We have just been through a loud and contentious Congressional debate regarding reform of our health care system. I support the reforms. We need a more equitable, efficient and effective health care system. Studies show that between 18,000 and 40,000 uninsured Americans die prematurely each year because they fail to get timely medical care.

That being said, the point needs to be made that there is much to criticize in the legislation and it represents only a beginning of a long term reform process.

The critics of the legislation argue that the law does not do enough to control costs. They are right. However, what they often fail to realize is that achievement of any substantial amount of cost reduction will require both a significant restructuring of the way we deliver care and a major change in the way we pay for care. We need to realign incentives so that providers are paid for better and more effective care – not just more care as in the current structure. These are very difficult challenges.

The reason the administration chose to focus on insurance reform is that it was judged to be the “easy” part – as if any of this is “easy”. Nonetheless, within the current legislation there are a number of components which begin the process of moving to reimbursement structures which reward efficiency and effectiveness and not just volume of services.

Many of the charges made by the opponents are simply without merit. There are not now and never were any “death panels” in the law. There are no proposals for any “cuts” in Medicare benefits to those enrolled in the standard Medicare program. The reduction in Medicare spending which is called for will be accomplished by a reduction in the rate of growth of Medicare spending in the future and a reduction in the subsidies which currently go to insurance companies that provide policies through the Medicare Advantage program. In fact a reduction in Medicare spending is essential if the program is to be kept on stable financial footing.

A word about Medicare Advantage. This is an experiment to see if private insurance companies could provide benefits to Medicare beneficiaries more efficiently and effectively than the conventional government run program. In fact Medicare Advantage is now costing taxpayer about 15% more than conventional Medicare without any evidence of better outcomes or more patient satisfaction. Insurance company profits however have benefited greatly.

This legislation is not a “government takeover”. It will make it easier for individuals and employers to buy insurance from private companies so they can in turn purchase care from private providers – hardly a government takeover.

This whole experience, with all the charges and counter charges, has, I fear left the public weary and in many cases confused. This is a complex, confusing and often intimidating issue. In spite of all of that I believe the new legislation is a step in the right direction and begins a process which will be highly beneficial in the long run.

Sincerely.

Tom Dean MD