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N.D. docs don't want public option tied to Medicare reimbursement schedules

Many doctors want to see a public option in the health care reform bill, two North Dakota physicians said in a Thursday news conference, in part because of how private health insurance companies increasingly "interfere" with the doctor-patient re...

Public option

Many doctors want to see a public option in the health care reform bill, two North Dakota physicians said in a Thursday news conference, in part because of how private health insurance companies increasingly "interfere" with the doctor-patient relationship and deny coverage for pre-existing conditions.

But benefits paid by a government-run health insurance program must not be tied to Medicare reimbursement schedules, they said, because those schedules discriminate against states such as North Dakota that provide quality, cost-effective care.

Private insurers are "an ever more invasive piece of the puzzle" for physicians trying to provide quality care, said Dr. Biron Baker, a family practice physician in Bismarck.

"Every decision we make now is second-guessed by someone in an office hundreds of miles away," he said. "We are forced to spend time justifying what we've done."

Dr. George Johnson, a Fargo pediatrician, also spoke of frustration with private insurers "refusing payments" for medications and procedures he has recommended.


He said he would prefer a single-payer insurance system similar to that in Canada, where government handles all insurance, but having a public option to compete with private insurers would be better than the current system.

Too many patients and their families "go into debt in a huge way, and that's just wrong," Johnson said.

The news teleconference was organized by NDPeople.org, a nonprofit progressive advocacy group.

Baker, employed by MedCenter One in Bismarck, said he has "heard a lot of opinions from patients" about what's wrong with the current health care system, and he has tried to follow the debate over health care reform.

"But it's not so much a debate as a forum for people to get angry and shut each other down," he said.

North Dakota "is possibly the most conservative place on the planet, and physicians, too, tend to be conservative here," he said, acknowledging that some doctors likely have deep reservations about a government-run public option.

"I have a general distrust of government as much as anyone," he said, "but I am wanting to feel optimistic about this," especially if it makes insurance more affordable and encourages insurance companies "to treat people fairly," for example by not denying coverage for pre-existing conditions.

Baker and Johnson said the current health insurance system, coupled with a battered economy, has had a crippling financial impact on many people. "This has to be a No. 1 national priority," Johnson said.


Baker said he sees too many patients who don't qualify for Medicare and who can't afford private insurance.

"I saw a couple this morning," he said. "They don't want any testing or procedures. ... They want a pill for $5 that will treat the condition for today. They don't plan for next week or next year. But if these people had coverage, every dollar we spend on prevention now would save $6 spent down the road" for treatment.

Dr. Robert Thompson, executive medical director at Altru Health System and immediate past president of the North Dakota Medical Association, did not participate in the teleconference, but in an interview Thursday, he agreed that Medicare reimbursement schedules are the snag.

"Physicians in the state are not opposed to public option per se," he said, but the bills before Congress still tie a government-run plan to "unfair" Medicare rates that favor some states over others, with North Dakota at the bottom.

"There is nothing in the House or Senate bills that addresses those geographic disparities," he said. "Doctors are supportive of any payer who reimburses fairly for services provided. But when a payer doesn't cover the cost of providing a service, it's not sustainable."

Physicians are sensitive to the cost of care, Thompson said. "But to be constrained by administrative rules and overhead not covered by the payer, it's very hard to provide services. It also makes recruitment and retention of physicians more difficult."

Thompson added that physicians in the state are disappointed that the reform bills don't address liability and malpractice reform.

National support


A survey commissioned by the Robert Woods Johnson Foundation, published in the Sept. 14 edition of the New England Journal of Medicine, found that 62.9 percent of U.S. physicians support reform that would include public and private insurance options.

"In every region of the country, a majority of physicians supported a combination of public and private options, as did physicians who identified themselves as primary care providers, surgeons, or other medical subspecialists," according to the survey analysis.

"Among those who identified themselves as members of the American Medical Association, 62.2 percent favored (having) both the public and private options."

About 10 percent of doctors support a single-payer system where a Medicare-like public program replaces private health insurance.

National polls gauging general attitudes toward a public option have shown similar results.

A Washington Post-ABC News poll in June indicated that Americans support a public option by 62 percent to 33 percent. The margin dropped to 52-46 in mid-August but grew to 55-42 in mid-September.

Hospital administrators in North Dakota, including leaders of Altru Health System, have been cool toward public option -- again, if tied to Medicare.

In news conferences Oct. 14 in Grand Forks, Fargo and Bismarck, hospital officials said such a system would diminish the quality of care in North Dakota. Roger Gilbertson, CEO of MeritCare in Fargo, said it could destabilize "the whole health care system in North Dakota, to the point even of making much of it nonviable."


Sen. Kent Conrad, D-N.D., has cited such warnings as he champions a system of nonprofit cooperatives to compete with private insurers.

"I'm a great admirer of Sen. Conrad," Johnson said during the doctors' teleconference Thursday. "But I really wonder about ... cooperatives" and whether they could be effective.

Reach Haga at (701) 780-1102; (800) 477-6572, ext. 102; or send e-mail to chaga@gfherald.com .

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