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State of the Nation's Health Care 2010 - Joseph W. Stubbs Remarks

The Declining State of the Nation's Health Care
And the Urgency of Moving Forward on Essential Reforms

Oral Remarks
Joseph W. Stubbs, MD, FACP
The American College of Physicians

Thank you for joining us for this report from America's internists on the State of the Nation's Health Care.

I have had the privilege of serving as president of the American College of Physicians for the past year. I've also had the privilege of serving adult patients for the past 27 years as a full-time internist and geriatrician in a nine-person primary care group practice in Albany, Georgia. Every day, I see where the rubber of health policy meets the road of real patient lives. In my practice, we also have more than 50 employees and I have seen the ratio of physician to staff grow from 1:3 to 1:6 in the last 10 years. We have had to raise the deductible on our own health care insurance from $500 to $2,000. I understand the struggles of small businesses just to keep the lights on.

Health care in the United States is facing an unprecedented challenge of affordability and sustainability.

Yet a highly-partisan and polarized debate over health care reform legislation regrettably has taken the country's "eye off the ball"-from the urgency of implementing reforms to making health insurance coverage more affordable, available and secure; to ensuring a sufficient supply of primary care physicians and other specialties facing shortages; and to reforming payment and delivery systems to achieve better value.

The year-long effort to enact comprehensive health care reform remains stalled in Congress, with no clear route forward, yet the urgency of reform is greater than ever.

The unfortunate truth is that by many measures, the State of America's health care is in decline.

We have:

  • Too many uninsured.
  • Too few primary care physicians.
  • While the cost of health care is rising faster than families, small businesses, and taxpayers can afford.

I see patients every day struggling to manage the costs of health care. Just last week, a patient of mine came to the office in desperation. The manufacturing plant for which she had worked and received health care benefits had closed and she had been no longer able to afford her heart and diabetes medicines. When, in desperation, she came to the office, her blood sugars were off the charts, she had extremely high blood pressure -- 205/110 -- and she had black gangrenous toes. As a result she had to undergo an amputation of her toe that could have been avoided.

The American College of Physicians, representing 129,000 internal medicine physicians and medical student members, releases this report today in an effort to re-invigorate the effort to enact and implement essential reforms to improve health care delivery in the United States.

ACP views health reform not from a partisan or ideological perspective, but from the standpoint of what the evidence tells us will be the most effective course of action.

Our review of the evidence tells us that comprehensive health care reform is essential:

If health care reform fails. . .

  • The Congressional Budget Office projects that, without any changes in federal law, spending on health care will rise to 25% of GDP in 2025 and close to 50% in 2082.
  • If premiums for employer-sponsored insurance grow in each state at the projected national rate of increase, then the average premium for family coverage would rise from $12,298 (the 2008 average) to $23,842 by 2020-a 94 percent increase.
  • By 2020, the Census Bureau projects that the number of uninsured will climb from 46 million to 60 million-one out of every five people.

Health care reform is integral to reducing the federal government's structural deficit. It is not possible to achieve substantial and lasting reductions in the deficit and public debt without reducing the Medicare and Medicaid spending.

The struggles of so many of my patients -- like the one I mentioned -- who do not have jobs or whose jobs no longer provide health care benefits cannot wait. Unnecessary amputations, other unnecessary avoidable complications of diseases, and unnecessary deaths are tragically occurring every day. This growing American calamity needs to be fixed urgently.

We are encouraged that President Obama has invited leaders of both political parties to meet on February 25 to share ideas on moving forward on consensus reforms. We urge them to consider common ground - and common sense - reforms, including enactment of policies to increase the numbers of primary care physician, accelerate pilot-testing of the Patient-Centered Medical Home, promote adoption of health information technology, and reducing the administrative costs of interacting with health plans. We believe that such reforms would have strong bipartisan support in Congress.

At the same time, we continue to believe strongly that any final bill must include the key provisions from the House and Senate bills to create a pathway to make coverage available to all Americans, increase Medicare and Medicaid payments for primary care, increase funding for primary care training programs, and accelerate the pilot-testing of innovative payment and delivery system reforms. We continue to support creating sliding-scale tax credits, expansion of Medicaid to cover the poor- and near-poor, insurance market reforms, and providing individuals and small businesses a wide choice of affordable health plans through a health exchange. Instead of "starting over" or passing a series of small bills that will likely would not be effective, we believe that Congress should build-and improve upon-the bills already passed by the House and Senate.

We also believe that the President and Congress should seek a bipartisan agreement on reform of the medical liability tort system. A bipartisan agreement on medical liability reform would demonstrate that Washington is willing to put aside partisanship to develop solutions to a vexing problem that drives up health care costs without ensuring fair compensation to patients injured by negligence.

We also believe that it is time for Congress, on a bipartisan basis, to enact a permanent replacement for the Medicare Sustainable Growth Rate (SGR) that provides stable and predictable payment updates that reflect the costs of providing services. Ending the constant threat of Medicare payment cuts is essential to preserving access to care for millions of America's seniors and military families insured by Tri-Care. We cannot support another temporary "patch" that kicks the can down the road and with it, the cost to taxpayers of enacting a permanent solution.

How can a small business like mine decide whether to give raises to my staff or let some of them go when we are faced each year with steep cuts in reimbursement like this year's 21 percent cut? How can we afford to continue seeing new Medicare patients given the possibility of such cuts?

We also are urging President Obama to use his executive authority to increase primary care workforce capacity and to reduce the time that physicians and patients spend on administrative interactions that take time away from patient care.

How would ACP's recommendations help my patients? Enhancing reimbursement for primary care services is essential for enticing more of our young medical students to pursue careers in primary care. Expanding the primary care workforce will benefit all patients and all physicians because it will ensure that there is someone who treats the whole patient and who coordinates the patient's total care. Further, primary care physicians will have more time to spend with their patients, especially those who have multiple chronic illnesses. They will have both the time and the ability to help patients have more control over their own lives and their own diseases. And the policies in both the House and Senate bills to provide coverage to more than 94% of legal U.S. resident would ensure that my patients never again have to delay care and suffer needless complications because they lose their job, and with it, their health insurance.

In conclusion:

  • Health care in the United States is not sustainable-for families, for businesses, and for taxpayers.
  • In the absence of comprehensive health care reform, affordable and high-quality care will simply be out of reach for millions more Americans, including middle class families.
  • Rising health insurance premiums will break the backs of small businesses, the primary engines of job creation in the United States.
  • Primary care physicians will become almost impossible to find, leading to long waits for appointments, delayed care, hurried visits, and more visits to the emergency room for conditions that could have been treated in a doctor's office.
  • Continued physician payment cuts will create enormous access problems for seniors and disabled persons on Medicare and for military families insured by Tri-Care.
  • Medicare will become insolvent, and increased spending on Medicare and Medicaid will drive an unprecedented budgetary and fiscal crisis-likely leading to drastic cuts in benefits and eligibility, reduced payments to physicians and other providers, tighter controls over utilization, and higher taxes.

The alternative to moving forward on comprehensive health reform is an unconscionable abdication of responsibility by our elected leaders to ensure that high quality health care remains available and affordable for American families today, tomorrow and for years to come.

Now, I am pleased to introduce Bob Doherty, the senior vice president of ACP's division of government affairs and public policy. He will describe the current political environment and provide more information on ACP's policy recommendations in this time of "urgency of moving forward on essential reforms."