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Why Congress Should Pass the Health Reform Bill Now

 |  By ebakhtiari@healthleadersmedia.com  
   January 28, 2010

While the healthcare reform process is far from over, the election of Republican Scott Brown to the U.S. Senate last week undoubtedly changed the process and made the passage of the current legislation less certain.

That's why American Medical Association President J. James Rohack, MD, sent a letter Tuesday to President Obama and members of Congress to encourage them to "continue efforts to enact meaningful health system reform this year." Many supporters, including several senators and representatives, have been getting cold feet about finishing the job that began so many months ago. Rohack's letter made it clear that, although the AMA still doesn't support every provision in the legislation, now is not the time to give up.

As President Obama put it during his first State of the Union address last night: "Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people."

And he's right. I've pointed out some of the flaws in both the debate's substance and process, but I've been consistently convinced that reform legislation should pass. That's because as long as I've been writing about healthcare, I have been hearing from physicians about the problems with the current system and the dire need for changes.

The reimbursement system is flawed. Quality is poor. Costs are out of control. The insurance system is impossible to navigate, and many Americans only have access to care through hospital emergency departments.

The Senate bill (which will likely be passed on its own instead of merged with the House version) isn't perfect. But even after months of debate most of us don't understand the nuts and bolts of the legislation. That is partially because of the misleading talking points coming out of Washington, but also because the focus has primarily been on small portions of the reform bills that legislators disagree about.

There are many good components of legislation that don't make the nightly news because they aren't controversial, but they will be lost if the reform efforts fall to poisonous politics. Here are a few:

Primary care reimbursements. For years, physicians have been telling me that one of the major flaws in medicine is that there are no longer financial incentives for doctors to practice primary care, and as a result we're looking at a severe provider shortage. The Senate bill doesn't fix the problem, but it does raise Medicare reimbursement for primary care physicians by 10% over four years, which helps.

Administrative simplifications. This was one of the key goals of the Medical Group Management Association, and current legislation could help cut out billions being wasted on medical practice administration. Machine-readable patient ID cards, electronic claims attachments, standardized insurance operating rules, real-time processing, and other improvements could make it a little easier to practice medicine.

Expanded coverage. Reducing the number of uninsured has obviously been the central goal of reform, and many providers are skeptical about whether the system will be able to handle an influx of patients. But many physicians have also for years been concerned about uninsured patients relying on the ED for care, not to mention the moral implications of a system that doesn't provide access to all members of society. With all the focus on the shortcomings in the areas of quality improvement and cost reduction, some are forgetting that expanding access was also one of the big three challenges of reform, and we're closer than ever to making that happen.

Pilot projects. Sure, the legislation won't begin rewarding providers for quality over quantity, and it doesn't get at the heart of our cost problems, but the answers may lie in its many pilot projects that test new reimbursement systems, medical liability models, and other potential long-term changes. If you don't believe me, Atul Gawande makes a much more compelling case.

(Eventual) payment system reform. Most physician groups aren't too keen on the idea of an independent Medicare payment commission that will have control over Medicare payment policies. That's because they've had success in lobbying Congress to prevent proposed cuts to reimbursement, and they don't want to lose that influence. But Congress' fickleness has been part of the problem. I think permanent payment reform—including a transition away from fee for service—will ultimately come from this new independent Medicare commission.

I could have easily found five flaws with the Senate bill and written about those instead, and there was a time for that. The healthcare industry was right to poke holes in the legislation and fight for an ideal bill as it was being developed.

But that stage has passed. Despite a year of smothering cynicism, this bill is better than it gets credit for and more bipartisan than politicians will admit (in substance it is more conservative than what Presidents Bill Clinton or Richard Nixon proposed in the past). It should be viewed as a first step, rather than a final solution to the healthcare system's problems.

Now we're left with a choice between an imperfect bill and the status quo, for possibly several years. The last time reform failed it was more than a decade before it again became a priority, and it could be that long or longer if history repeats itself. Unfortunately, that's how politics works these days.

Despite the missed opportunities and flaws in the process, the healthcare reform debate at this point boils down to one question: Are we better off with the current system for the next three, eight, or 16 years?


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Elyas Bakhtiari is a freelance editor for HealthLeaders Media.

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