Surgery News - February 2008 - (Page 7)

F E B R U A RY 2 0 0 8 • SURGERY NEWS THE THE E McCain Opposes Mandatory Insurance Editor’s Note: This article is part of a series of reports developed from health policy forums held at the Kaiser Family Foundation in Washington. them, including additional trust funds for Medicaid payments [for people] who need this kind of coverage.” Instead of mandating that people have health insurance, Sen. McCain, who is serving his fourth term in Congress, said his priority as president would be to rein in health care costs. “If we can bring down costs, as I believe we can I’m absolutely convinced more and more people will take advantage of [health insurance]. The panacea isn’t all just health care costs, but unless you address health care costs, you’ll never solve the other aspects of the health care crisis.” One way to control costs at the federal level is to not pay for medical errors involving Medicare patients, Sen. McCain said in an interview after the forum. “Right now we pay for every single procedure—the MRI, the CT scan, the transfusion, whatever it is. [Instead], we should pay the provider and the doctor a certain set amount of money directly related to overall care and results.” That would remove the incentives “for overmedicating, overtaxing, and overindulging in unnecessary procedures,” he said. To expand access to health insurance, Sen. McCain is proposing a refundable tax credit of $2,500 per individual and $5,000 per family to help the uninsured buy health insurance policies. To pay for the tax credits, he proposes abolishing the tax deduction that employees take when they pay premiums on employer-sponsored health plans. But he would leave intact the deduction employers take on their portion of the premiums as an incentive for employers to continue offering coverage. 20/20 / 0/20 V SION O SIO SION IO B Y J OY C E F R I E D E N Else vier Global Medical Ne ws or Sen. John McCain (R-Ariz.), having health insurance is desirable but not mandatory. “I don’t think there should be a mandate for every American to have health insurance,” the Republican presidential hopeful said at a forum on health care policy sponsored by Families USA and the Federation of American Hospitals. “I think one of our goals should be that every American own their own home, but I’m not going to mandate that. I feel the same way about health care. If it’s affordable and available, then it seems to me it’s a matter of choice amongst Americans,” he said. As Sen. McCain sees it, health insurance is something many people decide they don’t want. “The 47 million Americans that are without health insurance today, a very large portion of them are healthy young Americans who simply choose not to” sign up for it, he said at the forum, which was underwritten by the California Endowment and the Ewing Marion Kauffman Foundation. He added, however, that some people with chronic illnesses and other preexisting conditions do have problems accessing insurance, “and we have to make special provisions for The refundable tax credit would en- ducing the overall health care cost burden courage employees “to go out and make that we’re laying on future generations.” Sen. McCain said he does not support choices,” Sen. McCain said during the forum. “When it’s their money and their outlawing the “cherry-picking” that some decision, I think they make much wiser health plans do to make certain they indecisions than when it’s provided by sure mostly healthy people. Outlawing somebody else.” And because the tax cherry-picking “would be mandating credit is refundable, low-income Ameri- what the free enterprise system does and that would be obviously cans who currently pay no something that I would not taxes will receive a check for approve of.” Instead, he fathe amount of the credit, he vored broadening the highnoted. risk pools that states use to When a reporter pointed provide coverage for some of out that the average cost of a their uninsured residents. “I family health insurance policy would rather go that route is more than $12,000 per than mandate that health inyear—far higher than the surance companies under any amount of the proposed famcondition would have to acily tax credit—Sen. McCain A large portion of cept a certain level of pasaid the credit still would be the 47 million beneficial. “One thing it does Americans who are tients.” Sen. McCain also said he is if someone has a gold-platwithout health ed health insurance policy, insurance choose hoped the tax credit plan would encourage more peothey’ll start to pay taxes [on not to sign up. ple to open health savings acthose premiums] and it may SEN. MCCAIN counts (HSAs). make them make different deOn another front, the senator said in an cisions about the extent and coverage of their health insurance plan,” he said. “An- interview that he favors reforms