Legislative: New administration, old concerns: Healthcare reform remains priority for president-elect, Congress

January 1, 2009

The outline of plans to reform healthcare that may be developed under the Obama presidency is beginning to take shape, and while there no doubt will be positive developments for dermatologists, there are also some areas that could cause concern.

Key Points

A white paper published in mid-November by Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, provides the framework for the debate and includes many of the core principles espoused by President-elect Obama during his campaign. In short, Sen. Baucus' "Call to Action" would

* establish a policy that ensures meaningful coverage and care for all Americans;

* weed out waste, eliminate overpayments, and design a sustainable financing system that works for taxpayers, recipients and providers.

Health insurance exchange

The plan would establish a nationwide insurance pool called the Health Insurance Exchange, through which uninsured Americans could compare and purchase plans of their choice.

Private insurers offering coverage through the exchange would be precluded from discriminating based on pre-existing conditions, and premium subsidies would be available for qualifying families and small businesses.

While the exchange is being created, the plan would make healthcare coverage available immediately to Americans ages 55 to 64 through a Medicare buy-in and would phase out the current two-year waiting period for Medicare coverage for disabled individuals.

Every American living below the poverty level would have access to Medicaid.

The focus would be on prevention and wellness, rather than illness and treatment. Those who are uninsured would be given a "RightChoices" card that guarantees access to recommended preventive care, including "gender-appropriate" cancer screenings.

Fixing instability

The Baucus proposal says that "fixing the unstable and unsustainable Medicare physician payment formula is a necessary step," and that excess spending must be eliminated, with money correcting "imbalances" in the current healthcare system and to offset the high costs of reform.

One of those imbalances referred to, according to Sen. Baucus, is the need to strengthen the role of primary care and chronic care management, which would be done at the expense of healthcare specialists - a statement that immediately drew criticism from the Alliance of Specialty Medicine, which includes the American Academy of Dermatology.

"Primary care is the keystone of a high-performing healthcare system," the Baucus document says.

"Access to primary care that successfully manages and coordinates patient care, particularly for the chronically ill, is a proven determinant of high-quality, cost-effective care.

"Yet America's current system undervalues primary care relative to specialty care," leading to fewer medical students choosing primary care careers."

Primary care

"Increasing the supply of primary care practitioners and redefining their role in the health system - by using federal reimbursement systems and other means to improve the value placed on their work - is a necessary step toward meaningful reform," Sen. Baucus says.

The document also contends that payments for primary care physician visits "are undervalued, particularly compared to procedures and services furnished by specialists."

In fact, it says, the "overvaluation of procedures in the Medicare physician fee schedule has created financial incentives to provide unnecessary services, and served as a disincentive for physicians to become primary care physicians."

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