Tuesday, October 20, 2009

A letter to Michael Wolff of Vanity Fair

Mr. Wolff

I'm a busy physician and respect your writing. I hope that you'll appreciate the time I took to write this to you. I hope you can see a commonsense perspective that the vested interests in DC (both Dems and GOP) are missing.

I read your "I’ve Changed My Mind on the Obama-Fox Showdown" piece on newser.com. As an independent, I didn't vote for Obama, but I admire his concern for health care. And I think he has some good ideas. Of course the Republicans are all up in arms, but they had 6 years with a majority and never got a substantial bill to the table.

Yet, as a physician, I'm perplexed at why you would characterize the public revulsion to nationalized health care as 'perplexing'. Here's my opinion. It's because 'reform' is going the wrong way. It's not reform at all, but a government takeover. A better alternative would be increased government regulation and oversight.

You can cite polls to show public support for something, but this will vary based on how the question is asked. However, a stable trend this year has been seen in Gallup polls on this issue: 80% of Americans are happy (satisfied or very satisfied) with their current health care. A majority are concerned about the costs.

That begs the question of why we would want to muck up something that a super-majority are happy with? What we should be doing is fixing the costs--something that no bill that has made it out of committee in either house of Congress addresses. If you want to know what public opinion is, look at that poll. Most people are happy with their health care. The number one complaint I hear from patients is the cost of insurance. Number two is lack of access to care from my Medicare and Medicaid patients.

That's the essence of my argument. If you care to, please read on...

Everyone today thinks they are an expert in health care. I am an expert and certainly more of one than the people writing the bills. The public is rightly alarmed at what has been proposed as legislation this year. For example, HR 3200 was a slippery slope to a government takeover of health care. Why? If you look at that bill, it was crafted to force all employers with $400,000 or more in payroll to offer the public option or face a fine of 8% of payroll. Lots of businesses would be exempt, but it would move a large number of low wage earners into the public option.

Example: You're an employer like Walmart, McDonalds, etc. with mostly minimum or near minimum wage workers. So round their yearly pay to $20,000. Are you going to pay another $9,000-12,000 per year for commercial insurance, pay $1,600 for the public option or pay the fine. That's a no-brainer. Again, won't affect all workers, but it will entrench the public option (which will be a new entitlement).

In my opinion, what we need is increased regulation of the health insurance industry, rather than a government takeover of our multiple health care delivery systems. The federal government already has a proven track record in health care--a record of failure, namely 1) Medicare, 2) Medicaid, 3) VA and 4) IHS. Medicare and social security will both be bankrupt in the next decade. We don't have the funds to pay for our current entitlements and Congress wants to charge more to our national credit card? The worst part about the current Senate bill is it will add roughly 1 trillion to the budget, but it will still leave half of the currently uninsured still uninsured.

With the economic meltdown, people are realizing that politicians don't have all of the answers they say they do. They look at the bailout that was rushed through without anyone in Congress reading it. They see it hasn't worked where they live and now they see all the pork that was included in it.

There are many common sense solutions, most of which aren't even being discussed:

1. Tort reform--because the biggest driver of increase in expensive tests (other than shift in average age of population) is due to defensive medicine. However, this will probably never get passed since the vast majority of those in Congress are trial attorneys.
2. Make insurance providers compete across state lines--it's baffling that this hasn't been done.
3. Eliminate waiting periods--one of the largest chunks of people commonly lumped in as 'uninsured'.
4. Eliminate exclusion for preexisting conditions--duh.
5. Repeal nonprofit status for hospitals--these hospitals only provide <5% charity care, yet don't pay taxes due to nonprofit status.
6. Eliminate or reform Medicare D.

Thanks for your time.

Jim Webb, MD

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