Since the founding of Nueterra Healthcare 10 years ago, we have pursued a mission to improve the quality of health care, to ensure its efficient delivery to the public and subsequently make health care more affordable and accessible to more people.

Sound familiar?

We haven’t been waiting around for the government to pass legislation aimed at achieving a “reformed” health care system. Rather, we are pursuing that mission in the medical marketplace through strategic partnering with physicians – the only people who can really take care of patients. The more partners we involve in our business will mean there are more opportunities for patients to obtain high quality care. Simply put, we are expanding access and controlling the costs.

An example of how Nueterra helps to expand access is this week’s opening of Methodist McKinney Hospital in the Dallas area, a joint venture with the Methodist Health System and area physcians. The 65,000-square-foot facility features six fully equipped operating rooms, comprehensive diagnostic imaging including CT and MRI services, and 15 private patient rooms. The hospital is the second to open under Nueterra’s Community Hospital Division, following a facility that opened in Great Bend, Kan., in July.  We expect to open another health care facility in the Dallas area next year.

Real health care reform will take place in examining rooms and operating rooms as physicians working in efficient health systems are in control. Nueterra will continue to pursue our mission and will succeed in that mission.

We are extremely disappointed in the way the Senate handled the “health care reform” legislation. If Congress can reach a compromise bill that can pass both the House and the Senate, then surely we will look back on it as one of the worst pieces of legislation ever passed in the history of our nation.

If it passes it will be because the Democrats are buying votes.  When Congress regresses to this level of backroom bargaining, how can it not spell disaster?

Speaker of the House Harry Reid (D-Nev.) put so much money in front of Sen. Ben Nelson (D-Neb.) how could he not pass it up? All U.S. taxpayers will be forced to pay the state of Nebraska’s Medicaid share for many years into the future if this bill becomes law. How could Sen. Nelson pass it up?  A similar pay-off went to Sen. Mary Landrieu (D. La.).  Why aren’t the voters of all the other 48 states screaming foul?

Who knows how many more side deals are lurking in the fine print? The devil is in the details, indeed. This will not help our economy get back on its feet; we just can’t afford the huge blank check at this point.

In fact, poll after poll shows that the general public is no longer in favor of the health care reform that will result from either the House or Senate versions of the bill. The most recent Rasmussen Report, an independent polling organization, shows 55 percent of the U.S. electorate oppose the reform bills, although most (67 percent) believe the legislation will pass.

As the effects of health care reform begin to become clear, we have faith that the public will step up and require Congress to clean up much of the nonsense that our elected officials have allowed to transpire. Either that or elect people who will.

It’s amazing that after all the months that Congress has wrangled over health care reform as few as one or two senators will make or break the bill. Late last week it looked like the vote of Ben Nelson, a conservative Democrat from Nebraska, could block the bill from passage over the issue of abortion coverage.

The fight over abortion arises because, under the bill, the federal government would take on new responsibilities for health care, subsidizing coverage for millions of people. At issue is whether policies bought with subsidies could cover abortions even if private premiums are separated.

Advocates of abortion rights say that women who now have insurance covering abortion could lose it under the restrictions that would be imposed under a health bill passed by the House last month.

“There are other substantive issues,” Mr. Nelson said in the radio interview. But, speaking about abortion, he added, “That alone is a reason,” the New York Times reported.

The White House has assigned a full-time aide to deal with Sen. Nelson’s concerns as the Senate attempts to move toward a vote on the bill before Christmas. Meanwhile, liberal Democrats are complaining that they have compromised enough to the conservatives, and now they are threatening to block the bill.

It’s fascinating how so much time and effort have been spent to cobble together a health care bill that can garner 60 votes needed for passage in the Senate. While leaders in Congress and the White House seem willing to do anything to placate Sen. Nelson, it’s really unclear how the kowtowing will affect other aspects of the bill.

Meanwhile, our servicemen continue to put their lives on the line in the war against terrorism, which seems to have taken a back seat for the nation’s attention. It simply illustrates that government can’t solve problems for us. Every day we see the government doing things that make no sense, such as inhibiting the free market with needless regulations.

As we have stated many times, in order to reform the health care system we need to empower entrepreneurs to address problems in the marketplace. Take away the onerous certificate of need restrictions for more hospitals and curtail punitive damages for physician malpractice and we could solve the crisis in short order and stimulate the economy at the same time.

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We’re making a bold prediction: Health care reform won’t pass this year or in 2010. In November of 2010 the Democrats will lose control of the House or the Senate, maybe both.

