COSNEWS - An official publication of the Clinical Orthopaedic Society

From the Editor
Health Care Reform: Don't forget to use common sense!

Health Care Reform: Don’t forget to use common sense!

By Mark Scioli, MD
COS News Editor

As members of the Clinical Orthopedic Society, the only organized group in our subspecialty to use live patient presentations, we collectively and individually are proven patient advocates in orthopedics! From this premise, I make my position statements on health care reform.

First of all, it is never the wrong time to do the right thing. Our health care system can be improved in many ways. As physicians first, and surgeons second, we must fiercely guard our patients’ autonomy and safely and efficiently care for them. Unfortunately, emotional hyperbole and the use of fear tactics have taken on a life of their own as members of Congress debate this important issue. In point of fact, such emotional hyperbole should have no part in these deliberations. Claims that health care is an inalienable right don’t help solve anything, no matter what your belief is on this. Claims that we in the United States are 37th in the World Health Organization rankings are bizarre, were calculated in 2000 by the United Nations, and incorporated statistical parameters such as universal coverage as well as mortality statistics from drunk driving accidents and deaths following gunshot wounds. Leave those non-health care related parameters out of the mix, and we are ranked #1 across the board. It is reported that we in the United States spend upwards of 16% of our gross domestic product on health care for results something less than those obtained in a 3rd world country. The last big cry of the reformers is that we are the only industrialized country without universal access to “free health care”. None of these talking points are or should be part of the reason we need to reform the way our health care is delivered and paid for in this country. What then, is?

As the deliverers of care, we should advocate unfettered access to our expertise. That means different things to different people, but the common theme that all agree upon is that a third party payor should have no say in terms of access to care, indications for treatment, or method of treatment that you and your patient agree upon. Likewise, no physician has an argument with insurance companies being forbidden to deny coverage for pre-existing conditions, being forbidden to rescind a policy or cancel it if the patient becomes sick or inadvertently omits such things as prior treatment for acne on their insurance application form.

How many times have we been given a treatment authorization number and then performed a demanding procedure for a patient with all the indications met by any standard of care, only to receive a letter of denial of payment? As we say in Texas, “It ain’t right.”

The Dempublicans and Republicrats have no clue what we do or how we do it. In fairness, most doctors don’t know what our services cost and would have a hard time articulating the definition of cost transparency. The small numbers of physicians in Congress have done their best (but hardly noticed) to educate the press and the public about the real issues at hand. They don’t get much of a forum. State medical societies as well as the AAOS have done more than the AMA by far to articulate opinions on this complex issue of health care reform.

Ideology has unfortunately become the by-line for many, especially in Congress. Do they want to make our uniquely American system better or is it their agenda to expand a voting base to further a political position? Conversely, for those who advocate a free market solution to our problems, is there a position of fairness to be recognized which might hinder profits to the insurers, hospitals, and providers?

My take on it all… where’s our collective common sense? American problems are not going to be solved by “foreign” thinking or practices. Why? Our cultural biases are deeply ingrained. Is that a sin? Of course not. We shouldn’t try to impress the world; rather, we should work to make our system better for everyone here. Based on historical truth, entrusting our government to this leaves a lot to be desired. I say let the government make the rules but let physicians and patients play the game.

Common Sense Guidelines for Health Care Reform

Allow full competition between insurance companies, permitting the sale of policies across state lines as well as to individuals and small business at the same rates for big corporations.

Eliminate all preexisting clauses and the right of the insurance carriers to cancel existing policies.

Make fully transparent all hospital, imaging center, surgicenter, cancer treatment center, home health care, durable medical equipment and physicians’ bills.

Audit randomly one out of every 50 bills by medical providers for accuracy and fairness.

Make health savings accounts available to all as an option for insurance coverage.

Standardize all federal and state health care payments to providers.

Develop a fair payment structure for physicians and hospitals and eliminate the SGR formula.

Allow reasonable TORT reform in every state.

Recognize there are 20 million hardcore uninsured in this country. Subsidizing coverage for them shouldn’t be rocket science; nor does it mandate a wholesale change in the way we do things in this country. It is not necessary to turn one-sixth of our economy over to the federal government.

Allow physicians to own/operate health care facilities with strict audits and guidelines and then follow their lead as costs are controlled and quality maintained.

Allow total portability of all health care payors. Eliminate all networks and permit patients to seek care from any provider or facility they choose.

Any coverage plan available to a member of Congress should be available to every citizen in this country.

The thing about common sense is this: it’s readily available, easily applied, and simple to understand; and it never gets in the way of progress. It’s hard to argue with common sense, and if you think long and hard about it, common sense got you out of trouble in the OR more than once…