Consequences of reform

Editor's note: J.C. Noreika, MD, MBA, submitted the following open letter in September to Sen. Sherrod Brown (D-OH), outlining nine possible unintended consequences of health-care reform. Dr. Noreika is founding partner of Excellence in Eyecare, Medina, OH, and editor of the "Practice InSight" column in Ophthalmology Times. Attempts by Sen. Brown and Dr. Noreika to connect have been unsuccessful.

You are being pressured from all sides in this recent iteration of the movement for universal health insurance. As a student of history, you know that this issue has been debated for almost 100 years. You and your staff are fully informed in regard to the big issues. You share concern over the unimaginable deficits that this country is incurring. A projected $1 trillion for health-care reform alone! The nation's deficit is to exceed $1.17 trillion in 2010 and $9 trillion over the next decade.

The following is one physician's opinions. Although not statistically significant, these views, like good military intelligence, are conceived and refined on the front lines of the daily, all too frequent skirmishes among and between physicians, patients, insurers, bureaucrats, regulators, lawyers, and other vested interests. I have listened closely to the rhetoric. What I haven't heard is a discussion about the inevitable unintended consequences health-care reform will create.

UNINTENDED CONSEQUENCE #1

THE UNINSURED AFTER UNIVERSAL COVERAGE.

No one seriously opposes a safety net of health insurance for every citizen. Health-care coverage should be available to all who want it. I know no physician who refuses necessary and timely care to a needy patient. An unintended consequence of the current health-care proposals is that the uninsured will remain among us and, in keeping with their Hippocratic Oath, physicians and hospitals will be obligated to care for them.

Who will be the uninsured? When I attended a session at the Old Executive Office Building that was headed by then-First Lady Hillary Clinton and Clinton administration adviser Ira Magaziner, who led the federal government's Task Force on National Health Reform during the Clinton health-care initiative, I was made aware of the problems experienced by emergency room doctors in Los Angeles in their attempts to minister to the uninsured undocumented-worker population. Today, the problem is worse. Where will be the resources to provide pro bono care for this population?

Another example? I personally provide examinations to adults who could qualify for state or federal assistance for themselves and their children but fail to do so. Don't these individuals have a responsibility for their and their children's care? If they can't or won't accept this responsibility, who will fill the breach?

Finally, every physician sees patients who choose not to purchase insurance because they are young and healthy, see it as an opportunity cost and spend their funds elsewhere, or simply game the system. Can this subpopulation of resource-users be coerced by the government to purchase health insurance? Based on the number of uninsured motorists on the road, I doubt it. This unintended consequence of "universal" coverage may leave some vulnerable populations in worse situations than they find themselves now and further strain the providers.