Ultimately, in spring of 2011 health care reform will be passed in a form that makes sense and citizens can afford. Needless to say, it won’t resemble the bills that are currently being debated in Congress.

Here are my reasons:

1. The projected budget deficit is just too large. When you figure all the spending for the economic stimulus coupled with the war on terror, it’s simply incomprehensible how we could begin to dig our way out of the additional budget burden that this proposed legislation will impose. Just paying our current debt without health care reform, should give our legislators pause to wonder what this will do to the economy in general.
2. We’re already losing ground in the global economy with the devaluation of the dollar. The additional tax burden will blow that off the charts.
3. Our Medicare, Medicaid and Social Security programs, in their present forms, cannot be sustained. They represent some of the biggest Ponzi schemes of all times.
4. Our general economy is still two to four years from emerging from this recession.  Congress just can’t jeopardize our recovery with the additional cost of health care reform.

We will continue to comment on the debate.  Obviously, this is a contrarian point of view; most other pundits are saying health care reform will pass. But they’ve missed every deadline so far.

The Senate may have voted to move toward the final debate on health care reform legislation recently, but there are still huge obstacles in the road to final passage.

Note that both Independents in the Senate, Joe Lieberman of Connecticut and Bernie Sanders of Vermont, were needed by the Democrats to open the floor to debate. Certainly, all eyes will be on these two senators as the debate unfolds this month. Sen. Lieberman has stated that he won’t support reform if it includes a “public option” to allow the government to compete with private insurance firms in the insurance marketplace. Sen. Sanders has stated he won’t support reform without a “public option”. So the Democrats are stretched thin to meet the 60 votes required for passage.

As it now stands, the Senate bill is 2,074 pages long. It would cost American taxpayers (your children and grandchildren) $849 billion over 10 years. It supposedly will extend insurance coverage to an additional 31 million people through a “public option” and a mandate to require everyone to carry insurance. There will be a tax imposed on higher option “Cadillac” plans. And a new source of funding will raise Medicare taxes on every individual from 1.45 percent to 1.95 percent, which is usually deducted from our paychecks.

In addition to the two independent senators previously mentioned, three other moderate Democratic senators will be getting heavy lobbying: Sen. Ben Nelson of Nebraska, Sen. Blanche Lincoln of Arkansas and Sen. Mary Landreau of Louisiana. The Democrats will need all of their votes to ensure final passage, yet each moderate Democrat must be sensitive to the business interests in their respective states.

Let the debate begin.

While federal health care reform legislation still winds its way through the halls of Congress, it’s increasingly likely that some sort of bill will finally emerge for President Obama’s signature. We feel that the final bill will amount to tepid “health insurance reform” rather than sweeping reform of the American health care system.

What many people don’t acknowledge is that health care reform is already here and it directly affects physician investors involved with ambulatory surgery centers. ASC reimbursement rates have steadily declined during the past few years and more declines are planned unless our industry succeeds in convincing Congress to enact a “floor” for ASC reimbursement.

Please read “Health Care Reform: It’s Already Here” in the current issue of our quarterly newsletter, Point of View, Winter 2009.  It’s an excellent analysis of how our industry is already being impacted and how we can help educate legislators about the positive influence that physician-owned facilities have in the medical marketplace.

The simple fact is that true reform lies in the hands of the providers of medical care; government intervention is just going to complicate the market and drive up costs.

Nueterra Healthcare stands for the goals of true reform:

• Higher quality of care
• Lower costs
• Better access to care
• More efficient delivery of care

These are the points that politicians are talking about but will probably fail to address in “reform” legislation.  Meanwhile, we have been realizing them for a number of years.

If government wants to impact the medical system in a positive way then states need to do away with the limiting certificate of need laws and also start adopting policies that will make health care truly consumer driven.  Continue to let your legislators know the facts.

The inability of our politicians to reach a cross-party consensus on health care reform is enough to drive a person crazy. Just as the Democrats reached a vote in the House of Representatives on the health care bill, (House passes health care bill), the Republicans finally offered a proposal of their own, (Text of GOP Health Care Bill)

In reality the Democrats have some good ideas and the Republicans have some good ideas. Why can’t they come together a get something done that really would benefit the citizens of this country, or just leave the system alone?

What bothers me the most about the Democratic plan in the House is that it will eventually lead us to a government-controlled system while we watch the private system go by the wayside. In doing this, the next generations are going to be left with debts that they won’t be able to pay.

