ROE: After Obamacare: Principles for reform

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Washington, January 14, 2011 | comments

Next week, the House will vote to repeal and replace Obamacare with reforms that will keep control of health care decisions in the hands of patients and their doctors. As a physician, I've seen firsthand the problems insurance companies have created for patients. I've seen firsthand how government programs have made beneficiaries worse consumers of health care. I've seen how the cost of health care has exploded and made insurance unaffordable. I want to fix these problems. But Obamacare will not fix these problems - it is bad medicine for our nation.

Creating jobs and health care reform are at the forefront of my mind, and I am committed to helping this Congress implement true health care reform. By passing this legislation immediately, we will be sending the message that this Congress is not in favor of inserting Washington bureaucrats into a patient's relationship with his doctor; that we are not in favor of increasing the cost of health insurance; that we are not in favor of weakening Medicare to create a new entitlement; and that, at a time of record unemployment, we are not in favor of legislation that will eliminate jobs.

In medicine, there's no such thing as a Republican disease or a Democratic disease - there's just disease. Likewise, good ideas on health care reform shouldn't be defined by a party but by meeting a series of principles for reform. Through experience, listening to people from all sides of the political spectrum and from all walks of life, I have developed a few principles that I believe health care reform must encompass in the new legislation:

Above all, do no harm.

A doctor's Hippocratic Oath should be applied to any reform considered. While many have focused on what's wrong with the current system, there's still a lot that is right. Eighty-five percent of Americans today have health insurance, and for the vast majority of them, the system works. They go in and see their doctor, who, in turn, diagnoses them and sends them home with a prescription or remedy that addresses the problem. When Washington tries to "fix" our health care system for one person, I want to make sure the result isn't a downgrade of care for three others.

Doctors and patients should make medical decisions.

I prefer a system with private health insurers, who ultimately do a better job of putting decision-making authority in doctors' and patients' hands. The problem with publicly operated health insurance (the new way of saying "government-run health care") is that care must be rationed to meet the budget. Consider that here in America, the five-year survival rate for breast cancer is 98 percent, largely because of education, early diagnosis and sophisticated medical treatment. But in England, which has a national health system, mammograms are no longer covered because too many false positives resulted in more costly biopsies being performed. While it's less costly to wait for a lump to develop, no American in his right mind would think this is a reasonable approach to providing care. But these are the choices that have to be made in a public health plan funded with taxpayer dollars.

Every American should have access to health insurance.

We should be able to agree that all Americans should have access to a basic benefits package that makes sure he or she is covered when going to the doctor's office or hospital. This isn't Rolls-Royce coverage that includes cosmetic surgery, hair transplants or fertility treatments, but basic benefits.

Health care costs shouldn't bankrupt you.

Basic catastrophic coverage will prevent many people from being wiped out when they get cancer or a life-threatening illness. We had a good start when we coupled health savings accounts with high-deductible health plans. I'd like to see more done to move plans in this direction. I recently was helping a woman who worked in a local nursing home who was without health insurance and discovered she had lymphoma. What little money she had been able to save would soon be gone and then some to pay for her treatment. A low-cost catastrophic policy would prevent this from happening.

Health coverage should be portable.

People who get sick often feel trapped in their current job because if they chose to leave, their health insurance would be terminated along with their protection against pre-existing conditions. We need some changes to how individuals purchase their insurance so that if their job ends - by choice or by layoff - they won't find themselves without the ability to afford treatment.

To lower costs, everyone should have "skin in the game."

Study after study proves that when care is free, it is overused. In Tennessee under TennCare (our state's Medicaid plan) we saw firsthand that when patients got a cold, instead of simply going to the local drugstore and buying some cold medicine, they went to the doctor for a prescription so the cold medicine was free. Some argue that this is illogical or an anomaly, but the fact is, it's a logical, rational decision - they saved money by going to the doctor and getting a prescription.

Everyone has a lot at stake in this debate, and there are many good ideas that deserve debate and a thoughtful vetting. I am hopeful that if we come together to agree on a framework like what I've described, reform is possible. Then it will be incumbent on all of us to commit to getting it done right. Too much is at stake for us to fail.


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