April 2008

 

OPHTHALMOLOGY NEWS

 

Changes to health care imminent after election


by David Laber EyeWorld Staff Writer

 

 

U.S. senator/physician works toward healthcare reform

Health care promises to be an important topic during 2008 as the Republicans and Democrats will offer party platforms to accompany their presidential nominees. As a result, one senator predicts this will culminate into new health care legislation being passed in 2009.

U.S. Senator Tom A. Coburn, M.D. (R-Okla.), a practicing physician and member of the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP), is one of two licensed doctors serving in the Senate; the other is Sen. John A. Barrasso, M.D. (R-Wy.).

“The presidential debate will lead to legislation by 2009, but I don’t trust Congress to make the right decisions,” Dr. Coburn said because congressmen are concerned about doing what is best for their careers instead of what is best for the nation.

And Dr. Coburn is not sitting on the sidelines to see what proposals will surface; rather, he took the initiative in March 2007, when he introduced the “Universal Health Care Choice and Access Act.” The act is a comprehensive health care act, and it address prevention, taxation, insurance, Medicaid and Medicare, and medical liability.

Because it would restructure the tax code, the health bill, Senate Bill 1019, currently is in the Senate Committee on Finance. He estimates that if enacted, it would take about a year and a half for his proposals to take effect, but it would save $150 to $200 billion the first year it is in place.

Promoting preventative measures

“The biggest part in this bill is to promote prevention such as eye protection or decreasing diabetes,” Dr. Coburn said.

While it is said that an ounce of prevention is worth a pound of cure, in practical terms, prevention is worth trillions of dollars saved in medical costs, increased productivity, improved quality of life, and added years of healthy living, he said. Dr. Coburn said that 75% of the country’s $2.3 trillion in health expenditures is spent on treating chronic diseases, of which five preventable chronic diseases—heart disease, cancer, stroke, chronic obstructive pulmonary disease and diabetes—cause two-thirds of American deaths.

Therefore, his health bill would coordinate federal prevention efforts, provide priorities with measurable goals, award prevention success, and increase vaccination availability.

Opening the market to competition

The United States is going to spend $2.3 trillion on health care in 2008, and $700 billion of it will not help anyone get healthier, Dr. Coburn said. The system does not allow choices about health care, and the options being discussed are about taking even more choices away.

Therefore, creating a system that embraces competition is a key factor in his health bill.

Ophthalmology is a prime example of how creating real markets bolsters competition, which drives the prices down while improving the technology, Dr. Coburn said, noting the progress made in terms of laser vision’s results and lower costs.

“What I really believe is there should be a national insurance market with transparent cost and quality and more patient responsibility and choices,” he said.

The resources are not being allocated to where the need is. For example, currently in the United States, there is a shortage of general surgeons. This is because the compensation they receive is not worth the expenses, risks and lifestyle of general surgeons. An open market would not allow this to happen.

Of the 46 million people who are uninsured, almost 18 million are Medicaid eligible, and of the remaining 28 million, about 15 million lack the resources to get health insurance. The remaining 13 million have the resources, but they choose not to obtain insurance.

Taking the ‘gaming’ out of malpractice

With poor tort laws in place, many physicians are practicing “defensive medicine” in which they subject patients to unnecessary examinations in an effort to avoid the possibility of being sued for medical malpractice, Dr. Coburn said.

As a result of the current environment, which awards the party with the best lawyers, physicians seldom lose malpractice cases in Oklahoma, for example, because they only settle the egregious cases and fight everyone else.

“A lot of the patients who should be getting compensated today aren’t,” Dr. Coburn said.

To address this problem, his health bill would create federally-assisted, state-run Administrative Health Care Tribunals, or malpractice courts. These courts will comprise a panel of six independent state-appointed experts to review each case before it goes to the State Administrative Health Care Tribunal. Three of the experts will be attorneys, and the other three experts will be medical professionals. In the court, the judge, who will have health care expertise, chooses the expert witnesses, so it will be taking “the gaming” out of the process. The courts will offer injured patients the opportunity to receive compensation quickly, without ultimately losing their access to courts. And because most medical malpractice cases are not legitimate, many will be eliminated in this process instead of going to court.

If either party is unhappy with the result, they can request a hearing before a State Administrative Health Care Tribunal.

Even with the health courts, patients still can sue for medical malpractice. The health courts are more comparable to arbitration.

Contact Information

Coburn: 202-224-5754

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