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Have mixed feelings about new health reform law?
e-Reports, April 5, 2010
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To help inform your own thinking about the new legislation, here are some thoughts from your ISMA colleagues around the state

Analysts continue to sift through the more than 2,400 pages of the new health care reform legislation. But the AMA and the American Hospital Association are optimistic it represents an important first step.

Like the American public, Indiana physicians appear split about whether the controversial bill will prove beneficial for doctors and their patients. Many aren’t sure where they stand – or have strong feelings about only one or several parts of the huge law – so far.

Do you wonder what your colleagues think about the health reform law? The ISMA was curious, so, we asked a few for some comments.

Anne Eliades, M.D., pediatrician, Muncie
Dr. Eliades, whose practice population is 50 percent Medicaid, noted the new health care bill will expand the number of children on Medicaid, but not the number of physicians who take care of them.

“What the legislation does is reform health insurance. It does nothing to address health care. Who is going to provide care for all these new Medicaid patients? This bill does not increase the number of providers to take care of these patients.

“In my community, we have a big problem with babies being born to mothers on drugs. There are long-term health care issues with these babies. We need an overhaul in public health. If we don’t address these issues, the country will go broke.”

Ben H. Park, M.D., president, American Health Network, Lebanon
“I believe that the key to our future as THE noble profession is to put the interests of our patients first. We know that people without health insurance die earlier, seek care later and live sicker lives than those who have insurance. From the standpoint of patients, extending insurance to more is obviously a good thing. I believe the legislation will undergo many changes before the federal government issues the final regulations. How this will impact all of us is unknown at this time.

“The real reform will happen between groups of physicians who are dedicated to providing high quality, cost effective, evidence-based care and employers who want healthy, productive employees who incur lower health care costs. Physicians are best positioned to lead this type of health care reform, and we have a duty to do so.”

Andrew Satz, M.D., anesthesiologist, Indianapolis
“Forcing all plans to cover ‘children’ up to age 26 and banning lifetime limits, all of which we agree have significant merit, will not come without consumer cost. In effect, this will price more people out of the insurance market, except for high utilizers, despite the hotly disputed and presently contested mandate for all to have coverage.

“It is important to note that the Senate bill delays the enactment of the primary coverage provisions avoiding four years of spending while collecting tax dollars aimed specifically to lower the visible costs of the legislation in the 10-year budget window the CBO (Congressional Budget Office) uses to estimate scores – and this does not include any SGR ‘doc’ fix.”

Richard Feldman, M.D., director, 
St. Francis Family Practice Residency Program, Beech Grove
“I am happy it passed and I think it is good for America. The legislation is far from perfect – and likely problematic. Our country is crisis-oriented and maybe we need this to create crises to move us toward more meaningful health care reform. The resultant problems will hopefully move us forward.”

Dr. Feldman believes in five health reform principles: choice, universal coverage, minimum benefit, guaranteed issue and uniform community premium rating. While we’ve come close on universal coverage, he said, the other principles we’ve either missed, partially addressed or it’s still unclear if we’ve even come close.

“My fear is we’ve put 32 million more into a broken, expensive system that is not sustainable. There is little or nothing to lower health care costs. We’ve not dealt with the primary care shortage issue, and I’m not convinced we have created true competition in the insurance industry.”

David Rau, M.D., family medicine, Columbus
Dr. Rau is hopeful the new legislation will improve appropriate access and limit financial hardship, including bankruptcy caused by seeking and receiving medical care. He expressed concerns that:

  • New legislation may further disrupt the doctor/patient relationship.
  • We may lose the best aspects of Indiana's HIP (Healthy Indiana Plan) as we move toward health care reform.
  • Physicians will cease practice, or not choose primary care at all, if reform becomes too dysfunctional or reimbursement is too low.

“I think as physicians we need to remember that this will be a process – a work in progress – and we need to stay generally positive as we will be trying to soothe patient's fears. I also think now more than ever we need to stay politically active so as to quickly and loudly voice concerns should the evidence present for increasing care problems, as a result of health care system reform changes.”

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