Another Letter to Senators on Health Care

July 31, 2009

Dear Senator .......,

I am writing your office again to comment on the current proposed health care plans. I have reviewed HR 3200 as the benchmark plan, and am pleased that Senator Baucus and more reasonable heads in the Senate will attempt to mitigate the extreme positions of the House. Having now spoken with well over a hundred physicians in the State, ....., I find that they are communicating their concern and distrust in the House Bill to their patients.

This means that there is a massive undercurrent of dislike and in many senses distrust of Congress that for reasons unknown the legislation as passed in the House will be a massive burden and penalty on Americans. This also means that HR 3200 as current structured is one of the worst pieces of legislation ever enacted. You and the Senate can do much to remedy this and create a bill to have pride in, and to satisfy the needs of your constituents.
Let me point out the main concerns and opposition.

A GOVERNMENT SPONSORED PLANMUST BE ABANDONED: Everyone sees that universal coverage and cost containment are essential yet they also see how Congress has taken the funds out of Social Security and Medicare to spend elsewhere. There is more a gross distrust of Congress that is of paramount concern before the fear of a Government Plan.

SMALL BUSINESS PENALTIES SHOULD BE ELIMINATED BY MANDATING UNIVERSAL PERSONAL COVERAGE: Small business and entrepreneurs see the 8% tax as extortionary. They rather pay for performance and let their employees seek out their own insurance. That is why private Exchanges are preferred and why also taxing benefits are agreed to.

CONGRESS SHOULD TAX MEDICAL BENEFITS, ESPECIALLY EXCESSIVE BENEFITS AND PLANS, AND CREATE A TRUE LEVEL PLAYING FIELD: The Democrats in Congress are seen as being in the pockets of the Unions and this is nowhere seen more clearly than in the structure of exorbitant Union benefit plans which have lifetime duration and costs extensive amounts and in turn drive up health care costs. issue to deal with. The Union workers are not just the GM type but more importantly the Government workers, Federal, State and Local. New Jersey has a dark history of gross excess compensation hidden in these plans. That is why taxing excess plans, say those costing more than $12,000 per year, is essential. It also will raise the money to fund those uninsured.

ELIMINATE FEDERALLY CONTROLLED MEDICAL HOMES: The Medical Home concept has great merit but the control of them by the Federal Government flies in the face of achieving results. The Government should avoid any contact in this area.

BUNDLING AND OTHER ONEROUS PAYMENT OPTIONS: We have all seen what HMO type controls had done in the 1990s and bundling and capitation are the same pig just put in a different dress, it is still a pig!..

TORT REFORM WILL REDUCE PROCEDURES AND CUT COSTS:We have argued again and again that the most significant driver of excess costs is the lack of tort reform. Given end of life costs, those with Medical Directives and DNRs will cost little if anything. The people with the demand to do whatever to maintain a suffering patient result in the physician and all other health care providers taking extreme measures not to be sued by the family when the ultimate end eventually comes. If Congress ever hopes to reduce costs the answer is in your hands and there are many fine options on the table.

THE IRS SHOULD NOT BE THE ENFORCER: HR 3200 has the IRS as the enforcer. I really suggest you seek an alternative. Such a choice will result in long term problems. I believe this is obvious.

LET THE MEDICAL PROFESSIONS HANDLE THE COMPARATIVE CLINICAL EFFECTIVENESS AS THEY DO NOW: The CCE issue is a complex issue. Medical professional societies and their publications as well as University Laboratories continue to do and publish and critique their own procedures. One need look no further than NEJM and JAMA which weekly assess new methods and procedures. Each physician takes CME hours each year to expand what they do as a normal part of their practice, and there is the re-certification process on top of that. Having a Government agency get into the fray will be highly counterproductive. The system works now, improve it, do not break it.

PATIENT RESPONSIBILITY AND MOTIVATION MUST BE MANDATED BY CONGRESS: 18% of the 2-4 year olds in New Jersey are obese! The CDC just published that this week. We are second only to Virginia in 2-4 year old obesity. That means they will grow to be obese and have all the health problems of the obese. Obesity we have calculated costs us 15-18% of our health care budget today and it is exploding. One could argue that the cost increases are almost totally driven by obesity. I see no other way than taxing it out of existence as we did with cigarettes. New Jersey should be ashamed of such a statistic. Yet 41% of black females in the South are obese! Thus we have a pandemic. This is clearly a call for Congress to do something and do it now.

This is my third letter on the same subject. My physician friends have asked me again and again to raise this issue since I seem to have become a point person. Yet you and your fellow Senators are at a singular point to make changes in HR 3200 and its relatives in a positive direction and achieve a long term success and not create a burden on all Americans. The above are my most recent comments and observations.

Very truly yours,