At the NCMS, we continually ask members for their opinions and to share their experiences about the practice of medicine. We care what you think! This data helps the NCMS to represent members and advocate effectively on their behalf, both here in North Carolina and in our nation’s capitol. Health system reform is the number one topic in the United States Congress today. Both the House of Representatives and the Senate have passed legislation to reform the system. Inconsistencies in the two bills necessitate that Congress resolve the differences through a conference process. As an NCMS member, it is urgent that we receive your feedback as we work for you in Washington.
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at 5:04 pm
The Gatekeeper system increases the flow of information in the Health System and reduces repeat tests and costs.
at 5:02 pm
We should return to the Gatekeeper System where evry patient is required to have a Primary Care MD and can see a Specialist only on referral. This means the Primary MD receives a report and carries out Continuity of Care for the patients safty. Of course TORT reform would also help. GT Wolff,MD
at 8:16 am
In response to Dr. Swann, you are proposing yet another tax. By the way, I have heard anecdotally that if all those smokers quit and lived longer, their individual health care costs would really shoot up. So in a way, smoking is helping to control health care costs!
Now that the State of Massachusettes has a republican Senator, maybe this whole health care reform debacle will get derailed. Since it is nothing but politics as usual and pork barrel politics, that would be the best for us all.
at 12:34 am
I am communicating a concern which I have about the proposed healthcare plan.
The total annual public and private health care expenditures caused by smoking is reported to be $96 billion . Smoking-caused health costs and productivity losses per pack sold in USA (low estimate) is $10.28 per pack and the average retail price per pack in the USA (including sales tax is $4.80 . The difference between these figures of $5.48 is the amount that the cigarette health care cost per pack exceeds the price charged for a pack of cigarettes. A tax imposed on each pack of cigarettes for this amount would pay for the health care expenses and economic loss caused by cigarette consumption.
The cigarette consumption per year in the US was reported to be 451 billion in 1998. There are twenty cigarettes per pack which make this consumption by packs to be 451/20= 22.55 billion packs per year. If a tax of $5.48 per pack were imposed on cigarettes for health care finance it would raise a total of $123.574 billion per year. This would translate into $ 1.2 Trillion reduction in the federal deficit over ten years. The imposition of a tax on cigarette consumption seems to be imperative for financing health care reform. If people are mandated to have health insurance then those people who choose to indulge in behavior that will contribute to health care cost for every one should be required to pay for that indulgence.
Thank you for allowing me to share my perspective.
Sincerely,
Edwin Swann, MD MS
at 1:36 pm
The 800# gorilla in the room of the healthcare debate is that significant reductions in health care costs cannot occur without some form of rationing. But rationing does not have to be a bad thing if it is practical and done correctly…what I like to call “functionally appropriate” healthcare. The problem is that at the end of the day it is still the doctor that is ordering tests and procedures and, contrary to the accusation of our president, most doctors don’t prescribe procedures based on reimbursement but what’s in the best interest of the patient and, yes, also what will limit the doctors liability. Because you see, at the end of that same day there is no one that “has the doctors back” but there are plenty of lawyers waiting to take the shirt right off it. Every industry (hopitals, insurance companies, pharmacuetical companies, doctors) have been asked to “put some skin in the game”, except lawyers. That stinks, just like that 800# gorilla.
Secondly, the money being spent towards EMR’s will do nothing to improve efficiency or lower costs if there is not integration between these systems to easily share the information. Ideally this should be at the national level but at least on a regional level, otherwise all you have are individual EBR’s (electronic billing records).
at 7:44 am
The AMA has sold it membership out. The ACP has sold it membership out but is hiding behind “something is better than nothing” and if the present bill doesn’t pass nothing will happen for 15 years – that line is straight out of Obama Admin and Dem Party talking points. The NCMS is fence sitting – does anyone really believe, when Congress is selling votes at the price of $300,000,000 (Louisiana purchase and Cornhusker kickbacks – where is our $100,000,000 for a new med school in Charlotte the NC legislator couldn’t afford this year??)that organized medicine gets a “seat at the table”? We are pawns to be manipulated.
I am out of the AMA, the NCMS, and the ACP.
at 7:24 am
America will never be strong if 20% of its people have no health care coverage. Lack of insurance leads to delays in getting care and poor health outcomes. People without insurance arrive at costly EDs and can’t pay; they get admitted to hospitals and can’t pay; at the end of life, they get put in ICUs on ventilators because no primary care doc has spoken with them about end of life issues. WHO PAYS FOR ALL OF THAT? We all do in higher insurance premiums and taxes to pay for Medicaid and Medicare.
Congress is trying to put together a plan to pay for health care coverage that everyone can afford. As everyone obtains coverage, that coverage can incentivize visits for preventive care and healthier lifestyles.
Comparative effectiveness research can give us the tools to help patients decide what care options work best for them.