to the other thing,” he noted, “is that for low- malpractice system. “I would like to see income people who have no health in- that any medical provider or doctor who surance today, at least now they’ve got stayed within medical guidelines would $2,500, or $5,000 in the case of a family, then not be sued. Right now, it’s a lottery to go out and at least start beginning to for trial lawyers.” He is in favor of damage caps, “but more importantly, I’ve ophave [it].” Sen. McCain admitted that the tax cred- posed punitive damages.” Sen. McCain also noted that although it plan “is not a perfect solution, and if not for the price tag involved, I’d make it even he is against abortion, “I believe in stem higher. But according to the Congres- cell research. I think stem cell research sional Budget Office, by shifting the em- holds great promise in addressing some of ployee tax aspect of it, you save $3.5 tril- these terrible afflictions that face our nalion over a 10-year period, and I think that tion and the world, such as Alzheimer’s would have some beneficial effect at re- and Parkinson’s.” ■ COMMENTARY: RURAL HOSPITALS DOGGED BY DROP IN GENERAL SURGEONS Editor’s Note: This commentary was based on a presentation made at the annual meeting of the Southern Surgical Association in December 2007. The paper has been accepted for publication in the Journal of the American College of Surgeons. sitions were offered nationally for GSs, and during the second period 149 positions were offered in 40 states. This demand, occurring in the last half of the academic year when most chief residents have a job, demonstrated that there is a national shortage of GSs. Data from the Web site of the National Association of Physician Reor the past 4 decades, surgical training cruiters indicated that there were 758 posiprograms in the United States have tions nationally for a GS in November 2007. trained about 1,000 graduating chief resiIn an effort to define the economic worth dents in general surgery. At one time, perof a GS to a hospital, I used three sources: haps 40%-50% of them stayed in general surgery. But in January 2007, only 21% of A national survey done by Merritt, the graduating chief residents indicated Hawkins & Associates in 2002, 2004, and that they planned to stay in general surgery 2007 that asked chief financial officers of BY JOSEPH COFER, rather than pursue fellowship training. hospitals to estimate the net inpatient and M.D., FACS Among the many reasons for this decline outpatient revenue generated by a GS. are issues such as lifestyle, call schedule, and the perA request for financial data from the chief finanception of inadequate salary for the work performed. cial officer of my own hospital regarding net surgical As the program director for a general surgery resi- revenue generated. dency, I receive many requests to fill positions for a Data supplied by a GS colleague practicing in a rurgeneral surgeon (GS). al hospital in Oregon. To define the extent of this need, I collected the toThese data indicated that the estimated economic tal number of requests for a new GS for two separate worth of a GS to a hospital was $1.05-$2.4 million a periods: February-March 2007 (7 weeks) and May-Au- year. gust 2007 (10 weeks). During the first period 140 poAs much as 40% of a small rural hospital’s operating revenue is based on revenues generated by a GS. As these smaller hospitals find it increasingly difficult to retain or recruit a GS and stay financially viable, they will be forced to close, further straining the large safety-net hospitals, which are bursting to capacity. I believe that surgeons represent a discrete financial worth to a hospital, and a social worth to a community. Hospitals eventually should be, and will be, expected to provide adequate income to retain GSs. The Residency Review Committee for Surgery should consider expanding the number of slots available to train GSs in those training programs that have a record of training broad-based GSs, and the American College of Surgeons should quickly consider establishing a large national work force survey to better determine the factors causing this problem and develop solutions to solve it. The GS as we have traditionally known it is a dying breed, yet perhaps now more than ever, the GS is critical to the nation’s health care system. Steps must be taken quickly to avert this impending crisis in health care. DR. COFER is professor of surgery at the University of Tennessee, Nashville.

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Surgery News - February 2008 Contents IOM Committee Looks Into Safety Of Work Schedules Expertise Can Extend Liver Resectability Report Faults Specialty Hospitals' EDs Meeting Expectations Silver Lining HOD on Health Longer Liver Life?

Surgery News - February 2008

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