Wednesday, January 24, 2007

State of the Union and the Future of Healthcare

President George W. Bush addressed the nation tonight, hoping to lay the groundwork for bipartisan solutions in the areas of energy and healthcare. He also firmly defended his unpopular decision to send more troops to Iraq. Assuming the President was not wearing Kevlar beneath his conservative suit, he showed remarkable courage giving his address while standing directly in front of Nancy Pelosi (D-San Francisco- first woman Speaker of the House.)

Healthcare took a back to seat to energy consumption and the war, but Bush was able to outline the major points of his two-part plan to reduce the number of Americans (47 million) without healthcare insurance. In my opinion, there was a noticeable absence of a commitment to covering all the uninsured.

The first part of Bush’s plan to cover the uninsured involves a tax credit of $15,000 for families and $7,500 for singles who purchase health insurance. This will allegedly make it easier for families that must purchase private health insurance to afford the premiums. The other half of this proposal is that employer provided health insurance policies will be taxable income. So, if an employee receives more than the allotted tax deduction as a benefit, the employee will be taxed on the difference in the amounts. The Democratic comment on the President’s speech estimates that some 20 million middle class citizens will have to pay more for health insurance than under the current plan.

My immediate reaction to hearing about this plan was this: What keeps the health insurance companies from raising premiums above the deductible amount, making this a more costly alternative for everyone? Healthcare insurance providers: 1 Healthcare consumers: 0.

The second part of Bush’s overall strategy is to work with the states. To quote the President, “…support the states; the federal government would redirect a portion of the billions of dollars it now spends on care for the poor and uninsured.” His vision would have the states develop their own system for covering their uninsured.

SO, as I understand it, the President would take money away from state programs that pay the hospitals and providers for the indigent care they provide, and replace it with some as yet determined plan to obtain health insurance for the indigent.

Not included in the address, but furnished to the press and the Democrats were other parts of the President’s strategy, including medical liability reform, improvement in IT compatibility and availability, and a commitment to make pricing and quality information available to the general public.
I’m sure I will have nightmares about this tonight. I envision a patient, lying on a gurney in my Major room, telling me they need a menu of prices for the various options available to treat myocardial infarction. After reading through the choices, the patient says, “Well, I’ll take the Aspirin and the sublingual nitro. I think I’ll hold off on any anticoagulants. Definitely hold the x-ray. All I’ll really need right now is the EKG. Then I’d like to see the Cardiologist list. I would like your recommendation for a mid-price, fairly robust forty year old that has had at least 12 successful cardiac caths this year. Yep, that fits my individual needs. By the way, is the gratuity included?”

Somehow I doubt that President Bush has the vision that I do, but maybe that’s the problem……………..

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