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Physician: health care bill won’t fix system
Published December 24, 2009
SEGUIN — A local physician who runs a regional pediatrics practice warned health care reform as envisioned in both the Senate and House versions of the bill could gut the medical profession and lead to even greater gaps in the availability of health care than the plan is intended to fix.
“They’re taking money from physicians and from school systems to fund a dream,” said Dr. Ivonne Carreon, whose Seguin River Valley Pediatrics has more than 10,000 patients from as far away as South Austin, many of whom are on Medicaid. “They’ll have health care reform, but who will treat the patients? We need to open up everybody’s eyes that it’s not what it’s supposed to be.”
The U.S. Senate is set to vote at 8 a.m. Eastern today on its version of the 2,700-page health care reform bill. To become law, the Senate bill will have to be merged next month with the one that passed in the House of Representatives in late November and then be sent to the White House for President Barack Obama’s signature.
The bill, which proponents say would extend medical coverage to 30 million Americans who don’t have it now is important to Obama, who made the need for health care reform the centerpiece of his run for office in 2007 and his number one domestic priority in his first year in office.
“Every single criteria for reform I put forward is in this bill,” the president told The Washington Post.
Unable to stop it, Republicans stepped up their attacks Wednesday, contending the sweeping bill threatens to harm Medicare, the government’s main health program for the elderly, and will add billions to the government deficit.
Alone among highly developed nations, the United States has no government-sponsored universal health coverage. Most of the 300 million Americans get their insurance through their employers. The 30 million covered by both the bills are among those without insurance.
Carreon, who has practiced here for more than six years, belongs to a nationwide private online organization of 75,000 physicians, and recently returned from a trip to Washington, D.C., where she lobbied unsuccessfully against the legislation, which she said is being rammed through by the left wing of Congress without regard to the center or to the right — or even to the medical profession itself.
“We started getting concerned because nobody was asking the opinion of the doctors — of the people who actually do this work,” Carreon said. “The people who are on the front lines didn’t get to voice their opinions. They’re just ramming it through, and it’s scary.”
Carreon said President Barack Obama does not have the claimed support of the medical profession for his health care reform package and scoffed at the photo op he conducted in his office with members of the American Medical Association, some of whom wore their clinical scrubs for the occasion.
Around 15 percent of the nation’s physicians actually belong to the AMA, she said.
“It’s something they make you join in medical school,” she said.
Carreon said she and the colleagues she has communicated with in Sermo.com agree with Obama only in the sense that the system does need reform — as does Medicare, this country’s health program for the elderly, and Medicaid, its program for the poor.
“We do need to reform medical care,” Carreon said. “There’s no question it has failed a lot of people. But where will the money come from?”
Many physicians already refuse to accept Medicare patients because they can’t afford to with its low reimbursement rates for services. Many pediatric practices avoid smaller communities like Seguin and set strict limits for the numbers of Medicaid patients they accept.
“Many pediatricians can accept only 10 percent Medicaid clients,” she said. “We accept everyone who comes to us because we believe in the program. But it isn’t easy to make a living on Medicaid patients, so I can’t blame a doctor who chooses not to participate.”
Similarly, they could choose not to become involved in the new program, she said.
“Doctors have an option whether to take part, and they could have a lot of covered people and nobody to treat them unless they make us see them, and that’s totalitarianism,” she said. “It makes me feel like I live in Cuba, not the United States.”
Many physicians, she said, could find themselves in positions where they have to see even more patients in an effort to stay afloat, while at the same time losing the income to hire the help they need to do it.
“The problem with government control is there’s a whole lot less art and a whole lot more paperwork,” she said, noting she spends an hour each day filling out federal forms. “Nobody’s going to be able to create jobs, and the practice of ‘defensive medicine’ will go through the roof. It’ll be like, ‘You have a headache? Let me make sure you don’t have a brain tumor. Here’s an MRI.”
The costs to physicians could push some out of business and could cause others near retirement to decide it’s a good time to exit the profession. Already, Carreon said, fewer medical school graduates are going into primary care.
“People in family practice and internal medicine don’t do it for the money,” she said.
Barring a train wreck in conference committee — and the two bills differ in important respects that will have to be resolved before the bill goes to Obama — Carreon expects it to pass. She’s not happy about it and is concerned about what it would mean for the future.
What might have been better, Carreon said, is to look at the private insurance industry and find ways to regulate it that improve it and make it more affordable. Allow health insurance providers to operate across state lines, and end the rules and address the economics that often lead to coverage being denied those with pre-existing conditions.
“Half of all Americans have pre-existing conditions,” Carreon said.
Another thing that needs to be addressed in any reform scenario, Carreon said, is the funding for the government’s existing health care programs — as well as fraud and abuse in the Medicare and Medicaid programs, and the federal government, she added, must accept responsibility for the programs and not push the funding off on states or local governments.
A third issue is tort reform — finding a way to reduce frivolous lawsuits and bring the costs of malpractice insurance down. Texas took steps toward tort reform a few years ago, and while more could be done.
“Texas is one of the better places to practice medicine now,” Carreon said. “But it’s not perfect.”
The Associated Press contributed to this report.
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