Even with cutting doctor’s compensation, health-care costs will increase…

The chief actuary of CMS has recently released a 20,000 word document stating that even with the expected cost savings from our new health-care law, medical costs will continue to increase.  Shocking.

Our new health-care law means well.  It will surely help some, like those with pre-existing conditions.

As a preamble, I need to say: I like President Obama.  I find his intellect compelling and comforting.  He considers both sides of a debate. In drawing the line in the sand, in taking a stand–on health-care reform–he puts himself at substantial political risk.  Additionally, as we cyclists say, the man is on the gas; he is working really hard.  Nearly every day he is out there in his suit and tie making news. To me, hard work and taking a stand on a controversial matter are admirable qualities in a leader.

That said, as a doctor in the mix, one of my major issues with the healthcare law is its omission in addressing the spiraling costs of health care. As said recently in the NY Times…

In his report, sent to Congress Thursday night, Mr. Foster (CMS) said that some provisions of the law, including cutbacks in Medicare payments to health care providers and a tax on high-cost employer-sponsored coverage, would slow the growth of health costs. But he said the savings “would be more than offset through 2019 by the higher health expenditures resulting from the coverage expansions.”

Even the chief actuary of CMS tells us that cutting doctors reimbursement and taxing high cost plans will not offset the 30 million new patients who expect the same quality of care as those presently in the system.

Take two examples in electrophysiology…

1. The blood thinner, dabigatran, will soon be approved by the FDA.  In AF, it was shown superior to, and safer than the present-day blood thinner, warfarin.  Many million Americans take warfarin.  In Europe, dabigatran costs ten times that of warfarin, nearly 400 dollars per month.  Switching only a fraction of the 15 million patients from a 4$/month drug to a 400$-plus/month drug dramatically increases our health care cost.  Which patients will get the better drugs? 
2. Catheter ablation of AF represents a major advance in heart rhythm management.  Just ten years ago, a “cure” of AF was not imaginable.  Unfortunately, these procedures are billed by hospitals–not doctors–at 50-000-100,000 dollars.  Even a one hour SVT ablation costs 39,000 dollars. 

These two examples in my little world of electrophysiology are only the tip of the iceberg when the whole of health care is considered.

Medical therapeutics is expanding dramatically. Practicing medicine in this era of incredible leaps in technology makes me grin. My favorite gastro-doctor calls it, “living the dream.”  But the costs are staggering. Sometimes, it seems we are numb to the actual figures. The un-realness of health-care costs is illustrated in the example of my hospital bill for shoulder reconstruction more than a year ago. (Note: Before my insurance moved to a high deductible HSA.)  The bill said: total cost = 60,000 dollars and, here is the best part: “you owe,” = zero.

Our new health-care law looks around this elephant in the room, like it isn’t there.

I ask, at present day costs, can we afford to provide state-of-the-art care to all?  Will there be some who get ablation and others who get digoxin?  Will there be some who get dabigatran and others get warfarin?  And the list goes on. I try to do my part in holding down costs, but the tools are so expensive.

I enjoy being in the race.  I look forward to seeing how it develops.

JMM