Family Medicine|October 14, 2012 7:00 AM

In fear of the healthcare law

Dispute over details leaves some voters wary, doctors divided

Ben and Olivia Schwelling examine the pro-Romney, anti-Obama bumper stickers and buttons for sale at D'Evelyn Junior-Senior High School in Lakewood before the arrival of Republican presidential nominee Mitt Romney during a recent rally. Photo by Ann Imse/Colorado Public News

Voters at a recent rally for Republican presidential candidate Mitt Romney cited not just disagreement, but outright fear of the new healthcare law.

“I don’t think there’s going to be enough money,” said Karen Albright, a nurse from Parker, on a warm autumn evening waiting in line to hear the candidate. “I expect rationing … they will say you are too old.”

Armeda Freel, who traveled from Scottsbluff, Neb., to a rally in Lakewood, is on Medicare, the government health insurance program for people 65 and older. She said she hurried to have surgery on the carpal tunnel problem in her hands this year because she fears it would be denied after the healthcare law takes full effect in 2014. “I thought there was a chance they would say, ‘Live with the numbness. You’re not going to die.’”

Charles Patricoff, also in line, looked tanned, strong and younger than his 60 years, yet said he had suffered a major heart attack just three months earlier. He believes he might have been denied treatment under the new law. “They might have looked at me and my age, and said, ‘You’ve lived a full life.’”

Romney and most Republican congressional candidates have promised to overturn the healthcare law if they are elected. The law, passed in 2010, was upheld by the U.S. Supreme Court in June. If left intact, it will go into effect in 2014.

Colorado Public News asked two leading physicians in Colorado on opposite sides of the political fence whether these fears of the federal government interfering with treatment of their patients were justified. The answers were enlightening, and very different.

Dr. William G. Plested, president of the national American Medical Association from 2006 to 2007, retired as a thoracic and cardiovascular surgeon in Santa Monica, Calif. to Bayfield, Colo., near Durango. He is a severe critic of the healthcare law.

In stark contrast is Dr. John Bender, president-elect of the Colorado Medical Society and a family medicine doctor with Miramont Family Medicine of Fort Collins. He does not see anything in the health law that would cause “interference in the daily practice of medicine.”

Plested said he is certain that the Affordable Care Act will lead to rationing, though he concedes the bill does not stipulate that. “This is what an intelligent person, looking at what has happened, is going to say,” Plested said.

He questions the administration’s insistence that health costs will drop – noting 10,000 baby boomers reach 65 every day, and thus becoming eligible for Medicare. He believes costs will soar, so rationing is inevitable.

He also points to a board created in the first stimulus law to foster scientific research on which treatments work best. Cost will be a factor, he insists, and doctors will be penalized for non-compliance.

In contrast, Bender says that such research helps him provide better care at lower cost. For example, he discovered in 2009 that only 45 percent of his diabetic patients were meeting a standard of being tested every three months. “I never would have thought I was so low.”

Now he has that figure up to 85 percent. And more regular testing cuts costs dramatically. “If I keep one person out of the ICU, I save the system half a million dollars,” he said.

Bender said he would never have known his standards were so low without electronic records. Counting the paper records of thousands of his patients would have taken weeks, he said. Currently, many hospitals can’t even send records to the hospital across the street when a patient is transferred, and expensive tests get repeated, he said.

Providers who do not computerize their medical records by 2015 will face a small penalty.

But electronic medical records have created another worry to some voters – for other reasons. Alice Clark of suburban Denver said, “Somebody’s looking at my personal information. There’s this database where all of our health information is, and the government gets to look at this.”

Plested believes the Obama Administration is pushing computerized health records so the details can be transferred to the Internal Revenue Service and federal health officials. Then the doctor will be told to use a treatment “that is preferred by the government.”

Bender sees nothing like that in the law. He does not expect to call for government permission to treat his regular patients.

Bender says no one in government sees his regular patients’ electronic medical records, which are locked behind multiple firewalls. While Plested believes the IRS gets medical records, Bender said the IRS would need a subpoena to get the ones from his office.

But Bender said medical records do leave his office every day to go to insurance companies – in the billing records. Payments depend on diagnosis and treatment. And, he noted, Medicare is government insurance for people over 65. So lists of their treatments have already been going to a federal agency for years.

On the overall rationing concern: “The fear is 65-year-olds are not going to be able to get care. I don’t think that’s going to happen,” Bender said.

The concerns come when treatment is of doubtful value, he said. Take chest pain. Cardiac catheterization has the same results as simply taking certain pills, which carry far less danger than surgery, he said. Yet cardiac catheterization is done three times as often in certain locations compared to others. “We may be looking at unnecessary procedures,” Bender said.

“The patient perceives this as better care,” because he is receiving more care, he said. But that isn’t true, when one looks at the evidence, he said.

Finally, another change in medical care is beginning to pay doctors to keep patients healthy. If hospitals and doctors are not paid for each procedure done, they won’t have a financial incentive to provide procedures for which there is doubtful need, says Dr. Michael Pramenko, a past president of the Colorado Medical Society. And the government won’t have a financial incentive to limit those procedures.

Pramenko also said the law does not prohibit people from purchasing healthcare on their own that isn’t covered by their insurance.

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