We Are Being Hoodwinked and Bamboozled By The Health Care Reform Debate

When I read that the president had met with CEOs and other top representatives of the largest health insurance companies, hospitals and pharmaceutical companies before healthcare reform was crafted by Congress, I had my doubts about the direction of health care reform confirmed


I already had reservations about whether we would get true reform when the very members of Congress who were tasked to lead the crafting of the bill had received hundreds of thousand of dollars from the very entities that were the major cause of the problem – the health insurance industry, big PhRMA, and for profit hospitals.

No wonder we have been seeing commercials sponsored by big PhRMA in support of the current health reform bill. It appears it is quid pro quo for the administration’s deal to cap their concessions at 80 billion dollars over 10 years. NY Times Article

If I were a drug company executive or stockholder, I would be happy to support a bill that keeps the government from importing cheaper medication from Canada, and locks it into buying brand medication instead of cheaper generics. (The discounts that Big PhRMA is willing to extend only apply to brand name drugs – the most expensive choice.)

The health insurance companies who also support the healthcare reforms proposed by the President also stand to gain. Although they did not promise to make any concessions, they benefit by receiving more people to pay premiums since there is a mandate that everyone carry insurance (public or private) or face monetary sanctions. Market forces will draw people who are sicker and don’t have the economic means to the public option leaving private insurance companies with members who are younger, healthier and have the ability to pay the premiums.  

The argument that the public option will drive down costs is disingenuous – how can a program designed to cover about 10 million people (as per the Congressional Budget Office) really exert any pressure on the health insurance industry when a company like Blue Cross and Blue Shield has over 30 million members and United Healthcare is even larger? Even the President’s health adviser Dr. Ezekiel Emanuel admits that although small insurance companies would likely go out of business, those private insurance companies left standing would support a reform plan that would bring “45 million new paying customers to the industry”.  

Hospitals have been given a pass. There has been no discussion on cutting the costs associated with hospital care. I have performed surgeries where the hospital was paid 20-30 times what I was paid.  Is that fair? The hospital makes a profit on every item charged (e.g., per aspirin given, per IV placed or per box of tissue). It is this practice that has led to the astronomical costs and the prevalence of health care related bankruptcies. Initially there was talk of changing payments to a system where the payments could be bundled, but that has disappeared. 

The physicians and other healthcare providers on the front line who actually deliver care have been demonized as the cause of health care costs run amuck. That is simply not true. The fact is no physician can just order test after test. Each time a test is ordered or a surgery is recommended, there has to be a medical indication for it. Furthermore, the test or surgery requested must be pre-certified by the insurance company after patient records are submitted. There are medical indications and standards of care put in place by a medical or surgical board for whether a test or surgery should be performed. This is in addition to the pre-certification process of the insurance company. The reality is insurance companies have routinely superseded this and have denied care that is medically indicated to save money and boost their profits. 

My question still remains unanswered. How can a reform bill that clearly serves the interests of the health insurance companies, big PhRMA and for profit hospitals possibly be a good thing for patients or doctors?




No votes yet