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The Conversation: The Health Care Law

(AP Photo/Charles Dharapak)

It happened. At 11:52 a.m. on Tuesday, March 23, 2010, President Obama signed the much-debated health care bill into law, bringing coverage to some 32 million uninsured Americans. So what does it all mean? Here to discuss are Rosemary Gibson, Long Island author of The Treatment Trap: How the Overuse of Medical Care Is Wrecking Your Health and What You Can Do to Prevent It; Congressman Tim Bishop (D-Southampton), who voted “yes” on the bill; and Leonard B. Stein, MD, FACG, FACP, Clinical Assistant Professor of Medicine, SUNY at Stony Brook.



I’d like to look at the impact of the new law on people and how to sustain the health care system financially. First, there are many who are sick and who lack health insurance coverage for whom the new law could literally mean the difference between getting life-sustaining care and not. We can’t forget that. At the same time, we have to figure out a way to have a financially sustainable system. Right now, it isn’t. And with more people covered, financial sustainability will even be tougher. If we don’t fix the overall cost issue, the cost of health care will literally cause the fiscal downfall of the country. There is a place to start and that is to curb the waste and unnecessary care that doesn’t help people and actually exposes them to possible risk. Let’s take out the waste and have plenty of room to spend money for care that will make a difference in people’s lives.


Many people ask me, “Congressman, how can a bill that costs $940 billion purport to reduce the deficit?” It’s a good question. First off, the bill that I voted for is the largest deficit reduction bill Congress has ever passed. The Congressional Budget Office says the bill will reduce the deficit by $143 billion over the first 10 years, and $1.3 trillion in the next 10 years. But how does it reduce the deficit? The bill does all the little things we’ve talked about for years, but haven’t done: The most aggressive effort to crack down on waste, fraud and abuse in Medicare; tort reform; investing in preventative care; creating exchanges so there is real competition; and so on. To address Rosemary’s larger point about cost, a flaw with what happened in Massachusetts is that the emphasis was completely on expanding coverage but not on cost containment. This is why “comprehensive” reform is so necessary, because you cannot have one without the other. It is the reason, for instance, that you cannot end shameful practices like denying people with pre-existing conditions without bringing everyone into the system.


If one agrees that costs should be reduced by decreasing the number of “unnecessary” tests, procedures and operations, one must address the reasons that these are being ordered and performed. Our patients are accustomed to a prompt response (and hopefully resolution) to their problems and concerns. This expectation encourages us to do whatever is necessary to safely address them in a timely fashion. Additionally, there is much spending during the last six to 12 months of one’s life, and curbing this raises many sensitive “end of life” questions and decisions, issues that remain quite controversial. Finally, I am pleased that Congressman Bishop mentioned tort reform, as I believe that costs could be reduced if physicians would have less of a reason to practice defensively for fear of a malpractice action.


Congressman Bishop makes a good point about the important aspects of reform, namely clamping down on waste, fraud and abuse. Health reform also creates incentives for preventive care, which can help keep people healthy and make our system really a “health care” system rather than a “sick care” system. Dr. Stein correctly mentions patient expectations which affect the costs of health care. The public has a tendency to believe that more care is always better care. We’re learning that this isn’t always the case.


I have no doubt that we will be able to save money by spending money on preventive care for those who had not previously been insured. More importantly, we will be helping those who previously did not have access to health care. This, however, is only one small part of the puzzle. We must do our best to make sure that this increase in access does not dilute present resources to the extent that patients will either have services delayed or denied, phenomena that already exist to some extent today. I certainly agree that more care is not necessarily better care, and that our desire to “do something” for our patients must be tempered by reality. However, I would not want to be a doctor (or a patient) in an environment that interferes with the doctor-patient relationship and our ability to make treatment decisions together.

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