The long road ahead

Tags: texas family physician, president's letter, health care reform

By Kaparaboyna Ashok Kumar, M.D., F.R.C.S.
TAFP President, 2009-2010

It’s been more than a month since President Barack Obama’s health reform package became the law of the land, and we’re still dealing with the political and policy fallout. The legislative process and the yearlong debate have been painful, and remind us why it’s often better not to see the making of the sausage. As physicians, we can disagree about the appropriate roles for the market and the government in the distribution and financing of health care, but we should also begin considering the law apart from the partisan battlefield and analyze what its actual ramifications might be for our patients and our practices.

Throughout the legislative process, AAFP was engaged in the debate at the highest levels, working to fend off ideas that would have been detrimental to physicians and patients, and making the case that investing in primary care will result in better health outcomes and reduced cost. Lawmakers heard and understood that message.

The health reform package contains many provisions intended to move the country toward a health care system based on primary care, including the creation of pilot projects to evaluate new patient-centered payment models, increasing payment for primary care services for Medicare patients by 10 percent, increasing Medicaid payment for primary care to Medicare levels, promoting preventive and primary care, and protecting Texas’ hard-fought tort reforms.

However, as many TAFP members and leaders point out, the bill is far from perfect, and like any major reform legislation, it will certainly result in numerous unintended consequences. It does not include important provisions AAFP fought diligently for, such as a permanent solution to the Medicare SGR and responsible medical liability reform that would reduce the practice of defensive medicine. Rest assured the Academy will continue to advocate these positions.

TAFP has long contended that our health care delivery system is broken, and must be fixed for the good of all Americans, for the physicians who care for them, and for the state and national economies. The problems plaguing our health care system did not occur overnight, and no single bill is ever going to solve them all. Nowhere is the evidence of these problems more obvious than in Texas, with the nation’s highest rate of uninsured citizens, high rates of chronic disease, and a dangerous shortage of primary care physicians that threatens access to quality care. Our fragmented, disorganized health care system often fails to provide access to appropriate, high-quality care to those who need it, while allowing insurers to raise premiums and curtail benefits with impunity. Stopping the abusive tactics of insurers and protecting Americans from medical bankruptcy by requiring the private insurance market to offer affordable policies to everyone is essential for our citizens, our small businesses, and our economy. This law is the first step in a very long journey to reforming our health care system.

The hard part is ahead of us, as the success of this legislation will depend on implementation at the regulatory and state level. There will undoubtedly be changes to the legislation over the coming years, and we’ll learn from trial and error. The reforms will roll out slowly; many won’t take effect for years, and Congress will have every opportunity to shape them as their consequences are revealed.

Texas Speaker of the House Joe Straus has appointed a select committee to examine the impact of federal health care reform on the state, and the Senate State Affairs Committee and the Senate Health and Human Services Committee are holding joint meetings to study the topic as well. Our Academy will be a trusted resource to these committees and others throughout the interim and into the next legislative session. The creation of the House select committee and the joint committee meetings in the Senate are positive signs that our state lawmakers are ready and willing to work in a bipartisan manner to prepare for implementation of the reforms.

After the political rhetoric, the misinformation, the wild claims, and frightening predictions have died down, we will still face this fact: our health care system is broken. With the passage of this reform package, we will have many opportunities to improve that system. The road will be hard and the journey difficult, but this is a first step we needed to take.

Meanwhile, we have our work cut out for us heading into what is certain to be a difficult legislative session. We must continue to advocate for changes in the way we pay primary care physicians, changes in the way we train physicians, and any other reforms that will attract more medical students to pursue careers in family medicine.

We’ve been quite successful in making the case that Texas suffers from a dangerous shortage of primary care physicians; in fact, perhaps we’ve been too successful. The nurse practitioners are using the same argument to call for a broad expansion of their scope of practice.

Then there’s the looming budget shortfall of somewhere between $12 billion and $17 billion for the 2012-2013 biennium, and the next Legislature will be entirely occupied with redistricting.

In the aftermath of this divisive health care debate, we must pull together and prepare for what lies ahead. Together, we can face these challenges and help build a better future for our patients and our specialty. Our most important days are ahead of us, and the journey’s just begun.

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