"Return To Marcus Welby MD; The Real Health Care Reform?"

Fact check no. 5: Paying for Health Care Reform Without Adding to the Deficit

Americans support health care reform, but they don't generally support higher taxes. So it was important when President Obama said he could offer health care reform without adding to the deficit.

It will be a hard promise to deliver on. The price tag for health care reform, pegged at between $1.3 and $1.6 trillion for the several proposals on Capitol Hill, will need revenue to pay for it without adding to the deficit.

There is no consensus on how to pay for health care reform. President Obama has said he wants to pay for reform by lowering the percentage of their tax returns the wealthy can deduct. Essentially, this would raise taxes on the rich.

But even many Democrats on Capitol Hill don't want to change those rules. It could have unintended consequences on donations to charities, the subject of many deductions for the wealthy.

Moderates and some conservatives want to pay for health care reform by taxing health care benefits. Look at it this way: An worker is paid two ways -- One, they get a salary, which is taxed. Two, they get benefits, which currently are not.

One way to pay for health care reform would be to tax those benefits. This would raise taxes on everybody who pays taxes and could raise more than enough money to pay for health care. Candidate Obama promised throughout 2008 not to raise taxes on anyone making less than $250,000 per year. (Read Full Article)

The primary-care doctor is gaining new respect in Washington. Battles may be breaking out left and right over the various health-care bills emerging from Congress, but reformers on both sides agree that general practitioners should be given a central role in uniting the fragmented U.S. medical system.

This vision has a name: the "patient-centered medical home." The "home" is the office of a primary-care doctor where patients would go for most of their medical needs. The general practitioner would oversee everything from flu shots to chronic disease management to weight loss, and coordinate care with nurses, pharmacists, and specialists. A 2004 study estimated that if every patient had such a home, the resulting efficiencies might reduce U.S. health-care costs by 5.6%, a savings of $67 billion a year.

Instead, most patients today get a scant seven minutes with a general practitioner, who has time to do little more than ask cursory questions and focus on the problem at hand. The patient rushes to specialists for chronic conditions that could be managed by a regular doctor. (Today, these different physicians rarely coordinate.) Last-minute appointments are almost unheard of -- one reason patients with minor complaints flock to already crowded hospital emergency rooms.

This medical home may sound like the "gatekeeper" model of the 1990s, a managed-care creation that was all about holding down costs. But advocates say the new concept is designed to help patients, not insurers. It's more like doctoring 1950s-style, when a Marcus Welby figure handled all the family's medical needs. This time it's juiced up with digital technology.

It also represents a politically painless way to streamline a disorganized and wasteful system that chews up a crippling 18% of the U.S. gross domestic product. That burden is felt particularly by private industry, which covers 60% of the nation's insured. Since most businesses try to ferret out waste and disorganization in their own operations, the medical home is a concept they can embrace in good conscience.

Medical-home enthusiasts are lobbying for a change in primary-care reimbursements in any health-care bill that emerges from Congress, with a payment structure that rewards collaboration and prevention. They have a friend in Senator Max Baucus (D-Mont.), a key player in the health-care reform effort. As he points out: "Watching over a patient's full medical history... is a quality measure and a cost-control measure." (Read Full Article)

   Is the return to Marcus Welby MD, the real health care reform? In a generation when most medical students want to be specialists instead of general practitioners, mainly because of money, can this be a reality? As I see it, ultimately physicians will have to be the catalysts of change in bringing down the costs of health care. For too long physicians have "played the system" of government and private insurers paying for quantity of service instead of quality of service. Doctors order unnecessary and expensive scans simply because they can. Doctors have to figure in their expensive medical malpractice insurance in billings. More money is made by prescribing certain drugs than other drugs. Treating illnesses reactively is more profitable than treating illnesses proactively. Marcus Welby MD, where are you?

tags: health care reform  marcus welby md  politics  takebackamerica  home medicine