I’d encourage you to contact your legislators regarding the GOP plan and insist on the following five points:

• Put a cap on medical malpractice damages. Trial lawyers (who benefit from lengthy court battles) have consistently supported the Democrats and meaningful tort reform has always been out of the question as long as the Dems control Congress. Well, it’s time to stand up to the lawyers and put a limit on medical malpractice damages. The actual chances that a victim of lousy care would be shorted are actually very slim.
• Create real incentives for individuals to open health savings accounts. I’ve consistently maintained that the only real way to reform health care in to turn patients into intelligent consumers. This is just one way to empower patients.
• Allow insurance companies to sell their plans across state lines; it’s simply putting our free enterprise system to work.
• Allow trade associations and guild members the ability to band together and purchase group insurance.
• Create state-based high-risk insurance pools for individuals who have difficulty obtaining insurance coverage.

The GOP bill doesn’t include the prohibition against denying care for people with pre-existing conditions, nor does it require individuals to have insurance or employers to provide it.  While I agree with these positions, Republicans, nevertheless, should change their stance, because no bill stands a chance of passage unless it includes these particular points.

On the positive side, the GOP would not increase taxes.

Many lawmakers currently involved in the health care reform debate in Washington are operating under the premise that health care is a basic right of a U.S. citizen.

A long-time friend and a follower of this blog recently posed the question: Is health care a right?

It’s worth pursuing because it’s vitally important that we as a nation come to some conclusion on this as a basic premise in order to finally determine what kind of health care system we ultimately adopt.

Health care is not guaranteed specifically in the U.S. Constitution. But health care has been granted legislatively to those people eligible for Medicare and Medicaid. So that raises the “equal protection” argument that the rest of the population should at least have the same opportunities as those receiving Medicare and Medicaid.

The equal protection clause of the 14^th Amendment to the constitution has been cited in many Supreme Court decisions over the years to ensure to civil rights protection and to mandate public education opportunities to citizens.

However, we don’t think that argument holds up in the health care debate.

The point is worth repeating, we need to determine where health care lies in the legal landscape. Only after we have defined it legally can we have a foundation from which to build a philosophy regarding health care as a right or not.

Furthermore, there is a lot of talk about reforming the U.S. health care “system.” In fact, there really isn’t a system to reform. What we have is a patchwork of ever-changing arrangements between patients, providers, insurers and the government that work well for most, not well for others and not at all for a few.

We need to be talking about building a system, rather than reforming one that doesn’t really exist. Only when we can develop a sound philosophy as to where health care ranks legally based on our constitution, will we be able to determine who should receive care and by whom.

We hear a lot today about the estimated 46 million people in the United States who don’t have health insurance. It’s important to realize that not all of America’s uninsured can be considered victims of a system that excludes them financially.  Many go without insurance voluntarily.

Admittedly the majority of the uninsured, either can’t afford insurance or can’t get it because of pre-existing conditions, but about 2 percent of the uninsured say they just don’t want it and some scholars think that the number who cannot afford it is overestimated.

• Of the reported 46 million uninsured people, 43 percent earn more than $55,000 annually, which is 2.5 times the federal poverty level for a family of four.
• 7.5 million of the uninsured have incomes exceeding $75,000 a year.
• 44 percent of the uninsured are between the ages of 18 and 34, many of whom believe that because of their good health the don’t need insurance. Of this group of “young invincibles,” 10 percent are between the ages of 18 and 24.

Obviously, costs vary in different parts of the country and some do have other priorities that come before health insurance. But, safe to say, there is a sizeable minority that go without insurance because of the low probability that they will use it.

So should we be subsidizing healthy young people who choose to forego health insurance?

Experience tells us there are a lot of young healthy people out there who do without insurance by choice.

Here are four examples we are aware of:

• A young couple both under age 32 with three children. Their household income is $70,000, they live in an upscale house and own two late-model vehicles. Two of the children attend private schools. They don’t have health insurance.
• Another couple is under age 34 and both work. Their household income is between $70,000 and $90,000 a year. They own a modest $110,000 house and are financing two vehicles. Yet they carry no health insurance.
• A young couple with no children earn approximately $60,000 annually and live in a rented apartment. They own one vehicle and are financing another. They have two dogs and no health insurance.
• A young 26-year-old male is self-employed as a construction handyman. He makes $40,000 a year, has a late model vehicle, rents an apartment and owns a boat, but has no health insurance.

All of these people could afford health insurance if they simply put a priority on it. But they have chosen to spend their money in different ways.

Some of the health care reform bills under consideration would offer public subsidies to families up to four times the poverty level. That is your tax dollars going to assist people who can afford insurance, but would rather spend their own money elsewhere.