Primary care incentives and loan forgiveness for residents going into primary care can re-populate our practices and give our citizens access to the most satisfying and cost-effective place to obtain care: the primary care medical home.
All these improvements are part of the bills.
More people covered by government programs takes the cost of health insurance for emplooyees off the backs of industry and makes America more competitive in a world market where the other countries don’t have their industries paying for health care costs.
I am proud of our AMA leaders for holding their noses and staying at the table. If we are not at the table, how will we get what we want and what our patients need? We will get an SGR fix and tort reform if we stay at the table.
How many of those who have spoken on this blog have called their Congressmen to voice their concerns? I have. NCMS has. And AMA has, everyday.
I sense that physicians are again repeating their recurrent strategy of circling the wagons and shooting inward. Our opponents are the richest industries in America: insurers, pharmaceutical companies and hospitals. They have disrespected us phsyicians for decades and ripped off our patients. Can’t we come together and say, “WE PHYSICIANS DEMAND AFFORDABLE HEATH CARE FOR ALL”?
Thanks to anyone who has read this.
Chuck Willson MD
at 3:47 pm
Dr Davant wrote “I am dropping my 35 year AMA membership. They lost me when they endorsed a program with no tort reform and no payment reforms.”
The AMA lost me when they advocated socialist “progressive” programs like ClintonCare over 15 years ago.
Dr Davant’s views are part of the problem. He’s is so myopic, it’s all about “me” getting what I need. And then pretending to be compassionate and for the “needy”, then supporting socialist programs and incremental bureaucratic layers that govt. and 3rd parties place between patients and doctors, as long as “I am getting my share”. Well, you thought you could play with the fire and not get burned.
Of course a person should be reimbursed for their time, labor, supplies and services. To suggest otherwise is slavery. Oh, that is just about what ObamaCare is proposing.
But remunerating people for their work is how the Free Market and the Price System work. Physicians like Dr Davant have always engaged in appeasemnt of leftist politicians thinking they are being compassionate while looking out for their wallet. Dr Davant: did you think a socialist politician paid for by plaintiff lawyers and Big Unions will ever legislate taxpayer funding of your business while providing tort protection? Do you not see how what you and he wants are diametrically opposed? Are you the proverbial crocodile feeder, hoping the crock will eat you last?
NEWSFLASH to every physician. When you make government regulate every aspect of your life, the lobbying for govt favor and the corruption that follows will not only get very ugly, it leads to shortages and increased prices. This ObamaCare is not about healthcare. It is about little people greedy for control and power.
Michael March, M.D.
at 10:22 pm
We need reform but the current bills have turned into a haven for the special interests. Sadly the result is a bill we can’t afford without any ability to control the costs that are wildly out of control already. We nned a new organization to represent Physicians to save the best heathcare system in the world. We need to quit joining the politicians and playing their game by their rules. A place at a poisened table isn’t worth having…….
at 11:40 am
Unfortunately, we work for the government now. We just don’t have the retirement benefits, guaranteed salaries, and health benefits that the government supplies. The percentage of health care that is paid for by “government” may be surprising to each of us.
I refer each of you to the blog of the American College of Physicians’ chief Washington staffer, from 6 January 2010:
http://blogs.acponline.org/advocacy/
An organization such as the AMA or NCMS must always decide whether “being at the table” is in the best interests of patients and organization members.
Without such involvement, opting out of Medicare is the only option. I don’t see that happening much yet in NC, although the handwriting is on the wall.
Physicians are not committing money, time, and indebtedness to long term commitments, and that includes developing longterm relationships with patients such as is the hallmark of traditional primary care.
Even subspecialists, in eastern NC anyway, are taking salaried positions with hospitals or large groups in which they have no financial stake or debt. Future mobility is becoming the hallmark of medicine.
at 12:08 pm
It is hard is hard to support any current government healthcare bill, when both the house and senate composed them in secrecy, they have both been opposed by a majority of Americans, yet they are passed anyway by offering deals, concessions, compromises and special considerations. The current healthcare bill is NOT about healthcare, but about government – bigger government.
We all seem to agree that a healthcare overhaul is needed, and that any bill should assure portability, accessibility, affordability, quality, choices, innovation, and responsiveness. I personally believe that this should apply to all US citizens, including senators and congressmen.
Clearly federal legislation could make incremental improvements in our current system by requiring universal coverage of US citizens, state-based reform, allowing individuals to purchase across state lines, providing guidelines – not edicts — for appropriate fees and services (a form of rationing), encouraging use of generic medications (a signal to pharmaceutical firms to lower prices), tax equity for individuals and business, allow for a variety of plans (employer-based, private plans, HSAs, HMOs, PPOs), invest in innovative science and technology that will improve healthcare delivery and accelerate new breakthroughs in the treatment of disease. Notably absent from any current proposals are control of drug costs and limits on tort reform. These two deficiencies are obvious concessions to large lobbying interests.
