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    Consequences of reform

    An open letter from OT columnist to Ohio Senator outlines nine unintended effects of health-care bill

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    Editor's note: J.C. Noreika, MD, MBA, submitted the following open letter in September to Sen. Sherrod Brown (D-OH), outlining nine possible unintended consequences of health-care reform. Dr. Noreika is founding partner of Excellence in Eyecare, Medina, OH, and editor of the "Practice InSight" column in Ophthalmology Times. Attempts by Sen. Brown and Dr. Noreika to connect have been unsuccessful.


    J.C. Noreika, MD, MBA
    The Honorable Sherrod Brown:
    I hope you are well. It has been a while since you and I had a chance to discuss books, baseball, and affairs of state. As you know, I take an interest in the socioeconomics of medicine and, specifically, our nation's health-care system. I have witnessed its triumphs and problems from both sides of the exam chair and, unlike most of the academics, commentators, and bureaucrats who propose policy or critique it, I sit in front of patients every day, listen to their concerns, and do my best to improve the quality, if not the quantity, of their lives.

    You are being pressured from all sides in this recent iteration of the movement for universal health insurance. As a student of history, you know that this issue has been debated for almost 100 years. You and your staff are fully informed in regard to the big issues. You share concern over the unimaginable deficits that this country is incurring. A projected $1 trillion for health-care reform alone! The nation's deficit is to exceed $1.17 trillion in 2010 and $9 trillion over the next decade.

    Ours is the wealthiest country history has ever witnessed, but it must have its limits. This unimaginable deficit must not be the legacy that we beget to our nation, our children, and their children.

    The following is one physician's opinions. Although not statistically significant, these views, like good military intelligence, are conceived and refined on the front lines of the daily, all too frequent skirmishes among and between physicians, patients, insurers, bureaucrats, regulators, lawyers, and other vested interests. I have listened closely to the rhetoric. What I haven't heard is a discussion about the inevitable unintended consequences health-care reform will create.

    UNINTENDED CONSEQUENCE #1

    THE UNINSURED AFTER UNIVERSAL COVERAGE.

    No one seriously opposes a safety net of health insurance for every citizen. Health-care coverage should be available to all who want it. I know no physician who refuses necessary and timely care to a needy patient. An unintended consequence of the current health-care proposals is that the uninsured will remain among us and, in keeping with their Hippocratic Oath, physicians and hospitals will be obligated to care for them.

    Who will be the uninsured? When I attended a session at the Old Executive Office Building that was headed by then-First Lady Hillary Clinton and Clinton administration adviser Ira Magaziner, who led the federal government's Task Force on National Health Reform during the Clinton health-care initiative, I was made aware of the problems experienced by emergency room doctors in Los Angeles in their attempts to minister to the uninsured undocumented-worker population. Today, the problem is worse. Where will be the resources to provide pro bono care for this population?

    Another example? I personally provide examinations to adults who could qualify for state or federal assistance for themselves and their children but fail to do so. Don't these individuals have a responsibility for their and their children's care? If they can't or won't accept this responsibility, who will fill the breach?

    Finally, every physician sees patients who choose not to purchase insurance because they are young and healthy, see it as an opportunity cost and spend their funds elsewhere, or simply game the system. Can this subpopulation of resource-users be coerced by the government to purchase health insurance? Based on the number of uninsured motorists on the road, I doubt it. This unintended consequence of "universal" coverage may leave some vulnerable populations in worse situations than they find themselves now and further strain the providers.

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