Unpleasant consequences of HR3200

http://tinyurl.com/m88vpl
An Anesthesiologist's Take on Health-Care Reform Expect a two-tier medical system and needless ER deaths if Congress and the White House have their way. By RONALD DWORKIN...an old adage: You can skimp on some medicine, but you can't skimp on obstetrics or anesthesiology.... "In surgery, people die in days and weeks—a doctor has time to fix a mistake. But in obstetrics and anesthesiology, they die in minutes and seconds."...Incredibly, Congress's proposed health-care reform plan risks skimping on anesthesia. According to one of the health-care bills in Congress, H.R. 3200, the public option would reduce reimbursement for anesthesia by over 50%.****Dworkin discusses..the incorrect assumptions progressive politicians have made about the mindset of today's doctors and how the health-care system operates...the mistaken (indeed, crazy) idea that changing compensation won't affect behavior.****... Most doctors no longer think of their job as a calling.... Many doctors work part-time; others want flexible shifts....today's upper-middle class professionals are very sensitive to marginal tax rates. To preserve "lifestyle" and "quality time," they will work less. ...A second thing progressives fail to grasp is the genius of the American health-care system: It unites rich and poor in a common private insurance system...through a common private insurance system, poor people go to the same hospitals and doctors as rich people and thus enjoy the benefit of rich people's power.The public option severs this link. Dissatisfied with government-run health care, the rich will exit the system. ...Government-run health care will become like the public schools.****That's why both the U.K. and Canada try to ban private healthcare (except for things not covered by the public system, like cosmetic surgery.) The penalty seems to be denial of participation in the public plan if one tries to supplement it. It is doubtful that any attempt to simulate this in the U.S. would be Constitutional.*(***
The progressives' third mistake is to skimp on anesthesiology. In no medical specialty is the spread between the Medicare rates and private insurance rates greater. Progressives expect to pay anesthesiologists Medicare rates, which are 65% less than private insurance rates, without any change in the system. But there will be changes.Some anesthesiologists will leave the field. ...Quality of care will inevitably decline. That decline will come first in obstetrics....Other hospitals are less fortunate, and have on staff at most one anesthesiologist in obstetrics....eventually force these hospitals to cover obstetrics "when anesthesiology is available," meaning in between regular operating room cases. ...Don't forget, a baby has only nine minutes of oxygen when the umbilical cord prolapses, so time is of the essence.... If hospitals delay the administration of anesthesia because Congress skimped, needless deaths will certainly result.///
Health Plan Will Affect Anesthesiologists, Everyone Else
...I can state unequivocally that my anesthesiologist colleagues are primarily concerned with advancing patient safety and providing quality care.Physician-provided anesthesia has long focused on the heath and well-being of the patient. Moreover, over the past two decades we have made anesthesia even safer than ever.Any health-care reform proposal must support our continued efforts to make patient safety and quality care a central concern. The use of unreasonably low Medicare payment levels for anesthesia services in any new plan, public or private, does not provide that support.Roger A. Moore, M.D.,President
American Society of Anesthesiologists Park Ridge, Ill.//
Dr. Dworkin asserts that fewer students will train in anesthesiology—a medical specialty that has led the nation in patient safety by reducing morbidity and mortality rates during surgery to essentially zero—a great contrast to the performance of 40 years ago.Students are already abandoning other surgical specialties. Cardiovascular surgical programs are only half-full. General surgery residencies are even worse off. The practice of medicine has always attracted hard-working people dedicated to the relief of human suffering. That devotion, however, comes at a price: four years of college, four years of medical school, and four to six years of post-graduate training. That adds up; many trainees are in their early thirties when they finish. Mountains of debt and severely diminished reimbursements will discourage students from entering the practice of medicine in the first place. And as the current generation of physicians retire, fewer and fewer will be replaced."Keeping your own doctor" and "timely access to high-quality care" make great sound bites, but the reality might be quite different. Patients will wait for care longer, and more of them will die sooner. Thomas W. Andrews, M.D. Longwood, Fla.//
Downgrading use of professionals
ObamaCare will encourage empty M.D. anesthesiologist slots to be filled by Certified Registered Nurse Anesthetists (CRNAs). It's no accident that the American Society of Nurse Anesthetists vigorously supports H.R. 3200.
An unintended consequence? Perhaps. But this conspiracy theorist believes it is quite deliberate. In fact, I think anesthesiologists are merely the canaries in the mine, soon to be followed by other physicians driven out and replaced by Advance Practice Nurses and Physician Assistants whose salary expectations will be lower than those of doctors.
H.R. 3200 would create a health benefits advisory committee to determine appropriate medical policies, and also a national computerized health-care records. In combination, these two elements will allow medical care —from diagnosis to treatment—to be performed by computer-savvy nonphysicians using government-approved algorithms. The oft-repeated statement that no bureaucrat will come between a patient and his doctor is patently false.
I am proud to work with many excellent CRNAs, but I believe the loss of physicians will result in a bump in morbidity and mortality, which will be rationalized by the same government which encourages us to swap our SUVs for miniature cars, explaining that the increase in highway death and crippling injury is a small price to pay for decreased carbon emissions.
Steven S. Kron, M.D. New Britain, Conn. ****This homogenization of healthcare flies in the face of modern advances which enables and shows the merits of customizing healthcare to the individual patient. Everyone is different and similar drugs and procedures are effective for some and ineffective for others who superficially would seem to be in the same category.Clearly Obama's "blue pill / red pill" analogy shows he doesn't understand this (or is disingenuous.)****