Health care debate still unclear

It’s hard to get clear prognosis when it comes to health care reform, Northeast Mississippi doctors say.
“Right now, the whole thing is about posturing, not about health care,” said Tupelo Family Physician Dr. Edward Hill and former president of the American Medical Association. “It will be more about health care when we get to a conference committee.”
The U.S. House has passed a health care reform bill. The Senate is due to take up debate on its own version this week. If the Senate approves a bill, leaders from both chambers will have to hammer out compromise legislation for a vote before the end of the year.
It’s clear health care reform is needed, said Ripley family medicine physician Dr. Dwalia South, who has many patients who have lost jobs and health care benefits and are scrambling. But South is concerned that the solutions will not be in line with delivering the best health care.
“What we’ve got is not a health care problem,” South said. “It’s a health insurance problem.”
South’s patients are equally anxious about the shape of health care to come, and she said she doesn’t have any clear answers for them at this point.
“I would like to see things slow down,” said South, who’s concerned lawmakers haven’t had time to truly understand thousands of pages of proposed laws. “It’s too much change, too quick.”
South is already frustrated by insurance company cost-saving measures that often mean she has to switch a patient from a brand-name medication that’s working for them to multiple generic medications.
“It’s penny wise and pound foolish,” said South, who worries that a government-run health insurance program would mean more of the same.
Tupelo oncologist Dr. Chris Croot is particularly concerned cancer patients could lose out if treatment decisions are made at the population level using cost-benefit analysis instead of looking at a case-by-case basis.
Cancer treatments are extremely expensive, and some third- and fourth-line treatments can be effective in 10 or 20 percent of people, Croot said. But what doesn’t seem like much of a benefit on a population level is invaluable to the individual.
He’s had older patients live years with metastatic cancer that’s been held in check by these treatments who are able to live full lives and travel with their families, Croot said. Using cost-benefit analysis based strictly on age, those folks may not have been considered eligible for those treatments.
Croot said he finds insurance companies are often receptive when he’s made the case for patients to receive third and fourth-line treatments for metastatic disease.
“They will bend,” Croot said. From his experience as a physician at Veterans Administration hospitals, federal rules are less flexible. “Their rules are rules. They don’t bend.”
However, rationing already is taking place in many places in the United States based on who has insurance, Croot said.
“Tupelo is unique,” Croot said. “Even if you don’t have insurance, I can push the limits of modern medicine to help you,” using community resources, North Mississippi Medical Center’s charity care policies and pharmaceutical company programs.
In other places, it depends on what indigent programs can beg and borrow. He knows oncologists in other states who take only those with robust private insurance or cash in hand.
Hill said his prescription would be for legislators to take a step back and focus on areas where there is broad consensus, such as insurance reforms that would extend the safeguards for employer-based insurance to everyone, Hill said. Eliminating pre-existing condition exemptions and measures to strengthen preventive care have a lot of support.
“Let’s make this the first step in health care reform,” Hill said.

Contact Michaela Gibson Morris at (662) 678-1588 or michaela.morris@djournal.com.

Michael Gibson Morris/NEMS Daily Journal