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Doctors Address the "800 lb Gorilla" In Health Care Reform

Doctors on Health Care Reform

There is no doubt that doctors are among those most affected by health care reform in the United States. The proposed changes to the infrastructure of the medical system and health insurance affect not only their businesses and salaries, but the way that they can prescribe, diagnose and treat their patients. In the March 2011 edition of The American Journal of Medicine are four published articles written by doctors who voice their concerns about the current state of health care and the proposed and implemented changes to the system.

“The 800-Pound Gorilla in the Healthcare Living Room”
This editorial article was written by the journal's Editor-in-Chief Dr. Joseph Alpert. He argues that the new health care reform did nothing to address tort reform, which he refers to as the “800-pound gorilla.” Tort reform is the proposed change in the legal system which could potentially limit the amount of frivolous and expensive lawsuits brought against the health care community. Some argue that the constant pressure of potential lawsuits is what drives many providers to order unnecessary testing and procedure. This excessive use of diagnostics are expensive and contribute to the rising cost of health care. According to Dr. Alpert, doctors are taught to be conservative in their diagnostics and treatment practices. However, because of this pressure doctors “Order a huge array of test, including radiographic imaging, to rule out every conceivable clinical condition including very unlikely diagnostic entities.” He expresses his concern that this was not addressed in the health care reform and that if it remains ignored the entire health care system will eventually fail.

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“On the Critial List: The US Institution of Medicine”
Written by Dr. Salinder Supri and Karen Malone, MA this article addressed the current state of the US health care system. They argue that the system, which was once the best in the world, has become “fragmented, haphazard and broken” as a result of the lack of cohesiveness. Rather than the health care system being run as one unit, there are competing bodies within the system such as health insurance companies, Health Maintenance Organizations, corporate hospital chains and pharmaceutical companies who only look out for their own best interests. Each of these large institutions have set their own “rules of the game” which include restricting coverage, overcharging insurance companies, limiting patient choices, and excessive expenditure on testing and procedures. The authors say that the only way to end this exploitation of the system is to identify who is making the rules and correct them through targeted health care reform.

“The Affordable Care Act: Facing Up to the Power of the Pen and the Purse”
In his article, Dr. Eli Y. Adashi reviews the political and financial challenges facing the Affordable Care Act (ACA). As of now, repeal measures have been taken against the ACA in 40 states. However, Adashi says that they will likely fail due to the Supremacy Clause of the US Constitution which places federal authority above all other laws. He also notes the likelihood that Obama will use his presidential veto against any action by Congress against ACA. In other words, not much can be done to stop the current health care reform from going forward. However, Adashi also predicts that the widespread opposition in addition to efforts to block funding will likely result in the inability of the government to enforce the ACA.

“Medical Bankruptcy in Massachusetts: Has Health Reform Made a Difference?”
Massachusetts was the first state to enact universal medical insurance, a program which is almost identical to the new national health care reform. It was expected that the new universal coverage would reduce the amount of people filing for bankruptcy due to medical expenses, since more people would be covered by health insurance. However, the results of the study showed that the increased coverage had no effect on decreasing bankruptcies. The articles authors, Dr. Davd U. Himmelstein and Dr. Steffi Woolhandler said that “Reform expanded the number of people with health insurance but did little to upgrade existing coverage or reduce costs, leaving many of the insured with inadequate financial protection”. The outcome of this study, they argue, is evidence to the fact that it is not just expanded coverage that the US needs but improved insurance to provide income support for families and caregivers.

Resource: American Journal of Medicine
Image Source: Wikipedia Commons