Advocates for Evidence-Based Health Policy Speakers
Reform left-overs make for tasty election issue
A year ago, the American people were up in arms over the health reform debate unfolding in Congress. Nevertheless, after a long and bitter winter, Congress proceeded to pass the Patient Protection and Affordable Care Act in the spring of 2010. The health reform law’s first year will usher in benefits for many American health consumers.
This fall, parents will be able to keep their children covered on their health insurance plans up to the age of 26. Insurers will be prohibited against lifetime limits on coverage and must provide care for preventive services, including all services with a grade “A” or “B” recommendation from. And seniors that hit the coverage gap in the Medicare prescription drug plan (the “donut hole”) will be eligible for a $250 rebate.
Yet, two issues of extreme importance to physicians – and – merely got superficial window dressing.
Congress authorized $50 million to fund state demonstration projects experimenting with alternatives to the traditional system of tort law. However, patients seeking remedy to claims of injury are not required to participate in these alternative systems.
Existing studies and natural experiments have already demonstrated that certain tort reforms (most notably “direct reforms” such as caps on awards) have constrained the growth of malpractice premiums for health care providers (Mello, 2006). Unfortunately, this has not resulted in downstream savings for health care consumers (Morrisey, 2008).
Research has shown that in states that have tort reforms there is an increase in physician supply ranging from 3 to 12 percent. (Kessler, 2005; Mello, 2006). This change in physician supply is mostly attributed to either retirement of physicians or entrants of young doctors, not due to movement of physicians between states. Thus, in the states without malpractice caps (20 as of 2006), lawmakers can look to these proven strategies to improve the malpractice environment and lure bright, young physicians to their state.
But, to put the issue of malpractice into context, it should be noted that medical malpractice premiums only account for only one-half of one percent of all health care costs (Hunter, 2009).
A second area left out from the health reform law was a permanent solution to the annual charade popularly known as the “doc fix”. Since 1997 physician payments in the Medicare program have been tied to growth in the general economy. Because medical inflation has outpaced general inflation, the formula (the Sustainable Growth Rate or SGR) that calculates how much physician payments should be increased or decreased has consistently called for a reduction in payments to physicians treating senior citizens.
It seems unfair that physician compensation is tied to the overall growth in Medicare costs (which includes hospitals and pharmaceuticals) when physician costs represent only one-fifth of national health expenditures. It is akin to putting a loose fitting cap over a raging oil leak. Although you may catch a fraction, the bulk of the problem is still spilling out of control.
Congressional action conveniently postponed the debate over the SGR until after the November elections. However, Congress’ inability to act creates a tremendous opportunity for physicians and seniors to demand a true solution to the SGR.
Those affected by Medicare should make this an election issue for 2010. Whether lawmakers want to simply nix the SGR or replace it with another system of physician payments is a debate long overdue.
by
Cedric Dark, MD, MPH