Viewpoint: Will The Health Overhaul Improve American Health Care? An Open Letter to Medical Students (November Reporter)
By U.S. Senators John Barrasso, M.D., (R-Wyoming) and Tom Coburn, M.D. (R-Oklahoma)
Editor's Note: The opinions expressed by the authors do not reflect the opinions of the AAMC or its members.
Dear Students of America’s Medical Schools:
As practicing physicians, we congratulate you on your choice of the profession of medicine. As a medical student or resident, you have embarked on a journey we and thousands of other physicians have undertaken before you. By choosing to become a physician, you have dedicated your time, talent, and skill in service to others—our families, our communities, our nation, and our world. We applaud that commitment, enthusiasm, and devotion.
As physicians, we have more than 50 years combined experience practicing medicine. During that time we cared for thousands of patients. We learned that if we truly listened to our patients, we could discern what is wrong and attempt to fix it. Certainly the practice of medicine has evolved dramatically since we underwent our medical school training and began private practice. But a basic tenet of medicine remains the same—nothing should come between a doctor and a patient. Today, many physicians face a series of obstacles. They are forced to watch the clock. They are over-burdened by Washington mandates, paperwork requirements, and low reimbursement rates. And they feel tremendous pressure to increase the volume of patients they see each day—rather than having sufficient time to give each patient the attention they deserve. Unfortunately, even bigger changes for the medical community lie ahead.
We write to you a few months after Congress passed sweeping health care legislation that will significantly change the doctor-patient relationship. Instead of making it easier for doctors to connect with their patients, the new health care law gives Washington more power to determine care. Washington already funds 60 percent of health care in America. The health care law increases Washington’s role by creating more than 150 boards and entities invested with new powers that will inevitably intrude on the patient-physician relationship. The new law also encourages “cookbook medicine” with new comparative effectiveness authorities that will make coverage determinations based on cost—rather than what may be best for individual patients. Another similar new entity is an Independent Payment Advisory Board—a panel of unelected, unaccountable bureaucrats who are empowered to administer top-down reimbursement cuts designed to reduce federal health care spending.
Despite wide recognition that we need Medicare payment reform, the law relies on unproven pilot programs to deliver needed savings. We fear that many changes in the law will cause doctors to simply leave private practice or drop out of medicine altogether. The law incentivizes integrated care teams, which is indeed worthwhile. But the law’s changes will also push physicians toward greater centralization, which could negatively impact patient access to medical care.
The new law is bad medicine for millions of patients too. Under the new law, up to 18 million Americans will be enrolled into Medicaid—a government program that denies patients access to roughly half of physicians. Abundant data shows that, compared with uninsured Americans, Medicaid patients have higher infant mortality rates, use the ER more frequently, and have poorer health outcomes. However, under the overhaul, low-income Americans will be stuck in Medicaid. As you know, government coverage does not equal quality care.
Sadly, this congressional misadventure in health care could have been avoided. We supported reforms that would put affordable, high quality coverage within reach for every American. We offered many ideas during the health debate to give patients with pre-existing conditions coverage, protect physicians, decrease government involvement, lower costs, and give all Americans more control of their health care dollars.
Unfortunately, political passion overtook good policy. Now, health insurance costs will continue to rise. Bureaucrats and politicians will have more control, while patients and doctors will have less. Congress may have passed legislation, but the health reform debate is far from over. In the weeks and years ahead, we will continue to express our concerns about this new law. We will fight to improve health care in America through choice, competition, and technical innovation. And we can do it without raising taxes that kill jobs in a bad economy.
We encourage you to add your voice to the discussion. As physicians, what you think matters to us—and to patients all across America.