Frank Clemente wrote in ("Medical device tax giveaway would deny Americans healthcare," Your Column Here, Nov. 2-3) complaining about the Republican efforts to end the 2.3 percent excise tax on medical devices (part of the funding for Obamacare) calling that a "corporate tax giveaway." Does anyone think that tax, like all other taxes, isn't going to be passed along to the patients in the form of a higher price for those devices? What about some of the other sources of funding for this bill, the 0.9 percent tax on all incomes over $200,000 (a number calculated to be just a little bit higher than what a Congressman makes) or the 3.8 percent tax on the profit from the sale of real estate, including private homes?
The real problem with these commentaries is that almost everyone responds with their own political bias, either from a liberal or conservative point of view. The truth is that the entire process in Washington was, and remains, driven by political considerations and not health policy considerations, as it should have been. There are two groups to blame — Democrats and Republicans.
The two bills generated by the Senate and House were developed in a highly partisan environment without going to a conference committee at the end because the death of Sen. Ted Kennedy and his replacement by Scott Brown (a Republican) upset the political balance of the Senate. The Republicans have complained mightily about many aspects of the bill, but not about any of the things that are really wrong with it. There are some problems, but most of them are about what should have been in the bill.
Let's go through the list.
• There is a massive shortage of nurses in this country. There is nothing in this bill to increase the number of nurses trained each year.
• There is a growing shortage of physicians in this country, particularly in primary care. There is nothing in this bill to expand the size of medical schools to increase the physician output. Similarly, there is a shortage of primary care residency positions; nothing here to increase them either.
• The amount of medical school debt that graduates have is an increasingly severe problem, often preventing young physicians from practicing where they are most needed. Nothing in this bill deals with relief from those debts, perhaps tied to a period of service in the National Health Service Corps or to a signed contract to accept Medicaid patients, for example.
• In October 2009, the Congressional Budget Office issued a report stating that adoption of California-type tort reform nationwide would save our healthcare delivery system $54 billion. That wasn't in there either.
• We will be providing the for-profit health insurance companies with tens of millions of new premium-paying customers. Nothing in this bill calls for limiting (or even eliminating) the profit they make on the taxpayer-paid part of their business, or requiring them to provide any free care to the poor or uninsured (like every other company, hospital and medical group involved in healthcare delivery does).
• Increases in tobacco excise taxes that many medical groups lobbied to get passed were supposed to be used only for anti-tobacco education and to compensate states and counties for the cost of caring for tobacco-related illnesses. In most areas (including Los Angeles), much of that money was allocated by local governments to general fund expenses instead. Nothing in this bill forces that money to be used the way it was supposed to be.
The list goes on and on and on. Part of the problem is that correcting the bill by adding these items in now will be harder than it would have been to begin with.
It's time we should all stop responding as either Democrats or Republicans and all start responding as citizens and current or future patients and demand that all the people who work at either end of Pennsylvania Avenue establish a committee with a majority of technical experts who know what healthcare delivery is all about to draft legislation that will keep the good parts of Obamacare, change the bad parts, and add in the missing parts and then pass that bill intact. Then we can have health care reform legislation that will work the way it should.
Dr. Richard F. Corlin, M.D., is a Santa Monica-based gastroenterologist and past president of the American Medical Association.
