The endless political debates are over and President Obama has signed the health care reform legislation into law without a single vote from Republicans. Reactions to this historic event have been mixed and every person I talked to is concerned about what is going to happen next.
American medicine is considered perhaps the best in the world but the main question has been, "Can we afford it?" Now that the much-anticipated overhaul of health care is about to become a reality, we can't seem to agree on all the proposed reforms.
Some of my patients voiced their opinions in no uncertain terms; a majority seem to be quite disgruntled and expressed fears about cost, socialized medicine and a potential for rationed care.
Maryanne, a patient and friend of mine, was quite incensed for a different reason. She asks, How can the so-called richest nation in the world have millions of people without health insurance? Why are they saying only 31 million uninsured? We had 45 million of them last year and more than 11 million jobs were lost. Surely, none of them have health insurance. A better figure, she said, would be 56 million.
She believes insurance companies are not losing, but everyone else is. She is right, but maybe this bill will keep the insurance companies in check.
During the recent annual scientific sessions of American College of Cardiology in Atlanta which I attended, one of the featured discussions was "Health Care Reform — When, what and how?" The session provided two widely different perspectives from U.S. Rep. Paul Ryan, R-Wisconsin, and Chris Jennings, former White House policy advisor and co-director of the Bipartisan Policy Center's "Leaders Project on the State of American Health Care."
The U.S. spends more than $2 trillion on health care services — 2.5 times more than other developed countries in the Western hemisphere — that do not improve the outcomes. So it is time to revamp the whole health care system, Jennings said.
Ryan said he feared this bill will only increase medical expenses, especially since our Medicare, Medicaid and Social Security programs are already draining a lot of money. On top of that, "Why would a young physician want to accrue $300,000 in loans to become a de facto employee of the federal government?" he asked.
Almost everyone is asking the same question, "Would this bill reduce the health care costs as proclaimed by President Obama?" I am not so sure it would.
One important reason for the high cost of medical care is the practice of defensive medicine. Fear of malpractice suits leads to ordering of expensive tests and other forms of care, even when the yield is low. In other words, sound clinical judgment alone will not stand up in a court of law if one misses a diagnosis. This is an absolute devaluation of a doctor's judgment. The cognitive decision-making process is fast becoming obsolete. Frivolous lawsuits have increased over the past few years. And yet the bill doesn't address the much needed tort reform.
The second important factor is lack of preventive health care. Most people do not pay attention to their diet, exercise, weight control and bad habits like tobacco abuse or excessive alcohol use. It is well known that nearly 50 percent of the diseases can be prevented with good health habits. Hopefully, the bill will address the much needed preventive health care services which are not currently reimbursed.
Every U.S. citizen has a right to demand proper medical care and we should certainly make it affordable. Hence some form of universal coverage is needed. Then people won't wait till they are very sick to seek attention.
Preventive health services need to be made available to everybody. But this should not lead to entitlement either. I am all in favor of dispensing the best medicine at the cheapest price. Maybe this historic new bill is a start, but only time will tell if it lives up to our expectations.
Dr. M.P. Ravindra Nathan is director of the Hernando Heart Clinic in Brooksville.