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One Year Later - What Happened to Real Healthcare Reform?

Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD

Last year, as President Barak Obama addressed Congress, he said, “Let there be no doubt: healthcare reform cannot wait, it must not wait, and it will not wait another year."

A year later we are still without healthcare reform. And in the Jan. 27 State of the Union address, the President changed the focus to health insurance reform. And like big banks, health insurance companies are now being labeled as enemies of the state.

And while the President even promised that patients would be able to keep their doctors, the delay in healthcare reform looks to actually do the opposite for older Americans.

The problem is that there are some major components of healthcare that actually can’t wait any longer to be addressed. One of the most pressing timelines is the one governing physician reimbursement. As it stands today, in just about four weeks, physicians caring for Medicare patients will have a 21 percent cut in their reimbursement. Without congressional action, Medicare beneficiaries are likely to find it increasingly difficult to find a physician who will take their Medicare insurance because many physicians will likely stop seeing Medicare patients. And while Congress has historically acted to pass one year corrections to these Medicare cuts, in the face of massive debt and a focus on deficit reduction, this year might actually see those reimbursement cuts go through.

The question is what will be the effect on Medicare patients?

As a practicing geriatrician and health policy expert, I appreciate the concern of older adults. These fears come out of the concern that a large number of physicians will opt out of Medicare and privately contract with their Medicare patients. Older adults who find their physician has opted out of Medicare can choose to find a physician who does still take Medicare or they can pay privately out of their own pocket for services traditionally covered under Medicare. The delay in health care reform could actually cause a major break in the relationship patients have with their physicians.

Real healthcare reform is possible. It can start with focusing on just a few key issues:

Extend Health Insurance Coverage – providing coverage for the majority of those Americans who are currently uninsured can happen by:
- moving Medicare to 55 (this action would also move pre-retirees out of the work force, opening up opportunities for those currently unemployed)
- lowering the eligibility requirement for Medicaid
- providing tax breaks for those seeking personal insurance
- make mandatory the requirement for health insurance

Develop Efficient & Effective Systems – lower the cost of healthcare through promotion of integrated systems of care rather than the current fragmented silo’ed process.

Expansion of Information Technology – promote the use of electronic health records that are integrated among providers that can reduce unnecessary and ineffective treatments.

Reduce Administrative Burdens – the administrative burden is currently causing great waste and inefficiencies.

Support Primary Care Services – shift the financial incentives from procedures to primary care services.

Reform Malpractice – provide reform that works to eliminate nuisance lawsuits and the need to practice defensive medicine through a specialized court system absent of juries, governed by a skilled judge.

Promote Personal Responsibility – work to promote personal responsibility to reduce obesity, tobacco abuse, and sedentary life styles.

While time will tell the direction of healthcare reform – time is certainly running out at least perhaps on the promise that patients, especially older adults, will be able to keep the relationships they enjoy with their doctors today. Instead of the break of existing patient-doctor relationships perhaps real healthcare reform will happen.

Dr. Richard Stefanacci, Director of the Institute for Geriatric Studies at University of the Sciences. As an internist/geriatrician, Dr. Stefanacci has a longstanding interest and commitment to geriatric health, particularly the frail elderly and long-term care.



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The same thing happened to it that happens to all promised things...it goes by the wayside. Honestly, did anyone really think this reform would go through?


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