Stanley Feld M.D.,FACP,MACE
In order to gain support for Democratic candidates during the midterm elections , President Obama is on the campaign trail. During his campaigning he is telling Americans to be patient. His healthcare reform bill is going to be great for seniors and all other citizens.
Democratic candidates running for reelection are avoiding his support. They are not campaigning on the healthcare reform act many were forced to vote for.
Americans are not buying President Obama’s rhetoric.
The healthcare reform law is extremely complicated. Many people do not understand the consequences.
At this time, I feel it is important to repeat what is known about the law. The subtext is the government cannot afford to continue spending at the present level for the Medicare and Medicare entitlements .
None the less President Obama plans to expand the Medicaid entitlement in order to insure the uninsured. The logic to expand the entitlement is irrational within the framework of the present healthcare system. President Obama is attempting to change the framework. Budget deficits will increase, taxes will increase, access to care will decrease and rationing of care will increase.
Americans are not interested In President Obama’s plan to pay for the health care law by cutting Medicare services many seniors depend on. Below are just some of the Medicare cuts outlined in the law. There are many other unfavorable consequences of the law that I have discussed previously.
These cuts have been largely denied by the President on his present campaign trail.
· Medicare will cut reimbursements to inpatient psychiatric hospitals. It is not clear to me what profit margins these psychiatric hospitals enjoy. It would be important to know if these hospitals could remain viable. If the hospitals stop accepting Medicare patients the entire economic burden will be on the seniors.
- Wealthier seniors ($85K/$170K) begin paying higher Part D premiums. Presently Medicare Part B is means tested and pay high premiums. Wealthier seniors pay up to $250 per month per person for traditional Medicare coverage. It is anticipated these premiums will increase. the total cost for Medicare coverage can rise for full coverage to over $18,000 in after tax dollars for a husband and wife.
- There will be Medicare cuts to home healthcare agencies. I always thought the fees paid for home healthcare by Medicare were high. However, if the home healthcare agency refuses to accept Medicare, the burden of payment will be on the patient. Patients might have no choice but to go to the hospital. Hospitalization will increase the cost of care unless Medicare refuses to pay the hospital.
- Medicare payments for ambulance services will be reduced. I always thought that a $1000 plus fee for ambulance services was high. I could never understand how this fee was negotiated. I believe a study of the actual cost of ambulance services would be important before the fees are cut.
- Medicare payments to ambulatory surgery centers will be cut. Ambulatory surgery centers cost less than hospital surgery centers. It is not wise economically to drive ambulatory surgical centers out of business.
- Medicare will cut payments for diagnostic labs and durable medical equipment companies. The government should be stimulating competition and innovation. If should be negotiating prices. It should not be dictating prices.
- New Medicare will decrease payment to long term care hospitals. Long term care hospitals charge less than acute care hospitals. However, these hospitals are charging excessive fees. The government should be discovering where the inefficiency and overcharging is occurring and negotiate fees to increase competition among long term care hospitals. The government’s action will cut prices. The cost of the price cuts will be shifted to seniors.
- Medicare Advantage premiums will be increased and benefits will be decreased. There is no mention in the law of controlling the healthcare insurance industry effectively. Massachusetts’ healthcare insurance exchange has not be successful in controlling costs.
- Seniors will be prohibited from purchasing power wheelchairs. Seniors must first rent wheelchairs for 13 months before Medicare will pay for a wheelchair. I imagine the government figures the senior will die before the 13 months are up.
- Medicare reimbursements for dialysis treatments will be drastically reduced. This is a clear indication of rationing of care.
- Medicare will decrease the fees paid for hospice care. Hospice care is a great service. It keeps dying patients out of the hospital. It supposedly results in a tremendous reduction in the cost paid for a dying patient. In my opinion hospice care is one of the most innovative developments in the last two decades. I do not understand why President Obama wants to destroy one of the most cost effective services of Medicare.
- Medicare will continue to reduce payment for hospital services and nursing home services. Seniors will bear the direct economic burden of these reductions.
The government is at fault for the rising Medicare costs. Rather than setting up a system of competition and empowering patients to spend their healthcare dollar wisely it has dictated rules and regulations that have served to increase the cost of delivering healthcare. The government regulations have caused an increase in abuse and administrative waste by the healthcare insurance industry.
The only way to repair the healthcare system is to permit consumers to own their healthcare dollars. Only then will consumers be motivated to be responsible for their health.
President Obama’s healthcare reform law is accomplishing the opposite. He is making consumers dependent on the government.
It will not work in America.