Dx: Fear Rx: The Facts about Health Care Reform – Socialized Medicine

(cross posted at Quadsville.com in Dr Dx’s Blog)

HR 3200 is a good bill. It is not a perfect bill. But it is good enough that a far left progressive (yours truly) and the American Medical Association (not big on socialized medicine) both support it. You can bet if the myths about socialized medicine, physician payments, or government interfering with the practice of medicine were true, the AMA would not approve. You can read the AMA letter to Charlie Rangel here saying what they like about the bill (that exact expression must have been on Rep. Rangel’s face when he opened the AMA letter – hehe).

Parts of the bill the AMA likes include: expanding the availability of affordable health care coverage to the uninsured, increased support for prevention and wellness services, investments in the physician workforce, and increasing Medicare payments for primary care services without cutting payments for other services. There are more technical sections in HR 3200 vital to doctors and hospitals about how government plans, like Medicare and Medicaid, decide what to pay them. You don’t need to worry about these obscure laws and formulas, until they pay doctors so little they stop taking Medicare or Medicaid patients or hospitals can’t keep their doors open.

The AMA will lobby for some changes to the bill. They want federal support to states that implement liability reform (i.e., to control the cost of medical malpractice insurance) and they want to preserve patient access to physician-owned hospitals.

Finally, let’s talk about “socialized medicine”. Socialized medicine is when the government owns the health care facilities and pays the doctors’ salaries. The AMA is mightily opposed to this approach. The public option in HR 3200 in no way sets up this type of system. In our current government run health care programs like Medicare and Medicaid, hospitals and doctors are not owned or employed by the government. On the other hand, the VA health care system is socialized medicine, since the hospitals are owned and the physicians are employed by the federal government. (And isn’t it ironic that those anti-reformers most terrified of “socialized medicine” think that the socialized medicine VA system provides excellent care, better than our non-socialized Medicare and Medicaid programs?) Other examples of socialism in the United States include our public schools, police and fire departments, public libraries, and postal service.

Dr Dx (in the interests of full disclosure, I’ve been an AMA member for years)

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Here are some of the false claims relating to socialized medicine, physician pay, and physician self-referral made about the House bill, HR 3200 (you can read the full text of the bill here). The Truth comes from Health Care for America Now, one of the lead coalition groups fighting for health care reform.

"Page 127: The AMA sold doctors out: the government will set wages." 

TRUTH: The government will negotiate rates with providers under the public health insurance plan option. However, private insurers will continue to pay their own rates.

"Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected." 

TRUTH: This section has nothing whatsoever to do with reducing services. It makes much needed changes to the way in which physician reimbursement is recalculated every year. The bill will, in fact, create much more opportunity for seniors and the poor to receive necessary care.

"Page 241: Doctors: no matter what specialty you have, you'll all be paid the same (thanks, AMA!)" 

TRUTH:  Page 241 does not say this. Nowhere does it say this. It does say that physicians will be grouped into certain categories regardless of specialty.  These categories merely determine if the physician is engaged in primarily therapeutic or preventative care.

"Page 253: Government sets value of doctors' time, their professional judgment, etc."

TRUTH: There is no good response to this assertion as it appears to have been made up completely. The section deals with 'misvalued codes' meaning that the government is potentially not paying an acceptable rate for a specific service. This will allow the government to, for example, pay more for services that require more payment, such as high-overhead procedures. The author of these criticisms separately attacks the bill for paying the same rate to all doctors, then attacks again for paying different rates.

"Page 265: Government mandates and controls productivity for private healthcare industries." 

TRUTH: This section amends the Social Security Act to include productivity measures.  There is no mandate or control of anything. This merely updates the way in which doctors and hospitals are paid through Medicare.

"Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government." 

TRUTH: This is patently false. The section is about possible methods that the Secretary of Health and Human services might consider in order to address the growing problem of patient readmission. This section does not, in any way, create a penalty, nor does it even mandate policy. It merely provides examples of recourses that might be considered.

"Page 317: Doctors: you are now prohibited from owning and investing in healthcare companies!"

TRUTH: This provision only limits Doctor's investments in health care facilities that they refer patients to. The effort to limit self-referral has been ongoing for many years as an effort to reduce fraud and abuse.  This is, essentially, the medical community equivalent of insider trading. Limiting this incentive works to put the patient's health above all other considerations. Doctors remain free to engage in investment opportunities in areas that don't create a significant conflict of interest.

"Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval."

TRUTH: This section regulates physicians' investment in hospitals to make sure that physicians are not unfairly benefiting from their power to refer patients to hospitals they have a stake in. The section does not prohibit hospital expansion.

Dr Dx will be back on Monday.