Government Involvement in Health Care Reform USA

Because of this experience I am very leery to hand over health care to the government. Dr. Phil once said about relationships, to look at the past is a good indicator of what the future relationship would be. So lets look at the government involvement in health: Medicare.. would probably be in an OK shape if the Trust Fund had not been robbed so many times. My feeling is it is going down now. Medicaid.. not so good either.. Telemedicine, although the President and congress recognize the importance it could have on patients and the health outcome and have provided Grants. The issues regarding reimbursement remain basically the same.

Telemedicine.com describes Telemedicine as the ability to provide interactive healthcare utilizing modern technology and telecommunication. It allows patients to visit with physicians live over video for immediate care or capture video/still images and patient data, store it and send to specialists for diagnosis and follow-up treatment at some later time.

In 1997-1999 I was given the opportunity to be the telemedicine coordinator for the Good Samaritan Society for Northwestern North Dakota. We were on the forefront. The Good Samaritan Society recognized the need in rural areas to provide quality care for their residents of long term care and the difficulty for residents to ride several miles to see a specialist. They applied for a grant through the RUS (Rural Utility Service), which they received. They searched out and aquired the newest technology. Because of being a front runner we were given the opportunity and demonstrated a live telemedicine consult for the National Governor's Conference. We had the capabilities to go live or to store and forward similar to attachment on e-mails for the specialist to view at their convenience. An example of this would be following hip surgery, the capturing of several pictures of the incisional area and then provide a video of the patient working out with physical therapy, therefore allowing the specialist to see how they were doing and any recommendations they would have.

There were several hurdles to jump through to get this network to be viable. One large one was reimbursement. In order to get physicians onboard they needed to be paid. Senator Kent Conrad wrote a bill he presented to congress for Medicare to reimburse for telemedicine.. which passed. We were ecstatic! Then came the guidelines:

1. Only live conferences would be covered, not store and send.

2. There had to be physicians at both the remote site and the hub (specialist) site. Physicians are very busy with emergencies that come up. The chance of getting two physicians at different sites at the exact same time was challenging. How many patients when sent to specialist have their local physician come with?

3. And the clinker was this: The specialist would be reimbursed and he/she would then give a portion of their reimbursement to the local physician! How many specialists would jump on this bandwagon?

I contacted our Senators' office and this is what he said. "It is very difficult to change something once it becomes law." How the guidelines are written is not always the intent of the bill.

According to Telemedicine.com, real-time is the most common use in Telemedicine today. For it allows for live video for the providers and patient to all communicate together. Store and forward is used when both health providers are not available or not required at the same time.Reimbursement is varied specific to the state or country you are in. They have seen clinics and hospitals that are currently working under a Grant which may have allocated funds available to reimburse for the consultation in cases where the patient does not have insurance or their insurance does not cover the consultation.

Because of this experience I am very leery to hand over health care to the government. Dr. Phil once said about relationships; to look at the past is a good indicator of what the future relationship would be. So lets look at the government involvement in health: Medicare.. would probably be in an OK shape if the Trust Fund had not been robbed so many times. My feeling is it is going down now. Medicaid.. not so good either.. Telemedicine, although the President and congress recognize the importance it could have on patients and the health outcome and have provided Grants. The issues remain basically the same regarding reimbursement.

My fear is that by pushing a bill through so rapidly and then the guidelines written, is going to be a disaster! In closing a quote from Franklin Delano Roosevelt, "The only sure bulwark of continuing liberty is a government strong enough to protect the interests of the people, and a people strong enough and well enough informed to maintain its sovereign control over its government."

Copyright (c) 2009 Elda Titus