Surgery News - November 2007 - (Page 4)

SURGERY NEWS • N O V E M B E R 2 0 0 7 THE VISION Evolutionary Changes in Surgical Practice Edwards Shares Plans Commentary: Patients Come First For Universal Coverage O Editor’s Note This look at the health care proposals of former Sen. John Edwards (D-N.C.) is the first in an occasional series highlighting the health policy views of those seeking to be our next president. Each article is based on a 1-hour health policy forum with an individual candidate held at the Kaiser Family Foundation in Washington, D.C., and sponsored by Families USA and the Federation of American Hospitals. Forums that have been announced so far feature Sen. Hillary Clinton (D-N.Y.), Rep. Dennis Kucinich (D-Ohio), Sen. Joe Biden (D-Del.), Sen. John McCain (R-Ariz.), Sen. Christopher Dodd (D-Conn.), former Gov. Mike Huckabee (R-Ark.), Gov. Bill Richardson (D-N.M.), and Rep. Ron Paul (R-Tex.). B Y J OY C E F R I E D E N 20/20 Else vier Global Medical Ne ws WA S H I N G T O N — According to Democratic presidential candidate and malpractice attorney John Edwards, the best way to solve the malpractice insurance crisis is to put the onus on the malpractice attorneys. “I think that the bulk of the problem is created when cases are filed in the legal system that should never be there,” said the former senator from North Carolina. “The result is years of litigation and costs incurred by the health care provider that should not have been incurred. What I would do is put more responsibility on the lawyers.” In Sen. Edwards’ ideal world, before a medical malpractice case could be filed, the plaintiff ’s lawyer would have to conduct a complete investigation, which would include independent review by at least two experts in the field “who determine that the case is, first, meritorious, and second, serious,” he said. “Then you require the lawyer to certify that that has been done as part of the filing. If they fail to certify, the lawyer should bear the cost. If they do it three times, it’s three strikes and you’re out; you lose your right as a lawyer to file these cases.” The bigger topic at the forum, though, was covering the uninsured. In February, Sen. Edwards unveiled a universal coverage plan, which calls for expanding both the State Children’s Health Insurance Program and Medicaid, and for keeping Medicare in place. Employers would be required either to provide coverage to employees or to contribute to a system of regional Health Care Markets—nonprofit purchasing pools offering a choice of insurance plans. At least one of the plans would be a public plan based on the Medicare program. Once the markets were set up and other provisions put in place—including tax credits to help people purchase policies and limits on premium contributions for low- and moderate-income families—an individual mandate would go into effect requiring all citizens to obtain health insurance. The penalty for people who didn’t sign up for coverage would likely be “losing your individual tax exemption or some [other] tax consequence for not signing up,” Sen. Edwards said at a press conference after the forum. “Anybody who comes into contact with the health care system or any public agency will be signed up. If you go into the emergency room and are not part of the system, in order to get care you will be signed up.” To help save costs in Medicare, Sen. Edwards said beneficiaries should have a “medical home” with a single provider responsible for coordinating chronic care “so we don’t have overlapping care or unnecessary care.” He also said that he favors three steps to lower the cost of prescription drugs in the Medicare program: using the bargaining power of government to negotiate prices with pharmaceutical companies, allowing prescription drugs to be “safely imported” into the United States, and “[doing] what we can constitutionally to control drug company ads on television.” This universal coverage plan “was not intended to take us from where we are today directly to [a single-payer system],” Sen. Edwards said. “It was intended to allow Americans to decide whether they want government-run health care, or whether they want to continue the private system they have today.” He noted the benefits of single-payer systems. “The administrative cost associated with [government-run systems like] Medicare is 3%-4%, compared with 30%-40% profit and overhead in private insurance companies.” But some people hate single-payer systems, and they say that people have to wait too long for some procedures, he added. “We’re going to let Americans make that decision” by choosing which type of plan they prefer, he said. Sen. Edwards estimates his plan would cost $90 billion to $120 billion, and said he would pay for it by rolling back tax cuts for Americans making more than $200,000 per year. ■ ur health care delivery system is in burden that is leaving millions of Amercrisis. More than 47 million people icans uninsured and underinsured. Our are episodically uninsured annually, current system stifles competition by medical costs