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Guest column | Dr. Rao Musunuru

Misconceptions over health care reform proposals can color decisions

Lots of people quiz me every day about my thoughts on health care reform. I try not to engage in that conversation, as people get very upset when you say something that they do not want to hear.

There are a lot of problems with health care delivery in this country, including expense and access. It did not happen overnight and there is a lot of blame to go around. Surely, something needs to be done. But there are a lot of misconceptions about the present proposals.

Here are some myths:

Health care reform means providing insurance coverage for all people, guaranteeing prompt care with the best outcomes, without increase in health care expenditure.

It is a perfect pill, but too big to swallow. We cannot get something for nothing.

Do the right thing. Take politics out of it.

Politics is an integral part of democracy. Politicians earn their jobs by promising certain future accomplishments to the majority of their constituents. Understandably, to keep their jobs, they have to keep those promises, which automatically become "the right thing."

It helps to stop the fraud, abuse and waste.

There are already plenty of needed laws on the books to curb fraud, curtail abuse and eliminate waste. They need to be enforced to control greed, which permeates every aspect of health care, like every other industry. We may not need new laws to enforce the existing laws.

All partners of the health care industry are volunteering billions of dollars to contribute to the success of health care reform.

It is because of many more billions of profit that these partners are counting on, by providing services to the more than 40 million people with newfound coverage (which obviously does not control the overall health care expenditure).

New insurance coverage will improve overall health status of the country and will help the economic recovery.

Even though it is a necessary step, there is no guarantee that all the newly insured will use it for preventive or early medical care. Most of them may not even want to or can afford to have health insurance, unless it is totally and absolutely free (which will be ideal, but may not be realistic, considering the current economy and growing deficit).

It is not right that most of the health care dollars are spent during the last few days or weeks of life for the elderly.

Obviously, people are the sickest when they are older and before they die. Would we rather have everybody die suddenly to save money? Or anybody above a certain age not be provided any expensive medical care, because they may die soon?

We have the most expensive health care (with the best knowledge, facilities, technology, research and equipment), but our outcomes are not any better than most of the world.

Why then, do all the people from the rest of the world (who can afford it) come to the United States for medical care? Could it be that the portion of the population that does not care for themselves and abuse their God-given good health contribute to skew the outcome numbers? Do we have accurate ways to measure quality of life?

The billions of dollars being spent on promoting electronic medical records will help solve most of the problems.

It may help in many ways, but even the most tech-savvy physicians cannot believe that it will improve the quality of medical care. The practice of medicine remains an art, involving human judgment every minute of the day and night.

Patients need protection and there is no need for tort reform.

Physicians are human beings. They do make mistakes and they should be accountable. But outrageously enormous verdicts do not have to destroy professional careers and lives. The fear of these verdicts leads to excessive medical costs through extra fees to cover extraordinarily excessive insurance premiums and through practice of defensive medicine necessitating a lot of unnecessary testing. Defensive medicine is estimated to increase health care costs at least by 9 percent even though most of the time there is no direct financial gain to the practicing physicians.

Physicians make too much money. The government can simply save money by cutting their reimbursements.

Physicians are taking care of these 47 million uninsured right now, mostly for free. Considering expensive prolonged training, skills, responsibility, liability, time commitment and personal sacrifices, one may not find the reimbursements that lucrative or excessive. Moreover, physicians' reimbursements account for only a small portion of total health care expenditure.

If one cannot reduce the overhead to less than 50 percent and face an extra 30 to 40 percent cut in the reimbursement, one does not have to be too smart to figure out whether it is worth continuing to work.

Dr. Rao Musunuru is a practicing cardiologist and is the recipient of the Tampa Bay Business Journal 2007 Healthcare Heroes, Lifetime Achievement Award.

Misconceptions over health care reform proposals can color decisions 08/10/09 [Last modified: Monday, August 10, 2009 6:25pm]
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