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Editorial JULY
2009
Health Care Reform and the Obstetrician-Gynecologist
Ronald T. Burkman, MD
Numerous experts, legislators, reformers, and pundits all have stated that
the stars and moon have lined up at this time such that substantial health
care reform is likely very soon. The goal, which is certainly laudable,
is to provide high quality, comprehensive, and affordable health care for
all Americans.
The challenges are many. In 2006, 47 million people in the United States (almost
16% of the population) were uninsured—a
2 million person increase from the previous year.1 With the current recession,
the overall number of uninsured, as well as the rate of annual increase, is
likely to
be higher.
This issue significantly affects women. About 20% of women of childbearing
age are uninsured, a rate that is higher than for all Americans under the
age of 65 years.2 In addition,
13% of all pregnant women lack health insurance. There are significant racial
and ethnic disparities as well with women. For
example, among women who are Hispanic or Native American, the uninsured rates
are about 3 times higher than the rate for non-Hispanic whites. In contrast,
virtually all women over the age of 65 years are covered by Medicare, the
national insurance program introduced several decades ago when the country
last was serious about some type of health care reform. Obviously, being uninsured
decreases the likelihood that women will appropriately seek preventive and
prenatal care.
Another theme of health care reform is the concern that health care costs,
even without adding the large number of uninsured individuals into insurance
programs, are escalating at an unacceptable rate. Clearly there is a focus
of attention on the high administrative costs of the current system, cost-effectiveness
and efficiency of care, and reimbursement of health care providers. With the
current recession and our concern regarding the economic welfare of Americans,
the issue comes down to how much health care we can afford and still provide
it with a high degree of quality.
Although initially it looked like health care providers, hospitals, and insurance
plans were all on board in their support of reform, there have been some recent
indications of possible defections. For example, insurance plans indicate
that in a scenario where rates of insurance are likely to be reduced, it will
be mandatory that all Americans be covered, especially the young and healthy,
for them to be supportive of any reform package. It is their view that without
this segment of the population in the plans, there will be insufficient funds
to offset the cost of providing care to older, less healthy Americans.
Additional approaches to reduce costs include a single payer system (unlikely)
and the use of medical homes, a modification of the gate-keeper system of
the 1980s and 1990s in which a health care provider coordinates care for a
patient, including referrals. Providing more reimbursement to primary care
providers (likely at the expense of specialists) in an effort to increase
their numbers has gained some traction. Massachusetts’ current universal
coverage health care system is often discussed as a possible model for national
reform; it would involve scrapping the current fee-for-service payment system
and replacing it with a lump sum for a patient’s care throughout the
year.
Clearly, all of these proposed changes will significantly affect ObGyns. How
we deliver care, who controls it, how we are paid, and how much we are paid
are all on the table. Now is not the time to sit passively at the sidelines
and see how things play out. We should be contacting our local and national
legislators to make our views and concerns known. ACOG’s Department
of Government Affairs can provide talking points on pending national and local
legislation, as well as material on how to be more effective in lobbying efforts.
To be effective, however, access is needed, and access is markedly improved
by providing monetary support to legislators. For example, if there is pending
legislation in your state related to tort reform or discussion regarding modifying
the state’s Medicaid coverage or payments, it is helpful to sponsor
fundraising breakfasts or dinners for key legislators. If these are attended
by a significant number of physicians, it will provide a good forum to make
your viewpoint known. Similarly, sponsoring a fundraiser for your local congressman
will also allow you to exchange viewpoints on the many issues affecting health
care reform.
Additionally, we need to increase support for ObGyns
for Women’s Health, a political action committee (PAC) that is ACOG’s
lobbying partner on
Capitol Hill. The amount of money we donate to our PAC is
far less than what many other specialty societies donate to their PACs, and
miniscule in comparison to what trial lawyers donate
to their PACs. In my view, the amount of funds trial lawyers have donated
to key legislators in their lobbying efforts has had a lot to do with the
absence of meaningful tort reform at a national level and in the majority
of states. Like it or not, the system runs
on money, and we need to get involved. If we don’t participate and end
up working in a system that does little to support how we wish to deliver
our care to women, we have only ourselves to blame, or as Pogo once put it, “We
have met the enemy and he is us.”
back to top
Ronald T. Burkman, MD, Editor-in-Chief
REFERENCES
- US
Census Bureau. Current Population Survey. Annual Social and
Economic
Supplement. March 2007. Available at:
www.census.gov/cps. See also Income, Poverty, and Health Insurance
Coverage in the United States: 2006 and Factsheet. Available
at: www.census.gov/prod/2007pubs/p60-233.pdf.
- US Census Bureau data prepared for the March
of Dimes (MOD). MOD summary, Census Data on Uninsured Women and Children.
September 2007. Available at: www.march
ofdimes.com. See also March of
Dimes. The Distribution of Health Insurance Coverage Among Pregnant Women.
2001. Available at: www.marchofdimes.com/files/2001FinalThorpeReport.pdf.
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