continue to outpace infla- prohibiting so many common-sense option, and doctors are increasingly unable tions for the purchase of health insurto meet the needs of their patients, ance. H.R. 2626 creates an interstate marmostly because of the intervention of ket for health insurance, empowering nonmedical people in the decision-mak- patients to purchase quality affordable insurance products from across the nation. ing process. Personal ownership and portability As a surgeon for over 25 years, I have seen how the current structure is failing are central to the expansion of coverage, and new incentives are needAmericans. Yet we have an ed to promote the purchase opportunity to resolve this of individual health care problem through principled plans. H.R. 2626 provides inand innovative ideas. dividuals and families with In today’s marketplace, refundable tax credits or tax employers and the governdeductions to buy health inment often determine an insurance, a system that will dividual’s health care benebring us closer to the goal of fits package and decide insurance coverage for all. which services to cover. PaThese reforms are essential tients and doctors increasBY TOM PRICE for achieving universal covingly are being removed from highly personal health care deci- erage, but they will be meaningless if sions. A patient’s needs are often an af- there are no longer quality doctors to terthought, and decisions about care are provide care. With the looming threat of being dictated by outside parties. We a 10% cut in Medicare reimbursement must ensure that the needs of patients rates this year, fundamental reform is vicome first—not those of the govern- tal. H.R. 2626 eliminates the flawed Susment, insurance company, or employer. tainable Growth Rate (SGR) system and Unfortunately, the debate in Wash- implements compensation based on the ington has shifted in favor of a govern- Medical Economic Index (MEI), to make ment-controlled, one-size-fits-all ap- sure doctors are appropriately compenproach to health care that will further sated for the health care they provide. To ensure that patients’ care keeps up erode the ability of patients and doctors to make independent decisions, leaving with today’s dynamic social complexities, the legislation also offers health inpatients with fewer choices. When a similar plan was proposed in formation technology tax credits, bal1994, patients were horrified at the ance billing, and tax deductions for thought of Washington-controlled uncompensated care in the emergency health care. And nothing over the past room, and it eases antitrust provisions 13 years has made Washington any on physicians. To make common-sense more capable of delivering our nation’s malpractice reform and protect patients from the costs of defensive medicine, health care than it was back then. Since coming to Congress, I have used H.R. 2626 creates specialized health my experience as a physician to craft leg- courts, while also limiting noneconomislation that would bring important pos- ic damages to end the lottery mentality itive changes to our nation’s health care of our current system. Patients need meaningful health care system. The Comprehensive Health CARE (Coverage and Reform Enhance- reform that promotes competition, acment) Act, H.R. 2626, provides innovative cessibility, affordability, portability, choicand common-sense reforms to put health es, and quality. Changing the way peocare back in the hands of patients and ple receive health care in a positive, meaningful way will require solutions physicians, where it rightfully belongs. The legislation provides a transition of that put patients first. Fundamental reour delivery structure to a defined con- form throughout our health care system tribution system, allowing patients to will be required if we are going to shop for the health insurance that best achieve a 21st-century system that is insuits their needs. Once patients own and novative, responsive, affordable, accesunderstand their policies, insurers will sible, accountable, of the highest qualihave to respond to their needs. Defined ty and, above all, patient centered. contribution will give patients more portable, comprehensive coverage while U.S. Rep. Price (R-Ga.), who represents lowering costs and improving quality. the sixth district of Georgia, practiced Cost is often the most prohibitive bar- orthopedics for over 20 years and was rier to individual ownership. It is essen- previously medical director of the tial that we use the power of competition Orthopaedic Clinic at Grady Memorial and market principles to ease the cost Hospital in Atlanta.

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Surgery News - November 2007 Contents Black Patients Fare Worse Than Whites After Liver Surgery Survey Suggests Need For Acute Care Surgery New Law Bolsters FDA Funding, Authority Working Together Oncology: Marginal Evidence? Trauma: Screening Scrutinized News From the College: Healy Takes Helm

Surgery News - November 2007

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