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Health Care Reform: A System that Works for Patients and Providers

joe-sestakBy Congressman Joe Sestak

The health care reform measures that I helped passed in the House — the landmark Affordable Health Care for America Act (HR 3962), along with the Medicare Physician Payment Reform Act (HR 3961) — will dramatically improve our health care system for patients and providers.

The primary concern of all doctors is treating the sick and healing the wounded. Health care reform will expand access to lifesaving care for millions of Americans who lack insurance. It will also improve care for everyone by ending denial of coverage for pre-existing conditions and eliminating caps on coverage. Doctors understand that an existing health condition is all the more reason to help a patient, not deny them treatment. No longer will insurance industry bureaucrats make life-and-death decisions and interfere in the sacred bond between doctors and their patients.

The public health insurance option included in the insurance exchange will provide many Americans with real choice, increased access, and will lower average insurance premiums — but it is an option for consumers just as it is for doctors. Physicians will not be required to participate in the public option, though I believe many will, as providers’ rates will be fairly established through negotiation.

The important issue of Medicare reimbursement is addressed in the accompanying bill, HR 3961, which will permanently replace the outdated Sustained Growth Rate (SGR) for determining doctors’ payments through Medicare and military TRICARE. When the SGR was implemented, projections failed to anticipate the steeper rise in health costs relative to growth in per capita Gross Domestic Product (GDP). As a result of a flawed formula, every year physicians face cuts to their reimbursement. For six years Congress has kicked the can down the road, preventing cuts one year at a time but failing to address a problem that continues to grow. The result is a looming 21% cut in 2010 that threatens doctors’ practices and could force them to limit their services to seniors and military families. This bill will finally address the problem by rebasing expenditure targets on a rolling five year average to prevent the kind of cuts we’ve witnessed since the plan was first implemented.

This reimbursement fix is important to strengthening our health care workforce, something that is also addressed in our reform measures so that our health system is ready to provide for those who gain access to care. The reform bill includes over a billion dollars in additional funding for the National Health Service Corps, strengthened scholarship and repayment programs for providers in areas of need, and enhanced grant programs to training institutions to encourage expanded primary care programs.

Fundamentally, these reforms will allow doctors to perform their craft and fulfill their mission of helping those in need. That’s why our plan has been endorsed by the AMA and at least 13 other major physicians’ organizations. We finally have a plan that provides America’s doctors and patients the health system they deserve.

Congressman Joe Sestak, PA-07, serves on health care subcommittees in the Education & Labor and Small Business Committees and is a candidate for the U.S. Senate in Pennsylvania.


  1. Government must be removed from the establishment of fees for service. That is a negotiation that should occur between the physician and the patient. It will be based on free market forces such as the value the patient places on the service. The role of 3rd party payers would then be to re-imburse SOME of the cost that the patient incurs. That amount becomes a negotiable factor between the insurance company and the client (patient or business). Again, free market forces will control what percentage of a fee that the insurance company will pay. “Competition” for clients and customers will be the main factor as individuals and businesses shop for the best value. The elimination of the entire “insurance billing department” (translation: “racket”) from the physician’s office will allow fees to come down remarkably. A larger percentage of fee re-imbursement might be expected for expensive lab tests, medications and procedures. Even that should be left to free market forces.

  2. Medicare and Medicaid are going bankrupt at the current level of demand. So we increase access for patients 55-65 and expand Medicaid to 30 million or so patients. We do absolutely nothing to control costs which will explode with the addition of uninsured patients with more illness and more demands on the system. We do nothing to expand the supply of physicians, who will see their Medicare reimbursement decline 21% next year and in the out years. This is an aging physician population which can cannot be easily expanded. Finally we expand entitlements to more services, since more is the operative word for Democrats eager to fill the entitlement trough. And we do all of this on the backs of the shrinking productive segment of our economy. Good luck Admiral.

  3. This is astounding. This article demonstrates the total lack of understanding of how insurance works. Insurance companies deny coverage for pre-existing conditions in part because this could jeopardize the ability to provide the coverage they have agreed to give to their existing customers. The article also (wrongly) assumes that people are being denied care because they do not have insurance. Show me one emergency room where this has happened. The availability of insurance coverage does not determine whether or not someone gets care. There ARE people who become financially strapped because they can’t afford the medical bills, but hospitals are often willing to work around this, offering payment plans, timely payment discounts, etc. I have experienced this fact myself. Destroying whole system for the sake of a few million individuals is an irresponsible thing to do. Congressman Sestak, you and your cohorts should be ashamed. We are not that stupid.

  4. This whole “reform” is a joke. As far as the AMA backing; only 17% of the doctors are members of AMA, mostly made up of academia, students and retired doctors. Most practicing doctors do not agree with this “reform”. The “affordable” plan being shoved down the throats of the American people is ridiculous. Wait until the people realize they will be taxed years before any of these changes will go into affect. The premiums will be as high if not higher then they pay now and the out of pocket expense on top of the premium will be high. Our ELECTED politicians are so out of touch with the people is no longer funny. So you next election. Hopefully we can get you all out before you destroy this great country.

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