President's Health Care Proposals Fall Short, Says AAFP President

During his Jan. 28 State of the Union address, President Bush urged Congress to make health care "more affordable and accessible" by passing initiatives to reduce the ranks of the uninsured while giving consumers more options when choosing health care plans and making health care decisions. But Bush's proposals do not go nearly far enough in addressing the nation's ongoing health care crisis, said AAFP President Jim King, M.D., of Selmer, Tenn.

"The president's plan might help some of the 47 million Americans who do not have health insurance obtain health insurance," King said in an interview with AAFP News Now shortly after the president delivered his address, "but it still does not really solve the main problem with our health care system."

During his address, Bush said, "we share a common goal: making health care more affordable and accessible for all Americans," adding "the best way to achieve that goal is by expanding consumer choice, not government control." He called on Congress to provide tax breaks for individuals and families who do not have health insurance coverage through their employers, saying, "This one reform would put private coverage within reach for millions."

Bush also urged Congress to "expand health savings accounts," and to create association health plans to allow small business owners to collectively purchase insurance at lower rates. In the meantime, Congress should "promote health information technology," or HIT, and should "confront the epidemic of junk medical lawsuits."

"With all of these steps, we will ensure that decisions about your medical care are made in the privacy of your doctor's office, not in the halls of Congress," Bush said, sparking thunderous applause.

Not surprisingly, Bush's 52-minute speech focused primarily on the ailing economy and the war in Iraq. He addressed health care issues only briefly, failing in the process to propose any major initiatives that would fundamentally reform the nation's health care system.

Bush also assailed rising entitlement spending, saying that Medicaid and Medicare programs are "growing faster than we can afford."

"We all know the painful choices ahead if America stays on this path -- massive tax increases, sudden and drastic cuts in benefits, or crippling deficits," Bush said. "I have laid out proposals to reform these programs. Now I ask members of Congress to offer your proposals and come up with a bipartisan solution to save these vital programs for our children and our grandchildren."

King responded to Bush's statement by saying, "The answer is a primary-care-based system with everyone in a patient-centered medical home that controls costs and improves quality. That is the direction where we should be heading."

In a statement released by the AAFP, King said that "President Bush and Congress need to respond to Americans' concerns (about health care) with comprehensive reform that not only helps Americans gain access to health care coverage, but also fosters the medical home concept and medical education initiatives that encourage students to enter family medicine and national health policies that reinforce primary care."

King told ANN that he was disappointed Bush did not mention Medicare physician payment levels. "It may be too technical to talk about the complicated formula Congress uses to pay us," King said. "But it is obvious the formula doesn't work and is broken."

By mentioning Medicare payment levels, Bush would have acknowledged the problem, perhaps spurring action to "change and fix the Medicare formula," King said.

King also raised concerns about some of the health care initiatives proposed by Bush, including initiatives pertaining to HIT. The federal government should promote HIT, but it also should help family physicians pay for the implementation of the technology, said King.

"Can family physicians afford to put (HIT) in their offices?" he asked. "The government will have to come forth with some plans to … make it cost-effective for family doctors to make that decision."

Thirty-seven percent of family physicians have electronic health records, or EHRs, in their practices, and about 13 percent are in the process of installing EHRs, leaving about 50 percent without the technology, according to King. That 50 percent cannot adopt HIT primarily because of cost considerations, he said.

King also agreed with Bush's statement about ending "junk medical lawsuits," but he said, "the only thing that has really proven to control costs is putting caps on noneconomic damages."

In his address, Bush called for empowering both patients and physicians with "better information and better options," a reference to quality reporting data. That proposal needs more thought and consideration, King said.

"Family physicians are always for transparency," King said. But it is important for the federal government and private health insurance plans to measure "the right things" and for patients and physicians to understand what is being measured. A family physician taking care of patients with diabetes, for example, will have different patient outcomes than a physician who primarily treats healthy patients, King noted.