The nation's health: Derms express views on proposed reform

September 1, 2009

Despite urging from President Obama, both houses of Congress went home for their August break without passing any version of healthcare reform. All facets of reform appear to be on the table still, while the proposals being considered have a multitude of interpretations.

Key Points

With everything still up for discussion, On Call asked dermatologists what should be included in whatever healthcare reform proposal eventually does pass, if any does. We asked dermatologists to give us one or two ideas of features they believe should be included in reform for it to be as effective as possible.

From "no change" to a "national healthcare system," dermatologists' views of what is needed vary greatly - and yet have striking similarities. Even when doctors agree with the overall objective, wider-spread patient access to care, they don't necessarily see a means of achieving the goal.

"We need to move forward to get a larger portion of the population served by insurance in some form. If you pay attention to the free clinics and keep track of the care people put off because they don't have the financial means to pay, it's pretty appalling for our first-rate nation to have that many people who don't get the medical care they need," Dr. Blanchard says.

In practice 29 years, Dr. Blanchard says the problem is too widespread to disavow.

"All it takes is exposure to a few family members or friends who have lost their jobs or their insurance, and to find out what care or what medicines they can't afford. Even a high-deductible insurance can cost more than apartment rent," he says.

Despite the need that Dr. Blanchard finds completely obvious, the solution is more elusive.

"It's not appropriate to try to fool the American public that they can provide care for 30 to 45 million extra Americans and not have an increase in government expenditures. Something has to be cut, or taxes have to rise," he says.

Dr. Blanchard is concerned that a public plan would create bigger issues than it solves.

"We need to find a way to provide coverage without killing private insurance. No private business can compete with subsidized public business, and I'm not sure people are comfortable with evolving into a single-payer program in this country. There would be no more negotiating reimbursement, and I'm worried government fees would not keep pace with the cost of delivering care," Dr. Blanchard says.

Increased access

In Roswell, Ga., Kevin S. Berman, M.D., sees the same need in his practice of three years.

"We need increased patient access to healthcare. We are seeing many patients who, due to the economy, are losing their jobs; their insurance is going away.

"The problem is, I'm concerned physicians will be left out of the process, and other people will determine appropriate patient care based on cost, rather than on the patient needs.

"I've seen a number of patients come in to take care of everything at once, because their insurance will be gone in a few months.

"Patients with high-deductible policies end up paying for those, and, if they're healthy, they're still paying for most of their healthcare out-of-pocket, because everything is applied to their deductible," Dr. Berman says.

He also shares concerns about reimbursement levels. "We need to refigure reimbursement rates that will more fairly reimburse for the care we give and the costs we have to cover."

Dave W. Bray, M.D., who practices in San Antonio, Texas, is concerned about the speed with which the proposed reform is progressing.

"Healthcare for all is a reasonable goal we should shoot for, but I'm a little apprehensive about moving too quickly to meet that goal without going about it in the best way for everyone.

"Some elements definitely need further addressing. We all know the cost of healthcare plans are extremely expensive - specifically the medical/legal area is a huge expense.

"A lot of physicians seem to have been trained do protect themselves by practicing defensively. Sometimes this includes ordering tests to rule out less common, even rare, conditions (on) the off-chance the doctor might miss something and be sued.

"We need to decrease the overcautious, defensive medicine and reduce patients' and providers' fears about lawsuits, particularly frivolous suits," Dr. Bray says.