Public option will pay docs less
There has been much discussion about how much a public insurance option would pay doctors and hospitals. Though the amount is unknown, one thing is for sure—the government will not pay as much as private insurers.
A major reform would at the start likely result in more pay than Medicare, but less than private insurers. But as the federal government needs to invest more in healthcare reform and other domestic programs and foreign affairs wrestle for federal funds, Congress will likely need to find new funding sources and ways to reduce costs. Physician payments at rates that are greater than what Medicare pays would likely rise to the list of possible cost cuts. Doctors and hospitals will be asked to share in the pain along with taxpayers and employers.
The public won't support taxes to pay for reform
A comprehensive health reform package will likely cost at least $700 billion—and more likely closer to $1 trillion. Though the president has pointed to fraud prevention and reducing unneeded procedures and utilization as ways to pay for health reform, expect taxes to play a key role in the eventual health reform package. Most Americans don't want to pay more taxes in order to cover more Americans.
Without that funding avenue, Congress will be hard pressed to create a meaningful reform plan that actually covers most of the uninsured.
These are four fairly large barriers to meaningful health reform. Significant change will require plenty of sacrifice by the American people, a request Obama has made. But with so many Americans with coverage and physicians and hospitals worried what lower payments would mean to their already problematic bottom lines, I can't see any way that meaningful health reform will happen in 2009.