The Doctor Is In: The $634 billion down payment on healthcare reform

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The ten-year budget released this week by president Obama establishes a $634 billion fund as a down payment on health care reform. To subsidize an overhaul of the health care system, the new administration plans to raise taxes on people who earn more than $250,000, which has been criticized as an effort to redistribute wealth.

As a citizen I think we all need to pull together to help the 50 million or so Americans who are now uninsured. As a physician, I think it's about time we provide Americans with access to quality, affordable health care.

Every day I see patients who say that they are about to lose their job, and consequently, their health coverage. My practice is in Greenwich, CT -- not exactly an impoverished community -- and I'm seeing more and more patients who choose to forgo their annual exam or delay a surgical procedure because they can't afford health insurance. The weekend calls asking me to call in a prescription so patients don't have to make an appointment for an office visit are also picking up.

But if you put off routine care it may end up costing more in the end because preventive care is less costly than emergency care. For example if your appendix ruptures because you didn't go to the doctor when you first experienced abdominal pain, you may end up with an ER visit and extended hospital stay for a problem which may have been an outpatient procedure. This could rack up thousands of additional dollars in medical bills, not to mention added pain and suffering.

It's interesting to note that this is largely a middle-class crisis since the poorest of the poor have coverage because they qualify for Medicaid. Those affected are largely working class and professional people who didn't realize they were vulnerable until they lost their job and are suddenly faced with paying monthly premiums of $1,400 a month for a family of four. Even if you can afford insurance, if you have a preexisting condition you may not be able to get a decent policy.

The need for change is compelling, even though $634 billion sounds like a lot of money. The country spends $2.2 trillion on healthcare now, according to an article in the New York Times -- equal to 16% of the GDP, and the amount is expected to rise to 22% of the GDP by 2025. The bottom line is that America can't afford to spend what we do now or continue to have healthcare costs rise. Something has to be done or no one will be able to afford health care.

Russell Turk, M.D. is an obstetrician and gynecologist in Fairfield County, CT.

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