Importantly, no plan should be accepted unless it addresses cost savings in terms of appropriate fees for services, supplies, and hospitalization, reduced medication costs, and reductions in fraud and abuse.
I strongly oppose federal control of the healthcare system and any “public option” because such programs would be unwieldy, bureaucratic, and expensive. It is no joking matter that Medicare, Medicaid, Social Security, and even the postal service are all approaching bankruptcy under federal supervision. And federal control of our mortgage system has arguably triggered a worldwide recession. Why would we even consider turning over healthcare – currently absorbing 15% of the GNP — to our federal government? The proposed program rescinds one’s right to make personal healthcare decisions with your provider of choice, undercuts innovation and research, generates unsustainable government spending, and undermines state authority and autonomy in healthcare policy. The current proposals seek to reduce Medicare and Medicaid, which many physicians are already abandoning as inefficient, time-consuming, punitive, and unprofitable. Polls indicate that many physicians would retire rather than work under a federally-controlled system, and bright students will elect to pursue more lucrative, less oppressive careers, thereby reducing access and ensuring lower quality health care for future generations as well. Two federal pilot programs, RomneyCare in Massachusetts and TennCare in Tennessee, have not been fiscally successful, have not increased access to care, and have unfairly penalized members who have genetic issues with weight, glucose metabolism, and lipid levels. Such socialized medicine seeks to control every aspect of our lives, thereby confiscating freedom of choice and changing the very fabric of this great nation.
Obama has predicated the presence of a ‘healthcare emergency’ due to rising costs and a large uninsured population. The Congressional Budget Office and private studies have both shown that current proposals remedy neither, and in fact would increase costs considerably at a time when the country is in a fiscal crisis and already has plans to double the deficit in the next 5 years!
I am shocked and disappointed that the AMA endorsed the house and senate bills. I too have cancelled my AMA membership after almost four decades of support.
at 11:11 am
Clearly a number of state medical societies do not fall in line with the national AMA. Could there be a new, different national organization that uses the current state medical societies as its basis?
at 11:08 am
Single payer was “on the table.” But rationale thought regarding its excessive cost led to its demise. Expansion of Medicare system, one that underpays costs, leads to loss of office and hospital services, doesn’t make sense… Rationing is wrong; rationale choice is good. But the assumption that some gov’t panel can make the right choices, is flawed. Supporting a bill just because one individual feels it is better than current situation is also illogical. A new bill that leads to further indentured servitude, and excessive taxation is seriously wrong. Only workable solution would include greater personal responsibility by patients (e.g.,copays), and tort reform. Quit the AMA years ago, and no clear alternative voice. Health care debate noticeable for lack of physician input.
at 9:55 am
Harry Reid’s last minute amendment #3403 is not only an serious affront to us but is unconstitutional. The provision establishes overseers for care and states their power cannot be revoked. Such rules require 67 votes to pass whereas the bill had only 60 in favor. He claims the provision is procedural, not a rule change. That man is dangerous to understate the fact. I am a life member of NCMS but quit the AMA many years before I retired because of political positions I did not endorse.
at 6:16 pm
Opposed to most of the bill.
I’m appalled that the AMA endorsed it. I quit AMA.
No tort reform!!!!!!
An entry into “socialized medicine”.
at 5:45 pm
I oppose strongly government having anything to do with medical care except for financial aid to the indigent. Ordinary people should carry only catastrophic private insurance
at 5:12 pm
There were no levels for the NCMS/AMA questions but I generally support NCMS positions, although I feel we should be even tougher. I am dropping my 35 year AMA membership. They lost me when they endorsed a program with no tort reform and no payment reforms.
at 4:32 pm
I do not want to be the pawn of a bloated bureaucracy.
If/when Obamacare passes:
I will cut staff, further increasing U.S. unemployment.
I would opt pay a moderate fine rather than purchase increasingly-expensive (and no longer tax deductable) private health insurance for all of my remaining employees.
I will consider practicing medicine overseas, free of the omnipresent threat of Trial Lawyers and Qui Tam.
at 4:28 pm
Both bills are far from perfect. The fact that the single-payer system was not even “on the table” is a testament to the influence of the private insurance industry in Congress. Take Joe Lieberman as an example. He sold out to the private insurance industry a long time ago. A public option would have been good; expansion of Medicare would probably have been better. But with the threat of Joe Lieberman’s filibuster, neither is going to happen. I support the reform bill, not because it is good, but because it is better than the status quo.
We will never have a good and financially solvent health care system until we as practicing physicians learn to ration health care. We have a lot of expensive technology at our fingertips. The fee-for-service system encourages tests and encourages waste. Until we learn how to use technology in a cost-efficient manner, our health-care system is doomed.