With the recent passage of President Barack Obama’s health care bill, VillageSoup talked to three health-care providers about how their practices might be affected by the new legislation. While none claimed to know for sure what would come out of the 3,000-page document between now and when it is finally implemented, all three expressed concern that the bill overlooked one of the most important aspects of health care — keeping people healthy.

Waldo County General Hospital Director Mark Biscone said he was reserving judgment until the reconciliation between the House and Senate bills is complete. The Senate bill, with which Biscone said he is more familiar, would cut $800 million in reimbursements to hospitals over a period of 10 years, he said.

WCGH is currently owed $8 million by the state and federal governments and Biscone said he was wary of any further reductions in government Medicaid reimbursements.
Asked if he would have written the bill differently, Biscone said he would like to have seen limits set on malpractice claims. On the health care side of the equation, he noted the absence in the new legislation of anything that would address chronic lifestyle-related problems like obesity that contribute to many other medical conditions.

Here, Biscone referred to a March 8 article from the Archives of Internal Medicine, in which the authors concluded that raising the price of soda and pizza could steer adults toward a healthier diet, reducing long-term weight gain and insulin levels.

“Forty percent of the cost of health care is because of our behavior. That’s not in there — in Obama’s bill,” he said. “He needs something of substance to address how society’s been behaving and the consequences of that behavior, especially when you have sugar and salt in virtually everything we eat.”

The hospital is in the process of doubling the size of its renal dialysis facility, from six to 12 stations, to be located on the first floor of a building currently under construction. Kidney failure, like the more widely publicized Type 2 diabetes, is on the rise, Biscone said, in part because of an aging population, but also because of a rise in chronic diseases like high blood pressure, which is linked to salt intake, and can, in turn, affect kidney disease.

Biscone also decried the possibility of across-the-board cuts to hospital reimbursements coming as a result of the health-care bill. It would be unfair, he said, for states that have high-quality care and low health-care costs, like Maine, to take the same cuts as states where medical services cost more and the overall quality of care is comparatively poor.
But for now, it’s wait and see. “We knew what was in the initial 2,000 pages plus 200 amendments [of the Senate bill],” he said, laughing. “And there have been tremendous changes since then.”

Seemingly at the other end of the health-care spectrum are the alternative medicine practitioners.

Tim Hagney, a naturopathic physician who lives in Camden and works out of Belfast, said he didn’t anticipate being affected by the bill because insurance companies mostly don’t cover his services, which include homeopathy and lifestyle consultations. Consequently most of his patients pay out of pocket.

All of the health-care industry workers interviewed for this article noted that the federal legislation, touted as a “health-care” bill, is primarily a reform to the health insurance industry, not to the practice of medicine. Most agreed that the insurance industry needed oversight, but the absence of anything on health care, specifically, didn’t pass unnoticed.

Hagney said he was disappointed that the bill did not include support for preventive care. On the importance of maintaining good health, he said medical doctors and alternative medicine practitioners had tended to agree. He would also like to have seen a public option or a provision that would allow people to buy insurance out of state, both of which, he said, could encourage competition that would bring insurance prices down.

Hagney conceded that among the 3,000 pages of the bill, some of these issues may have been addressed.

“You never know. The way the news reports on something, it seems to hammer the same things over and over again,” he said. “There might be other things in the bill that most of us don’t even know about.”

Dr. David Loxterkamp, a physician at Seaport Family Practice in Belfast, said his initial impression of the bill had been positive.

“It’s just the first step in restructuring our health-care system,” he said. “But if we didn’t take this step, there’d be no other steps.”

As a small business, Seaport Family Practice would, under the new legislation, get tax credits for offering employees the health insurance that the practice has always offered, Loxterkamp said. And these, he hopes, will encourage other small businesses to offer insurance to their employees.

But Loxterkamp said there were many things about the health care system that weren’t addressed in Obama’s health-care legislation — things that he says need to be changed.

“One of those is going to be how doctors are paid. We can’t be paid for doing things to people,” he said. “We’ve got to be paid for keeping them well.”

Like Biscone and Hagney, Loxterkamp said he believed that placing an emphasis on preventive care would improve the general health and reduce the number of emergency room visits and expensive procedures, which contribute to high insurance costs.

“Most people in the health-care industry know the system is broken,” he said. “We could have gone any direction in trying to fix it, from payment reform to establishing strong incentives for the development of primary care. I think this is a good step, a necessary step, and let’s call it health-care insurance reform, call it what it is, and work on the rest of it down the line.”

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