A DOCTOR ON OBAMACARE

Dr. Arthur M. Feldman, a cardiologist and chair of the department of medicine at Jefferson Medical College, isn’t enamored with ObamaCare as presently envisioned.

I want [my patients] to have insurance that will pay for their care, and I want to be able to offer new medications and the most sophisticated treatment. I want to be able to give preventive care as well as to monitor patients effectively if they develop diseases. I want to be able care for my patients in their homes, and I want to offer palliative care if it becomes necessary. I want them to be able to afford all this.

I want to see major reforms in health care -- I just don't want what is on the table.

Here’s Dr. Feldman’s “top ten” list. My comments are in italics.

1. Private insurance companies escape real regulation.

I respect his experience, but I suspect the problem is over-regulation rather than under-regulation. I’d like to be able to buy health insurance to my own specification, even with a pre-existing condition, outside an employer plan, as an individual or as a member of a “common-interest” coalition, out-of-state, if necessary. Over-regulation, not under-regulation, prevents me.

2. We urgently need tort reform, but it's nowhere to be seen.

Yes, but ... the neurosurgeon who operated on my mother was afraid of single-payer healthcare specifically because there would be no lawyers. His fear is that malpractice will increase rather than decrease under a single-payer healthcare system.

3. "Prevention" won't magically make costs go down.

Too true, and much under-discussed. The fact is that “prevention” has been driving costs up, not down.

4. Reform efforts don't address our critical shortage of health-care workers.
5. We need more primary-care physicians -- but we also need specialists.

Agreed, but 4 and 5 are not health insurance issues.

6. We have to streamline drug development and shake up the Food and Drug Administration.

Yes, but again it isn’t an insurance issue. The FDA is far too conservative, and its “nanny-ish” tendencies badly need curtailing.

7. We can't fund health-care reform by cutting payments to doctors.

We can if we cut their overhead at the same time. I’ve read that something on the order of 30% of a doctor’s income is spent to comply with pointless bureaucratic regulation.

8. We can't forget about research.

OK, but again, this isn’t an insurance issue.

9. Cutting reimbursements could shut some hospitals down.

Same comment as 7 above.

10. We need to improve the quality of care.

Quality? or process? In either case, it isn’t an insurance issue.

My bottom line is that we need to put the patient (me!) back in charge. To put it somewhat crudely, I own the car; I drive it; I’m responsible for it. Therefore I make the decisions.