Obama’s Unintended Consequences for Anesthesia
Michael Casey from the Associated Press Wire Service reported on an effort to preserve sea birds on Macquarie Island. All the cats on the island were removed or exterminated. Unfortunately, this led to an explosion in the rabbit population. The rabbits destroyed the vegetation that the birds required for cover. Ultimately, the move hurt the birds far more than the cats ever could have. This story provides an illustration of the law of unintended consequences. Manipulation of complex and sensitive systems carries with it both risks and benefits. Change in one area typically impacts others.
President Barack Obama has made health care reform a priority. In doing so the House has drafted a bill (e.g. HR3200), that in its present form will decimate the speciality of anesthesia, an unintended consequence. The president intends to insure affordable healthcare and improve access, but by doing so he will cause unintended consequences that will be counter to his objectives. By using the Medicare fee schedule as the basis for payment under the proposed “Public Option” health plan the government has signed the death warrant for the specialty of anesthesia .
Medicare payments for anesthesia services are calculated using a different method and a different “conversion factor” than that used for other medical specialties. While Medicare pays primary care and other physicians an average of 80% of private sector fees, according to the GAO, Medicare rates for anesthesia providers average only about 33% of what private insurers pay for our services, across the country. This unequal treatment is already driving many anesthesia providers to seek early retirement and it will ultimately limit patients’ access to anesthesia care as fewer anesthesia providers enter the specialty. Payment rates in any health plan, including a potential “Public Option”, must be fairly negotiated to encourage all providers to participate. Anesthesia providers need to educate House members on this unintended consequence so that it can be removed from the bill or the bill modified to correct the unintended consequence for anesthesia.
Blue Dog Democrats Raise Concerns for Healthcare Reform
The Blue Dog Coalition, a group of fiscally conservative House democrats, has submitted a letter to Speaker Nancy Pelosi and Majority Leader Steny Hoyer outlining a number of concerns about the Tri-Committee draft health reform bill. American Society of Anesthesiologists (ASA) strongly supports the Blue Dog Coalition’s concerns about a public plan option based on Medicare payment rates.
ASA President Roger A. Moore, M.D., has released the following statement in response to the Blue Dog Coalition’s letter: “On behalf of ASA’s 43,000 physician members, I applaud the Blue Dog Coalition members and leadership for opposing a public plan option based on Medicare rates, and for recognizing that a Medicare-like public option would negatively impact doctors and patients. Further, I am pleased that the Coalition maintains that physicians and other health care providers should be able to voluntarily participate in the program, rather than being mandated by Congress.
“We are working together on one of the most comprehensive health care reform efforts this government has ever undertaken. We commend the “Tri-Committee” members and staff for their efforts toward meaningful and effective delivery reform. However, we believe that as part of responsible reform, we must ensure that a public plan option fairly compensate physicians for their services. As it stands, Medicare pays anesthesiologists 33 percent of what private insurers pay—a rate that simply does not cover the costs of providing anesthesiology medical care. An expansion of this inadequate payment system as proposed by the “Tri-Committee” would not be sustainable for private practice and academic anesthesiologists.
