments for chronic back pain
3.) As you've probably noticed, two of the above cuts could have serious consequences for many chronic pain patients. We already know that chronic pain disorders can be difficult to diagnose and even more difficult to treat. How much harder will it be to get an accurate diagnosis or adequate treatment when cutting costs is a primary goal? And if the use of antibiotics is being limited, how long do you think it will be until opioid medications are also limited? The FDA is already discussing putting stricter regulations on the prescribing of opioids. How easy it would be to just refuse to cover their cost?
4.) There are no incentives built into the plan that would encourage more people to become doctors. On the contrary, cost-saving measures will likely reduce doctor reimbursement rates. As a result, the same number of doctors that are now treating 250 million people will suddenly be expected to treat nearly 300 million people. And if reimbursement rates become too low, we'll see increasing numbers of doctors being forced to give up their practices. It can already take weeks to get an appointment. I can only imagine what the wait will be then.
5.) The U.S. government has yet to prove that it can effectively run a medical benefits program. Just look at the Veteran's Administration, Medicare and Medicaid. Veteran's Health Care – I hear from a lot of veterans who are very unhappy with the treatment they receive. There are long waits to even get an appointment and the care is often clinical and impersonal. Medicare/Medicaid – It's difficult to find a physician who will take Medicare or Medicaid. Finding a specialist is nearly impossible. The reason? Too much paperwork and too little reimbursement. Yet, despite the low reimbursement rates, the Medicare and Medicaid programs are on the verge of bankruptcy. If our government can't effectively run the health care programs it currently has, what makes us think it could run an even more massive program?
Looking at Other Countries
To see what the future holds for us if we move to a government-run health plan, we have only to look at two countries that have had such a plan for many years – Canada and Great Britain. I've talked with quite a few people from both countries and most are unhappy with the health care they receive. Following are some of the reasons why.
• Long waits abound. It takes four months to get an MRI, nine months to see a specialist, and two to three years to schedule surgery.
• Some of the most effective treatment options are not available. For example, the top two chemotherapy drugs for colon cancer cannot be used because of their high cost. As a result, the Canadian death rate from colon cancer is 25% higher than in the U.S.
• There is a severe shortage of doctors. In 2007, 1.5 million Ontarians couldn't find a family physician. And one Nova Scotia community held a lottery to determine who would get doctor appointments.
• Patients have little choice of who their doctor will be.
• Because of low compensation, there is a significant shortage of specialists and few physicians are available at night or on weekends.
• 40% of cancer patients never see an oncologist.
• Things like kidney dialysis, open-heart surgery and treatment for terminally-ill patients are rationed.
• There are long waits for doctor appointments and subsequent treatments.
Countries like Canada, Great Britain, and other European countries that have government-run health care are now looking for ways to privatize at least portions of their systems because what they have is not working. Canadians with potentially life-threatening illnesses who can afford it are coming across the border to be treated in the U.S. because of the long waits for treatment in Canada. So why is the U.S. trying to emulate these programs that clearly have not worked well for the countries that have implemented them?
There's no doubt that our health care system needs some reform. And I personally need some kind of health care coverage. But I don't want either if it means reducing the overall quality of health care for all Americans. That's just too high of a price to pay.
Gratzer, David (2007, Summer). The Ugly Truth About Canadian Health Care. City Journal, from http://www.city-journal.org/html/17_3_canadian_healthcare.html
Health Care Around the World: Great Britain. Healthcare Economist, (2008, April 23). from http://healthcare-economist.com/2008/04/23/health-care-around-the-world-great-britain/
Published On: July 23, 2009