Health Care Reform Bill Part 1: The positives

After 22 hours of blood, sweat and tears, I can finally answer "yes." Just go ahead and ask: "Have you read HR 3200?" No one made me do it. In fact, no one even asked me to do it, but I felt compelled by the massive number of protests led by many who have never read it. I'm also motivated by the period of time that my brother and his family paid $1600 per month for healthcare due to a lapse in his insurance when he changed jobs. "That was the year we almost didn't make it," my sister-in-law said. The insurance industry took advantage of their family because my niece has cystic fibrosis. Being punished for being born with a "no-fault" disease reeks of injustice, and I hate injustice.

I made a terrible misstep early on by reading a preliminary 600-page document I thought was the bill in question. I teared up from frustration when I realized I had 1018 more pages of the latest draft to go. With the same enthusiasm as a dead man walking, I reopened my laptop and backed into the corner of my big overstuffed couch. I read much of it on my "weekend off" that followed a very busy workweek. Dark circles under my eyes testify to the late evenings and early-morning hours devoured by this gargantuan self-imposed task made with a special effort not to infringe on the family time I so desperately needed.

The insurmountable task began by condensing the 1018 pages into 22 pages of summary notes and then into a couple of smaller capsules more easily swallowed. On top of the bemoaned 22 hours, I spent several more hours discussing it with the representative of a political figure, and then doing more research. My ultimate goal was to get to the bottom of what this bill means to our patients, but I also went in search of what this bill means to us as cardiovascular healthcare providers and, perhaps more important, what it does not.
First, I'll list the positives:

(1) The insured will be informed about their treatment options and their financial responsibilities at the point of service.

(2) "Self-pays" will be covered under a Medicaid expansion, ie, maybe we'll actually get paid something for our services on behalf of this growing minority of patients.

(3) Many cardiologists will be considered "small-business" owners and will get tax credits for offering their employees insurance coverage.

(4) 100 pages of this document were devoted to nursing-home transparency with consumer-friendly informative websites, which is probably a good thing for our patients and eventually for us and our children.

(5) The phrase "smoking-cessation medication" was dropped from the exclusions.

(6) Multiple pilot projects and task forces will be commissioned to examine whether or not entities like "a medical home model " is a good idea and whether or not "physician models" or "community models" are the best way to deliver care.

(7) Grants will be awarded to increase the number of primary-care providers, nurses, and extenders.

(8) Although some may think it controversial, the Physician Sunshine Provision will demand the publication of travel, honoraria, and research grants, and any remuneration above the amount of $5.00 by pharmaceutical and device companies.

(9) There will be funding for the Medicare recipients who speak English poorly, a huge problem for Border States and inner cities.

(10) A task force will report recommendations to the president every two years based on the outcomes of pilot projects.

It is apparent that the essence of this bill is the intent to fund a large number of pilot projects and create multiple committees that decide how to best address our healthcare needs. Senator Mitch McConnell, from Kentucky, recently stated that "the major debate is whether we should have a major rewrite about one-sixth of our economy." I think he missed the point. The major debate is between the basic tenets of a two-party system that sometimes doesn't work to everyone's advantage. If a Republican had written it, the Democrats would be picking it apart today just as voraciously, and that is a shameful and stupid fact about America.
What I really like about this bill is the potential to motivate hospitals to get behind personal-responsibility campaigns. Hospitals will soon learn that without city- and countywide smoke-free ordinances and campaigns that get at obesity and detection and prevention programs, their readmit rates will continue to skyrocket. Their reimbursement rates will plummet, and it might awaken them for a comfortable slumber that allows preventable diseases to go unchecked. I like the idea of physicians publishing their financial ties with industry and believe we need more nurses and primary-care physicians. But that isn't all we need, and that isn't all we should fight for. The current House bill missed some very important opportunities, and I really don't understand why.

I'll discuss those "negatives" in part 2 of the HR 3200 blog.

See also:
Part 2 of this discussion: HR 3200 Part 2: The largest inkblot in the history of US politics
Topolog: Cash for clunkers, cash for lowering obesity rates?
Private practice blog: Do physicians agree on some aspects of the healthcare reform
ACC and AHA: Leadership in today's healthcare environment 

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