Friday, July 17, 2009

An open letter to the physicians of California: Obama care won't work


On July 16th, the American Medical Association endorsed legislation pending before the House of Representatives, H.R. 3200, the America’s Affordable Health Choices Act. As a member of the Health Subcommittee, and author of an alternative comprehensive health care reform bill, I was highly troubled by the AMAs decision. It violated the group’s longstanding commitment to oppose government control over health care and health decisions and may have significant repercussions as Congress moves forward with the reform debate.

There are a number of issues associated with the AMA endorsed legislation that I call to your attention. Firstly, the bill wrongly expands the role of Medicare payment rates by including them in the “public option.” As you are aware, Medicare payments have not kept pace with the cost of delivering care. These payments are on average significantly below private insurance compensation and in many cases represent a fraction of private insurance compensation.

While AMA believes the bill represents progress by updating the Medicare payment system for physicians, the improvements associated with the Sustainable Growth Rate do not resolve current disparities and will come with a productivity adjustment that will significantly impact future payment updates. Furthermore, the price physicians and other providers will pay will be enormous as the public option consumes the private insurance market and federal officials begin to implement coverage decisions that limit the ability of providers to care for their patients.

The Democrat bill also expands Medicaid eligibility, a program with payments worse than Medicare and one that is characterized by access problems and poor health outcomes. This system of second class medicine should not be expanded, it should be replaced. Furthermore, both Medicare and Medicaid are heading toward insolvency – tens of trillions worth of unfunded liabilities according to the Congressional Budget Office. The establishment of a new public program will do nothing to improve the outlook of these programs and will simply pile more debt on future generations.

I also note that government spending limitations associated with “public health plans,” including complex payment policies, have unfairly disadvantaged the Central Valley of California – a problem many local physicians have brought to my attention. Geographic disparities and program definition limitations are perpetuated by the AMA endorsed bill. While aspects of some programs are improved, they remain fundamentally flawed and unsustainable. Indeed, the entire plan is cleverly crafted to hide the full cost outside the 10 year budget window.

Clearly, health care in America is in need of reform. But the premise that we do not spend enough today and that trillions in new spending will be needed defies common sense. We spend more on health care than any other industrialized nation and many are not receiving the fruits of that significant investment. Most Americans understand this fact but Congress is barreling down the road of vastly increasing spending nonetheless. Alternatives, including my bill – the Patients’ Choice Act – are not even being afforded time for debate.

In addition to unjustified spending levels, the AMA endorsed legislation fails on a number of fundamental reform fronts. In an effort to improve the bill, I and other Republicans offered a number of amendments in the Ways and Means Committee. We tried to eliminate the public option. We sought to protect the doctor patient relationship from rationing or coercive reimbursement tactics. And we sought to address medical liability – an urgent issue of national significance. Each of our amendments was defeated along party lines.

In my view, the legislation passed by the House Ways and Means Committee will radically and permanently eviscerate the relationship medical professionals have built with their patients by empowering a government juggernaut to make critical care decisions that currently rest solely where they should: in the hands of doctors and patients. The vast majority of Americans will be subject to government decisions, based on the recommendations of an appointed board, which would define the “covered treatments and items and services within benefit packages.”

The new government plan will also exacerbate provider payment challenges which have served as a major impediment to patient access to appropriate medical treatment. As I have already mentioned, the legislation sets strict government plan reimbursement rates equal to Medicare which are 20 percent below those afforded providers by private plans. An independent research firm estimates that under this reimbursement structure, average physician reimbursements will decline by more than $16,000 annually. This unsustainable structure, according to the study, will raise private health insurance rates by $4,000 and starve medical practices of the necessary resources to provide quality care.

We must reform our health care system to control costs and strive toward universal access to affordable care, but without stripping medical providers of power to decide appropriate courses of treatment or handing the reigns of our health care system to a bureaucratic machine geared toward arbitrary decision making instead of patient well-being. Republicans, including myself, have offered many alternatives. My plan, which is sponsored by Rep. Paul Ryan (WI) and Senators Richard Burr (SC) and Tom Coburn (OK), places the focus where it should be and allows Americans and their health professionals to make the very personal decisions needed to deliver the best health care in our country. Details are available on my website ( and I encourage you to submit your comments or suggested improvements.

At a time when our health care system is facing an acute crisis, we cannot afford to allow haste to compromise our principles. I encourage you to disavow the AMA’s endorsement of this legislation and join me in working to enact health care reform that will serve all Americans.