TMA comments on latest congressional actions on health system reform
The Tennessee Medical Association remains unified in its belief that the U.S. health care system needs to be changed to allow physicians to continue to provide the quality care Americans expect and deserve within this country’s fiscal constraints. We support health care reforms that provide affordable, essential health insurance coverage for all Americans.
Amid the debate, a number of measures have been added to the Senate version of the bill, 3590 -- some good and some not so good. In the case of American Health System Reform, we believe this is not an instance when we must “take some bad with the good.”
The Tennessee Medical Association strongly urges Congress to:
- >Take the necessary time to craft the best solution to thoroughly and adequately address the cost of medical care; coverage and access for the uninsured; improve overall quality and build a reliable information sharing network. These are the issues that began the entire process.
- >Reduce rather than increase the governmental bureaucratic control over health care.
- >Take measures to reduce the financial burdens on our already financially strapped state; and
- >Rescind the repulsive deals that were cut to benefit some states individually to the detriment of other states and their citizens.
The TMA acknowledges that significant improvements have been made to HR 3590 thanks to the relentless advocacy of the AMA and organized medicine collectively; most notably:
- Insurance reforms to help the uninsured and under-insured get coverage, provide more choice of coverage through insurance exchanges, and the removal of preexisting conditions and lifetime limits in health plans;
- Measures to promote wellness and preventive care;
- Increased reimbursement for primary care and general surgery (in shortage areas) not to the detriment of other physicians;
- The scuttling of the Medicare “buy-in” proposal;
- Removal of the so-called “public option” from the Senate version;
- Provisions allowing physicians to review and correct erroneous online profile data before their ratings are published;
- Deletion of the $300 Medicare enrollment fee (tax);
- Elimination of the tax on cosmetic surgery; and the
- Removal of the 5% tax on so-called “high utilizing” physicians.
While these changes are significant and positive, the resulting bills in both chambers still fail to adequately address key issues that could make for meaningful health system reform. As Tennessee’s physicians, the TMA will continue to voice the following concerns to members of Congress and those participating in the final crafting of a joint bill in the Conference Committee:
- There appears to be little in either bill to address the bureaucracy and complexity of health care and health insurance in our nation – the original intent of this legislation. This 2,000-page plan appears to add more rules and regulations, destined to continually rob our system of resources intended for patient care.
- Americans with satisfactory health insurance will face significant premium increases, forcing many patients and employers into exchanges to try to find less expensive and less comprehensive insurance packages;
- No mention of plans or strategies to increase the supply of physicians to care for those added to the system and the aging populations that will require even more care and services.
- Physicians are left with only a promise from Congress to finally fix the flawed SGR formula, even as the clock ticks away the time for physicians to consider Medicare participation for 2010 while facing the institution of a 21%+ cut on March 1;
- The token acknowledgement to investigate medical liability reform options is paltry in light of the financial impact of defensive medicine. Congress can do better.
- Significant cuts in high tech imaging such as CT, PET, and MRIs, which will limit physicians’ ability to diagnose and care for certain chronic and/or life-threatening conditions.
- The scope and authority of the Independent Medicare Advisory Committee is of great concern. Physicians must retain certain freedoms to best care for their patients. The current provision could result in arbitrary exclusions of coverage services or decreases in reimbursement for services without notice, thereby increasing financial risk to patients and providers alike;
- We oppose mandatory participation and penalties for non-participation in the flawed quality reporting program – PQRI -- especially when Congress’ efforts to address funding fall short and place the financial burden to buy required technology mostly on medical practices;
- We oppose cost containment exemptions for certain hospitals or any other providers because it will place the burden on physicians to absorb the cuts;
- . Uncertainty as to what the public quality reporting release of data will look like and no guarantee that quality measures will be based on scientific rather than cost criteria;
- . Comparative effectiveness research must be useful from a clinical standpoint and remain separated from payment policies. There is no indication that this will be the case; and
- . Congress’ failure to address CMS’ elimination of the consultation code.
The TMA urges fairness in health care reform and asks that members of Congress heed the concerns of physicians -- we are the ones primarily entrusted with the medical care of our citizens.
We support reform but not at the cost of undoing what is working and jeopardizing care for millions of patients. We pray that logic and thoughtfulness will win out over haste and politics because our entire nation’s health, prosperity and productivity depend on it.
The Tennessee Medical Association was founded in 1830 at the behest of our own state legislature to protect the citizens of Tennessee, and we are driven by our mission to speak out in this health system reform debate. We believe the founding principles of our organization serve as good advice for members of Congress: “Health is universally acknowledged to be essentially necessary to the happiness and prosperity of society.”
Read the TMA’s official position on health care reform.