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10 Things I Hate About Health-Care Reform

One Doctor's Orders for How To Really Fix Our System

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By Arthur M. Feldman
Sunday, September 6, 2009

As a cardiologist and the administrator of a large practice that includes general internists and specialists, I spend much of my time trying to figure out how to provide care for a growing number of uninsured or underinsured patients. I also have to battle billion-dollar private insurance companies that don't adequately cover patients with preexisting illnesses and often deny coverage for necessary treatments.

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On a basic level, I'm with the president: Our health-care system needs to be changed so that all of my patients, and all citizens, have access to the care they need. But I don't agree with how he wants to fix things. Most of my colleagues and I strongly oppose the health-care reform bills that Congress will take up again this week. The proposals leave enormous gaps unfilled.

Before President Obama addresses a joint session of Congress on Wednesday, I hope he will consider these 10 major reasons why I -- and doctors like me -- worry that the legislation on the table will leave us worse off.

1. Private insurance companies escape real regulation.

This is what makes my colleagues and me so cynical about the reform proposals. Every physician has insurance company horror stories: patients who went untreated because their carriers wouldn't pay, endless hours on the phone to get administrators' approval for necessary tests and mountains of paperwork to collect reimbursements. It will be hard for doctors to buy into health-care reform if insurance companies get a free pass.

2. We urgently need tort reform, but it's nowhere to be seen.

Malpractice costs rise each year, as do the number of frivolous lawsuits. Our practice has seen a 10 percent increase in malpractice expenses this year. Sure, doctors make mistakes, and patients deserve fair compensation for their injuries and lost wages, but in this area of the law, physicians and hospitals are too often at the mercy of capricious juries.

When the president brought up the "fear of lawsuits" in his address to the American Medical Association in June, he got a huge response from the crowd. That's because practically every doctor has a story about a jury that awarded huge damages to a plaintiff despite the absence of wrongdoing by the physician. The best from our practice group is the physician who was sued -- even though he was out of town during the patient's entire hospitalization. Without fixing these spiraling insurance costs and the legal environment that allows large payments in unjust suits, physicians will continue to practice expensive "defensive" medicine or simply leave states that do not enact tort reform.

3. "Prevention" won't magically make costs go down.

Obama has called for disease prevention on a national scale, but that won't be a cure-all. Louise Russell,, a researcher at Rutgers University, analyzed hundreds of studies on prevention and medical costs and found that, in general, prevention adds to costs instead of reducing them. That's because it often means medication for hypertension and elevated cholesterol, and screening and early treatment for cancer. Unless Congress outlaws McDonald's, cigarettes, alcohol and idleness and cleans up the environment, no amount of "prevention" will put a dent in the cost of keeping Americans healthy.

4. Reform efforts don't address our critical shortage of health-care workers.

Many people believe that the fix for our physician deficit is simple: expand class sizes at existing medical schools and create new ones. Sorry, it's not that easy. There is a cap on the number of federally funded training positions for newly minted M.D.s. It hasn't changed since 1996. If the number of graduates of U.S. medical schools increases but the number of post-graduate training positions remains the same, we won't have fixed the problem -- we'll have created a different one. Training programs will simply take more U.S. graduates and fewer foreign ones, and the total number of physicians trained each year will remain the same -- too low. And foreign medical school graduates tend to practice in rural and underserved urban areas, the very places that need the most help.


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