HR 3200 Part 2: The largest inkblot in the history of US politics

Now for the negatives: (If you've not read part 1, please click on prior post to see how the bill may positively affect your patients and your practice.)

(1) Hospitals will be ranked by the "excess readmit ratio" based on 30-day bounce backs. Imagine two subspecialists having a casual conversation about their readmit rates, ie, that of a gynecologist compared with that of a cardiologist or a pulmonologist for that matter. Imagine the same comparison between hospitals in California, where the education level is higher, vs hospitals in Kentucky, writhing with the uneducated noncompliant. Where is the factor that will account for cultural differences? 

(2) We'll be paying for marriage counseling for the mentally ill, which will be an expensive exercise in futility

(3) The term "specialty physician" appears only once in the entire 1018-page bill regarding "applications for grants from geographic areas that propose to coordinate healthcare services . . . across a variety of health care settings." I cannot fathom why President Obama would not consult with specialists who attend the most expensive DRG in our nation (CHF) about how to go about improving AMI care and preventing diabetes and hypertension nor why we would not be included on many of these committees.

(4) I could find in only one instance where the Surgeon General would be sitting on a committee (it was the task force on prevention) reporting directly to the president, whereas device reps and pharmaceutical reps will have up to three chairs on at least one committee.

(5) Despite an immediate and severe shortage of cardiovascular healthcare providers, educational funding for primary care and OB physicians is treated preferentially. Why ignore the data that demonstrate a dramatic improvement in mortality for heart-attack treatment by specialists by ignoring our need to increase access to this type of subspecialty care? Shouldn't we be funding cardiology fellowships as well?

(6) Despite explicit reference to ESRD patients and renal-transplant-recipient immunosuppressive agent coverage, not one single word was written about heart-transplant recipients.

(7) As I've stated previously, a glaring lack of tort reform will choke any efforts toward curbing unnecessary spending. Why we cling to being able to easily persecute physicians for the consequences of aging and poor lifestyle choices is beyond me. If physicians are repetitively making mistakes and/or doing stupid things like giving Michael Jackson a general anesthetic in his bedroom, they need to go to jail. If they are guilty of Medicare/Medicaid fraud, they should be prosectuted. If someone makes a glaring error, it must be examined, discussed, and if there is to be restitution, mediation to help the patient and/or family would be appropriate so as to exclude greed from the process entirely.  

I also went in search of the basis for the now-infamous "You lie!" accusation made by Representative Joe Wilson during the president's address to the joint session of Congress. I have no idea where he gets this impression, as every single reference to any covered individual always states "Medicare- or Medicaid-eligible" individuals. I'd like to ask him what he thinks we are doing now. I've treated patients who spoke no English on many occasions and I've never asked them once to show me any documentation. The "you-lie" shout-out was a shameful exercise in destructive bipartisanship that screams division over unity on any American healthcare reform effort. I am a human being before I am a political party member, and any political figure should remember that their vital organs are neither Republican nor Democrat but rather entities common to all of us that will ultimately face disease and death. If we start there, we will have much more in common than we think, and progress will be inevitable.

Another negative is the worry about the trillion-dollar cost of this bill, but I think the savings from studying what works and what doesn't will offset any of those concerns and wind up saving the US trillions in the future. We should be looking at long-term solutions, not quick fixes, and we should be more concerned with helping those who cannot help themselves or haven't been given the tools to know how to do it than the political affiliation of who wrote what. However, I still wonder where the startup costs will come from.

I confess that the perceived "positives and negatives" of this legislation depend upon your own personal Rorschach of this monstrous bill. The noted psychologist Anne Anastasi said of the controversial testing method that "the only thing the inkblots reveal is the secret world of the examiner who interprets them. These doctors are probably saying more about themselves than about the subject."

In trying to condense HR 3200 into something digestible and readable, I guess I still did just that.  

See also:
Part 1 of this discussion: Health Care Reform Bill Part 1: The positives
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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