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.

The Senate Finance Committee on Friday completed its mark-up of a “health care reform” bill.  The process went extremely quickly over the course of two weeks and the committee considered more than 500 amendments during that time frame. That’s indicative of how out of control the process has become. It leads us to some overwhelming questions: Do any legislators actually know what’s in the bill and what the effects will be?

The bottom line for President Obama has always been expanded coverage, yet he continues to insist on a “budget-neutral” bill, one that won’t increase taxes. Our next question is, “Can anyone really believe that is possible?”

And furthermore, how can we expand coverage, keep the funding neutral and still retain quality care for the people who already have access? It seems the variable in the equation is the quality of care. How will it not suffer?

Despite assertions to the contrary, we believe it’s still very much an uphill battle for this bill to eventually pass both houses of Congress. The margin will boil down to whether moderate and conservative Democrats will come on board. Many have been elected to office on the promise of lower taxes and less government. From the looks of this bill, those principles have been sacrificed. Obtaining 60 Democratic votes in the Senate seems like a long-shot.

We’ve had the preliminary debate. Now it’s time to start over on health care reform.

We’ve been blogging on the subject of health care reform for a couple of months and, frankly, have been very circumspect in our comments, wanting to see exactly what bills that Congress will be considering.

There have been many articles published recently in which health care officials have reacted to the various reform bills in Congress. In fact, a good overview of health care industry reaction can be found in the following Health Care Leaders article. But we have to say the individuals quoted still skirt the issue by remaining politically correct.

Now that the Senate Finance Committee has released its long-awaited draft bill for mark up, the debate is moving into high gear with more than 500 proposed amendments being introduced. The result is that there has been a huge increase in the complexity of the reform effort and the debate about it, a complexity that deserves appropriate time for thoughtful, reasoned discussion. Unfortunately, the Democrats are adamant about moving legislation through in a very short period of time that will not allow for adequate discussion and evaluation of the impact of the proposed legislation. This is extremely disappointing given that this has the potential to be the most significant piece of legislation in decades.

We think that everything currently on the table opens the door for the eventual takeover of our private healthcare system by the government. Even incremental steps, no matter how small, provide opportunity for government intrusion. Current proposed legislation would increase the size of government, reduce choice for patients and doctors, and result in a trillion dollars of new deficit spending. Quality will suffer and millions of Americans will receive poorer coverage than they now have.

We encourage everyone to contact their elected representatives to let them know how the American public feels about the proposed legislation. Many representatives have online petitions regarding health care. Kansas Congressman Jerry Moran, for one, has what we believe is a reasoned approach to reform:

• Make patients more accountable for their own health and therefore, health coverage.
• Enact tort reform so doctors can practice medicine freely. Lip service to “tort reform test projects” is ducking the issue. Several states have shown that real savings can be achieved by ensuring that doctors don’t have to practice “defensive medicine.”
• Let employers participate in “defined contribution” programs to fund health care for employees rather than “defined benefit” programs. That way, consumers can purchase plans appropriate for their needs rather than having to accept a “one size fits all” health plan.

The time to voice your opinion is now!

This week President Obama will address a joint session of Congress and the American people on the subject of health care reform. His speech appears to be a ninth-inning effort to regain control of the health care reform discussion, which has spiraled off in a hundred different directions over the summer. In fact, the president never really took the lead in the discussion in the first place; he merely set Congress on the task while providing a few glittering general principles as a framework for legislation, such as universal coverage and a “public option”. He then stepped back and let Congress go to work.

Well, Congress did in typical fashion. And what a mess we have now – the country is polarized over the issue, any attempts at true bipartisanship were superfluous, and even the Democratic majority in Congress is split.

Americans are justified in their vocal objections to “Obamacare” because it defies all logic – we simply can’t expand coverage to millions of people without incurring huge increases in spending and we can’t cut $500 billion from Medicare without affecting care. Plus, promises that you can keep your current health care plan if you like it ring false because those decisions are made by employers that provide the coverage, not by individuals.

The president has missed an opportunity to enact real reform and engage in bipartisanship by not seeking a truly American-style health care system that is driven by free market principles. We hope the president realizes that Americans’ sense of fair play is insulted by the prospect of a “public option” and scraps that idea.

Let private insurers compete, while requiring their return to “community rating” rather than “experience rating”. Today insurers compete by avoiding bad risks. Requiring them to take on all comers regardless of medical condition solves the most basic problem that every day people face in today’s system. The health insurance industry agreed to this principle early in the current discussion as long as they didn’t have to compete against the government as well.

The administration’s insistence on the public option just inflames the debate. We hope the president has listened to America this August and comes before the country with a new vision of reform that will include us all – conservative and liberal alike. But he’s going to have to give one heck of a speech.

Last week a Health Care Forum was held at the United Methodist Church of the Resurrection, a very large congregation located near our offices in Leawood, Kan.  In contrast to some recent forums on health care reform, the audience listened respectfully as each of the seven panelists explained their particular point of view. http://www.cor.org/seasonal-special/health-care-forum/

The Rev. Adam Hamilton, pastor of the church, framed the issues from a moral point of view as one would expect.  His point is that 47 million Americans do not have health insurance, and therefore, don’t have access to adequate care. We applaud the civil discourse that dignified this event in contrast to some of the shouting matches that have been held in the name of health care reform, but the real moral issue is not about access.

Ultimately, anyone in America can get necessary care, but too many times that care is delivered in an expensive hospital emergency room and the costs of that care are shifted to all the other people in the country who are covered by insurance. The moral issue is about access to education that enables individuals to make decisions about their health and consequently their own health care.  The problem isn’t lack of access; it is over-utilization of health services by people who are living unhealthy lifestyles.

If we could have a few forums that focus on personal health decisions such as proper nutrition to avoid obesity and diabetes, stress reduction, minimizing environmental pollution, for example, we’d be taking steps toward real morality in our health care system.

Currently, health care consumers don’t have incentives to make proper health care decisions.  Most people get their care through an employer-sponsored health insurance plan. Quite likely, that plan provides a list of providers from which they can choose; but they get no incentives to lead healthy lives.

From what we can see churning through Congress under the rubric of health care reform, the consumer won’t be any more enlightened if any of these proposals actually become law. The government will probably make matters worse by expanding the rolls of the insured by several million without making the public accountable for their own health. We would, in fact, be removing them from all responsibility. And that doesn’t seem moral to us.

The public needs education. People need to know that the every-day decisions they make – consuming junk food, drinking to excess, taking illegal drugs, misusing firearms – all lead to a health care system that is overused. Our company partners with about 2,000 physicians. Most of them routinely provide care to uninsured patients. However, this is care that is delivered in hospital emergency rooms, the most expensive health care venue you can find.

Yes, let’s expand coverage to the uninsured, but not without getting something in return. The free enterprise system rewards those who can identify the wants and needs of their customers and then provide a product or service that meets those needs. We can’t have the government provide a “one-size-fits all” health care plan that will reward bad behavior. Consumers owe something in the bargain and that is a good-faith effort to be healthier. Give them credit for healthy decisions, but don’t make the rest of us pay for their bad ones.