“We’re still going to be talking about reform in January, even if Congress passed a bill in November,” said the president of to the Medical Association of the State of Alabama (MASA), Jorge Alsip, MD.

 

When the House passed their first healthcare bill in mid-November, Alabama physicians voiced their opposition. But the American Medical Association (AMA) surprised physicians and MASA by supporting the House’s version, which contained several contentious programs, including a public option.

 

“Public option is a big issue, because it means the government will either create or finance an insurance entity that will compete in the private sector, like Medicare did,” Alsip says. He adds that almost all Alabama physicians who attended MASA’s 2009 summer town hall meetings, or emailed or phoned MASA — totaling more than a thousand — opposed a public option.

 

“A public option will lead to single-payer government healthcare,” says W. Jeff Terry, MD, chair of Alabama’s AMA delegation. “In a football game, if you’re one team and you’re also the referee, then who’s going to win the game? Private insurers won’t be able to compete. It will take time, but eventually they’ll go out of business.”

 

“We need to bring in market forces and competition,” Alsip says. Opening sales of insurance across state lines and releasing the restrictions on required coverage would lower costs by allowing greater diversity in the programs offered to the public. “Because of coverage mandates in many states, younger patients have to buy services they don’t need, which drives the cost up, so they don’t buy coverage,” Alsip says.

 

MASA believes putting money in the hands of consumers through tax credits would force insurance companies to vie for their business, creating better and more affordable options. Terry adds that mandating insurance, even through employers, also limits policy options. “Mandates in general are wrong,” he says. “Insurers should be developing policies that patients see value in and want to purchase,” Plus the policing and enforcing of the mandate by a government agency would further raise healthcare costs.

 

Costs also escalate under the current medical liability laws, another hot area for healthcare reform. MASA and AMA agree that caps on the pain and suffering portion of lawsuits would save tremendous costs without harm to patients. Alsip cites a conservative savings of $50 billion a year, but estimates range as high as $300 billion.

 

Terry says it will “save more money than any one item.” He points to California’s MICRA law, in place for over three decades, that puts a $250,000 cap on pain and suffering, and has kept premiums stable.

 

One early healthcare reform bill did address medical liability. It granted $25 million to be shared amongstates to fund trial projects. “That’s ridiculous,” Terry says. “We know what works.” Yet the bill denied funds to any project that instituted a cap on legal fees. “It’s obvious who’s writing these bills — lawyers,” he says.

 

Another area of contention for physicians in healthcare reform had been the Medicare fee calculation. “The formula used to calculate and set physician’s fees is flawed,” Alsip says. The 1997 law set payments for the coming year based on costs of the previous year. For 2010, physicians were looking at a 21 percent decrease in reimbursement fees. In December of almost every year, Congress has rescinded this cut with a temporary fix.

 

A separate bill to finally fix the flawed system emerged at the end of November and passed the House in a vote of 243-183. The “Medicare Physician Payment Reform Act” (HR 3961) was awaiting Senate action as this article went to print. However, Alsip notes, “The Senate rejected a similar bill in October because, like HR 3961, it did not include offsetting budget cuts and would have added to the federal deficit.” Likely another patch will be passed this year, and the fix will have to wait until deficit fears die down.

 

“The Medical Association supports the need for health system reform, but we need to decrease the government’s role,“ Alsip says. MASA’s overall concern centers on additional interference of government in healthcare. “We oppose any bill that will interpose government in the decision of what is appropriate for patients,” Alsip says, citing the recent study recommending that mammograms not be given to women younger than 50. “Those kinds of decisions should only be made by patients and their physicians.”

 

Terry admits that for physicians, it can be hard to stay up on the latest healthcare reform actions. “Politics can change from day-to-day,” he says, but MASA encourages physicians to stay engaged in the debate. “Take time to speak out,” Alsip says. “Even if a bill passes the initial committee vote, that’s just the beginning of the process.” It will take months or even years to develop the federal and state policies and regulations necessary to implement what Congress passes, and input from physicians can still sway outcomes.