Wednesday, March 31, 2010

Nashvillians who lived abroad see flaws in health reform

In Europe and Canada — broad regions with nearly universal health coverage — conventional wisdom was that providing insurance options for 32 million more Americans under health reform had dragged the United States into the 21st century.
But not all Nashville residents with firsthand knowledge of health-care practices in other lands agree.

Some see flaws in the reform package passed by Congress this month, saying it increases the role of government without adequately addressing the rising costs of medical care.

Judy Bishop, chief executive of Brentwood-based home health services provider Guardian Home Care, worries that insufficient planning to increase the supply of physicians could affect access to care in the long run.

She's also concerned that cuts to Medicare could lead more U.S. doctors to opt out of the federal program, practicing instead a sort of concierge medicine to focus on patients who can pay out of their own pocket for services.

One result could be an even more pronounced shift to a two-tier system of care in America, akin to the one in England, where those with money can avoid longer wait times by paying private practice doctors directly, said Bishop, who worked in the Canadian system for 25 years before spending 16 years in this country.

Craig Rowe experienced longer wait times for doctor's appointments and medical checkups firsthand before moving here a decade ago to start a consulting firm. Rowe is British, a London native.

"I'm now very spoiled by the health care that I've received in the United States," said Rowe, a U.S. permanent resident. "The expectation, the level of service is much better. But you pay for it. It's extremely expensive."

Rowe doesn't consider health-care reform as socialized medicine because companies and individuals still will share the costs. He believes health-care reform was needed but isn't sure it will save money.

"When you start excluding pre-existing conditions and (setting) policy limits, it's hard to see how you're going to save money because someone's going to have to pay for that," said Rowe, a marketing representative at a benefits consulting company, Benefit Communications Inc.

Too much government is fear

Meanwhile, Vanderbilt geriatrics physician Ralf Habermann, a native of Germany, would have liked to see more done to address the quality of care and medical liability under the federal makeover of the U.S. health system. Today, a fear of lawsuits causes doctors to order more tests as a safety measure, he said.

Habermann said many of his European colleagues never understood why the United States didn't have health insurance for all. But changing U.S. health policy to provide insurance coverage for millions of additional people won't be a panacea.

"History shows that whenever the government starts to get involved too much, the flexibility of planning and the flexibility of the markets get lost, and suddenly the system is not adjusting to changes. That ... leads to longer waiting times and certain services not (being) offered," he said.

Getahn Ward an be reached at 615-726-5968 or

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