Obama says health-care reform must be done--this year!

June 2, 2009
Ronald Piana
Ronald Piana

President Obama wants to push forward his health-care reform initiative this year. Republicans have expressed strong reservations about the plan and its express-train timetable, but they do not enough clout on the Hill to stop it.

The debate over health-care reform is beginning to heat up on Capitol Hill. In a telephone call made from Air Force One, President Obama told thousands of supporters in his political organization, Organizing for America, that the opportunity to reform our health-care system would be lost if Congress does not act on it this year.

With campaign-like rhetoric, the President exhorted his organization to gather the same energy and momentum that whipped up during his successful election bid.

Obama wants to parlay his overwhelming democratic majority in Congress to succeed where the Clinton's failed. But successful health-care reform will take more than political clout in order to get the various stakeholders and interested parties at the same table.

One of the centerpieces of the Obama proposal is a public-plan choice model in which Americans younger than 65 who lack employment-based coverage would have the choice of enrolling in a new public health insurance plan that competes with regulated private plans.

When it comes to oncology, this scenario is already happening with the current public insurance program, Medicare, which controls about 45% of American cancer care. But Medicare is a broken program when it comes to appropriately paying doctors for delivering cancer care. Many in the oncology community fear it  might get worse under Obama's plan.

See Community Oncology Alliance: "Increased government leverage will magnify proposed cuts in payments for cancer care."

The government finance committee proposes to pay bonuses to primary care doctors and general surgeons, in an attempt to stem the losses to their ranks due to low salary potential. The most likely way to pay for these bonuses is by cutting payments to specialists, such as oncologists. That means community oncologists could see more cuts to their drug administration and related payments.

Moreover, CMS plans to further decrease payments for drug administration reimbursements to offset a 1% increase in E&M reimbursement. The net result is a severe cut in the revenue stream of community practices, many of which are already hemorrhaging red ink.

In short, the proposal to create another broken public insurance system modeled after Medicare needs careful consideration. Public policy always has unintended consequences. In this case, the consequence might be at the expense of our already financially stressed community cancer delivery system.