PEORIA, IL -- Most of the physicians who spoke at the Peoria Medical Society's health system reform forum on Sept. 1 want reform.
Perhaps 300 people crowded into a room for the 90-minute forum, led by two Peoria doctors who advocate different types of reform. The ambiance was informal, comic at times, civilized and smart. Everyone seemed to enjoy bashing the insurance companies, and expressing outrage over high profits in the system.
Dr. William Albers, a pediatric cardiologist, and Dr. Don Crane, who practices occupational medicine and is co-author of a book on reform, were the principal speakers, aided by others in the audience who made comments and asked questions.
Albers supports a single payer system. He told of seeing his former patients, now adults, uninsurable because they have pacemakers or valves installed as children.
Crane prefers to see the insurance companies regulated as public utilities, required to take everyone who applies, and operating on national rules, with high profits banned.
Both want to expand access to everyone and control costs.
"This is perhaps the most important domestic issue of our time," Albers said.
The research and educational aspects of the current system should be preserved, he said. Doctors need adequate compensation and tort reform, he added.
The evening got interesting as the doctors drilled down into specific issues.
Private insurance now subsidizes public plans such as Medicare and Medicaid, Crane said.
New physicians now have so much debt they cannot afford to treat Medicare and Medicaid patients because of low payments, he said.
Albers said the insurance companies are in business for profits, and spend $700 billion yearly in marketing and administrative costs.
Crane noted that hospitals spent $100 billion to collect payments, and that the drug companies' proposal to forgo $80 billion over 10 years is "nothing," compared with their profits. One spent one-fourth of a trillion dollars last year to acquire other companies, he said.
Dr. Rick Pearl, a physician who treats children at OSF Saint Francis Medical Center, advocated for a single payer system. He predicted it will occur sooner or later when other plans fail.
"I qualified for Medicare today," he said, to applause. He has worked in Canada, and said 91 percent of the public there approves of the Canadian single-payer, Medicare-type system. "The overall system works well," he said. Drugs cost 1/3 of what they cost in the US because the government negotiates with the drug companies, he said, to applause.
Several doctors told of employing numerous people who only deal with insurance companies, and do nothing to treat patients. "That is wasteful," Albers said.
"The problem is, someone's waste is someone else's income," he said.
Crane called insurance company profits "inexcusable." Asked about waste in the system, Crane said HR3200, the 1,000-page bill in the US House of Representatives, does not do enough to control waste. "Their costs are way too high," he said.
"We need private insurance with a government safety net," he said. "If they (insurance companies) cannot compete with more regulation, they go out of business."
Yet there are complications, he said. Insurance companies must by law maintain certain levels of reserves to pay claims. Public plans such as Medicare have no such requirement.
Albers suggested three regulated insurance plans, a basic, enhanced and premium plan, with the same, standardized forms for patients and doctors.
When a woman asked whether her taxes will go up with reforms to the system, Crane said with HR3200, "taxes will go up."
She questioned how many people are really uninsured, but Albers responded "whether 47 million or 20 million," the nation must provide affordable health insurance to every citizen, to applause.
Pricing needs reform, he said. Hospitals and providers "charge eight to ten times what they expect to get," he said. A hospital CEO told him he had no idea what real costs were, and just charged "what the market will bear," Albers said.
During the presidential campaign, the public initially wanted to reform the system, but as the debate has progressed, there has been no consensus on solutions, Albers said. Meanwhile, there will be a shortage of doctors because the medical schools have maintained enrollment levels while the US population has been increasing.
A doctor in the audience commented "I'm a free market doctor. Why give one-sixth of our economy to the federal government when they can't manage anything?" He predicted "single payer will cause rationing, the elderly will have a requirement to die," and doctors will be subject to fines. He blamed "meddling by the federal government" for the system's problems.
Crane responded "every physician in this room sees hopeless cases and money is poured into more tests" and treatments. Relatives want every possible treatment, he said, if Medicare is paying for it.
He suggested that advanced directives, which may be weak, are still useful, and end of life decisions should be left to professionals. "There are few miracles," he said.
When one man offered an extensive comment on illegal immigrants, the audience grew inpatient, and called out "get to the point."
Another doctor said the Canadian system has waiting lists for some procedures, "their taxes are higher," and there are guidelines and inefficiencies. Germany has a better system, he said.
Crane said 9 percent of medical costs are attributed to defensive medicine, to avoid lawsuits. A solution, he said, is for the National Institutes of Health to adopt practice guidelines and protocols that have been developed by the various specialties, and exempt the doctor who follows them from legal liability, as determined by a neutral panel.
-- Elaine Hopkins
If you want to read a mind bending report on how to save money with health system reform, click here.
It's a George Washington University report that states: "Expanding health centers to reach an additional 20 million patients as part of national health reform would result in overall health care savings of $212 billion over the ten-year period 2010 to 2019, including federal Medicaid savings of $59 billion. The dollar value of these expected savings far exceeds the cost of the health center investment of $38.8 billion called for in the July 14 version of the House health reform bill."
Here's another useful link which analyzes the entire HR3200.
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