While the healthcare reform process is far from over, the election of Republican Scott Brown to the U.S. Senate last week undoubtedly changed the process and made the passage of the current legislation less certain.
That's why American Medical Association President J. James Rohack, MD, sent a letter Tuesday to President Obama and members of Congress to encourage them to "continue efforts to enact meaningful health system reform this year." Many supporters, including several senators and representatives, have been getting cold feet about finishing the job that began so many months ago. Rohack's letter made it clear that, although the AMA still doesn't support every provision in the legislation, now is not the time to give up.
As President Obama put it during his first State of the Union address last night: "Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people."
And he's right. I've pointed out some of the flaws in both the debate's substance and process, but I've been consistently convinced that reform legislation should pass. That's because as long as I've been writing about healthcare, I have been hearing from physicians about the problems with the current system and the dire need for changes.
The reimbursement system is flawed. Quality is poor. Costs are out of control. The insurance system is impossible to navigate, and many Americans only have access to care through hospital emergency departments.
The Senate bill (which will likely be passed on its own instead of merged with the House version) isn't perfect. But even after months of debate most of us don't understand the nuts and bolts of the legislation. That is partially because of the misleading talking points coming out of Washington, but also because the focus has primarily been on small portions of the reform bills that legislators disagree about.
There are many good components of legislation that don't make the nightly news because they aren't controversial, but they will be lost if the reform efforts fall to poisonous politics. Here are a few:
Primary care reimbursements. For years, physicians have been telling me that one of the major flaws in medicine is that there are no longer financial incentives for doctors to practice primary care, and as a result we're looking at a severe provider shortage. The Senate bill doesn't fix the problem, but it does raise Medicare reimbursement for primary care physicians by 10% over four years, which helps.
Administrative simplifications. This was one of the key goals of the Medical Group Management Association, and current legislation could help cut out billions being wasted on medical practice administration. Machine-readable patient ID cards, electronic claims attachments, standardized insurance operating rules, real-time processing, and other improvements could make it a little easier to practice medicine.
Expanded coverage. Reducing the number of uninsured has obviously been the central goal of reform, and many providers are skeptical about whether the system will be able to handle an influx of patients. But many physicians have also for years been concerned about uninsured patients relying on the ED for care, not to mention the moral implications of a system that doesn't provide access to all members of society. With all the focus on the shortcomings in the areas of quality improvement and cost reduction, some are forgetting that expanding access was also one of the big three challenges of reform, and we're closer than ever to making that happen.