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Update on Obamacare in the Senate

Wednesday, December 2, 2009  |  posted by Hugh Hewitt

Opposed to Obamacare? Don’t forget to visit and contribute at

Arizona’s Jon Kyl joined me on today’s program to update us on the debate in the Senate. The transcript of that conversation will be here later. Obamacare can be defeated, but the huge majority of Americans who oppose the bill have to act on that opposition, not just grumble about the Democrats. Contribute, and call 202-224-3121 and tell a senator to stop, especially Arkansas’ Blanche Lincoln, Indiana’s Evan Bayh, and Nebraska’s Ben Nelson.

This e-mail arrived from an Oregon surgeon:

Dear Hugh,

I am a Portland, Oregon general surgeon, and have been in practice for about 20 years. I have listened to your interviews with Obamacare-supporting “experts” and have been struck by their evasiveness or apparent ignorance about the practical effects of past Medicare and Medicaid funding decisions, and the likely effects to come if the current proposals pass.

One of the striking shared views is that 1) yes, current law mandates a 25% reduction in fees paid to physicians, and 2) Congress won’t really enforce that law, so physicians don’t have anything to worry about.
They fail to acknowledge the past practice of “budget neutrality” on the part of CMS by drastically reducing the reimbursement of some of the most common procedures, while increasing other fees – thereby pitting proceduralists (surgeons like me) against primary care doctors.

I suggest the following questions of such experts to assess their true grasp of the situation:

1. What has happened in recent years to the Medicare reimbursement for coronary artery bypass procedures, aortic aneurysm repairs, hernia repairs, emergency gallbladder surgeries (hint: they all have been reduced by more than 50%).
2. How much does Medicare pay a surgeon to save someone’s life by performing a lower leg amputation?
a. $30,000 or $40,000 or $50,000 (President Obama’s answer)
b. $862 (The actual amount paid for the procedure and for 3 months of post-op care)
3. Compared to commercial (non-government) insurance, how much does Medicare pay for any given procedure (Answer: less than half).
4. How much does Medicaid pay (Answer: even worse, less than 40%).
5. What do they anticipate the “public option” fee structure will look like — closer to current commercial rates or more like Medicare or Medicaid (Hint: the government has never paid doctors or hospitals anything close to the going rate).
6. Given the incentives built into both the Pelosi and Reid plans to do so, how many people will be dumped from their current private insurance plans into the expanded pools of Medicare, Medicaid and the public option insurance.
7. Given the resultant dramatic decrease in practice income, how many physicians do they think will opt for early retirement or change in occupation?

8. All 3 guests I listened to mentioned the billions of dollars that will be saved by “increasing productivity.” What exactly are they talking about. Productivity is work unit per hour. So, am I expected to see more patients per hour, operate faster (I’m already one of the fastest surgeons in Oregon) or just see more patients by working longer hours. Sorry, I already work 60 hours per week, including emergency operations at 2:00 am — I’m not gonna work any harder for government rates.
9. Maybe they mean increased productivity by use of electronic medical records and electronic information systems. But most practices in our area already use those, so counting on cost reduction by future implementation of procedures that are already in use isn’t really fair, is it?

Just a few thoughts, maybe some that you hadn’t thought of.

Thanks for your focus on this issue!

Sincerely yours,
RH, M.D.

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