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Senator John Barrasso was “Doctor” Barrasso, an orthopedic surgeon from Casper, Wyoming, long before he came to Washington. So, after the passage of broadsweeping healthcare reform, it came very naturally for him to offer a physician’s perspective on the floor of the Senate. Since then, he’s given these “second opinions” about the unintended consequences of healthcare reform nearly every week. EPM caught up with the Senator for some of his thoughts on how the Affordable Care Act is going in its early stages of implementation.

EPM: What are your thoughts about the Supreme Court’s ruling on Obamacare?
Barrasso: “Well, I think the votes going to be 5 to 4. I just don’t know which way. It ought to be overturned, because it’s unconstitutional. They can’t come into your home and say you have to buy a product, which is what this is. It’s a mandate that you have to buy a product. You can’t mandate that someone buy a private product. They (the Supreme Court) are looking at it from several different ways. They are looking at whether you can require citizens to buy a government approved product. They are looking from the standpoint of Medicaid whether they will be able to put that onto the states.

EPM: If conservatives take control, what will they do?
Barrasso: “It all depends on who is in the White House. Whatever happens that person will have to sign or veto whatever a Republican majority does. I don’t see any scenario where, with an Obama re-election, Republicans will be able to override a presidential veto. So you have to have a Republican president and the House and Senate. And the Senate, no matter what numbers you look at, even the most optimistic don’t give us 60. So we would be using reconciliation just like they did. So everything came in with reconciliation will go out using reconciliation.

EPM: What parts of the legislation would you take down first or preferentially?
Barrasso: “I’d like to get rid of the mandate where everyone has to participate. I think people ought to have waivers. I would work to get anyone who wants out from under it to have a waiver.”

EPM: There have already been over a thousand waivers granted?
Barrasso: “Yes, and some of those have been granted to unions with over 30,000 members. Over 3.5 million covered individuals have gotten waivers. Unions are about 10% of the workforce, but they have gotten about half of the waivers in terms of covered bodies. 50% of people who have received the waivers get their health insurance through the unions. These are the same unions that lobbied for the health care law. If you go to their web sites they show their success, you know, the protests in the park with the signs “We want health care NOW!” Now they’ve read the bill. Nancy Pelosi said “First you have to pass it before you find out what’s in it.” Now that they know what’s in it they say, “We can’t do that. It’ll break our plan. If we have to provide this level of coverage. Because it’s government approved coverage, which gets very expensive. And they say “We can’t afford this.” Now the incentives in this health care law are for employers to dump providing health care and just pay the fine.”

Tell us about your “Second Opinion” speeches to the Senate.
Barrasso: “When this law was passed, 2700 pages, 1700 times it says the Secretary will write the rules and regulations, it just seemed to me that every week there was going to be some new unintended consequence. So as states look into what happens if they set up an exchange. And when Wyoming did this they brought in a consulting group to look at it. And they said that if you are required to provide this high of coverage the cost will have to go up 30-40%. Well the President promised as a part of his initial speech that your health care premiums would drop for a family $2500 per year. People heard him say that. And he also said that if you like what you have you can keep it. Now we know that about half of the people who like what they have will not be able to keep it. And now government actuarials are saying that premiums are going up faster than if we had never passed the health care law.

We are always looking at what to discuss next. Well today (Dec 1st) USA Today published a story how doctors and hospitals are firing nurses and health care providers hiring pencil pushers. So the health care sector is actually growing in terms of jobs, but it is decreasing in terms of the people who provide the actual care.

EPM: Can you discuss the disproportionate impact of the increase in health care on young people?
Barrasso: When you compare what a young healthy person who’s not overweight, who goes to the gym regularly has to pay in health care premiums to a 62 year old who smokes, sits on the couch all day eating Cheetohs, who is not taking any responsibility for his health, you can only charge, according to this law, the older person three times what you charge the young health person. So if you are going to provide the high level of care for the older person, you have to charge the young person more.

EPM: Let’s talk about Accountable Care Organizations
Barrasso: If you go to the bill and read through the six pages on accountable care organizations, you sort of say this is reasonable, you know, accountable care. And the President talked about the Mayo Clinic Model, the Geisinger Model. But then they come out with the 400 pages of regulations and 25 pages of “guidance” that had to do with the Stark bill. You know they didn’t want you to refer to yourself. Now they want you to refer to yourself. And when the Mayo Clinic looked at the list of 60 different criteria. And they said “We can’t do it.” Geisinger said they couldn’t do it. And what is really distressing how much money would be saved by doing this, by rejiggering all of medicine. Secretary Sebelius said that over four years we would only save less than one billion dollars over four years. Well, we borrow four billion dollars a day because of our debt. So we are going to do all of this, to all of medicine, for four years, just to save what we borrow from China every day or what we borrow overall every six hours. It’s ludicrous.

EPM: If the nation rejects this approach to health care and elects a Republican President and a Republican House and Senate, and there is a repeal of this legislation, do the Republicans have anything to ready to go to put into it’s place?
Barrasso: The question is whether any Congress can come up with a comprehensive answer to this and the answer is no. We should take a step by step plan and make positive steps. People should be able to buy insurance across state lines. That’s a positive step. I think you have to deal with junk law suits. You have to let small businesses join together to form buying units to purchase insurance. That’s positive. I think there need to be incentives. There needs to be incentives for that 62 year old who’s eating Snickers and Cheetohs, to turn off the TV and go outside and exercise. I think you have to have skin in the game. People are smart about their own money. I used to have all the people who had met their deductibles come in for their “free” carpal tunnel procedure between Christmas and New Years. I would just line them up. People are smart when they are using their own money.

EPM: How is the best way in your mind to attack junk law suits?
Barrasso: I think the idea of health courts makes sense. There are already “copyright courts”. There are specific courts out there who could make these determinations. I like the English rule, where the person who brings a junk suit, if they lose, they are responsible for not only their expenses, but the defendants costs as well. We also want to find a way for the patient who is truly injured by negligence to be compensated quickly and fully. And right now we know that 60-70% of the awards are not going to the injured parties, it goes to the system.

EPM: What are your thoughts on the IPAB (Independent Payment Advisory Board)?
Barrasso: “This is the President’s ‘Denial of Care Board’, because that’s how they are going to do it. They will say “Oh yeah, you can have anything you want done but we are only going to pay this much.” That’s why Medicare patients are worried. They are afraid that they won’t be able to find a doctor which is likely to happen. If you have a doctor, they are not going to turn you away. But if that doctor retires, or you move, you could have a very hard time finding a new doctor.

Watch the video of EPM’s interview with Senator Barrasso on www.epmonthly.com


 

Comments   

# ** 2012-01-14 06:55
The individual mandate is unconstitutiona l under commerce clause. The plans for the draft are ok.
Reply
# ** 2012-01-14 15:53
The plan to use the pilot for the draft is okay.
Reply
# Jeremy Voros 2012-02-19 18:41
I appreciate the perspective. But Senator Barrasso's critique fils to address so many of the important points salient to EM physicians. What of the EMTALA care we provide to trauma patients, underinsured patients with AMI, or indigent drug and alcohol users? The system already burdens the well-insured gym-going 30-year-old with the cost of all this care. It is just hidden away in the fees charged by hospitals to recoup their costs. And what of the healthy young person who chooses to forgo insurance and then is brought in as a trauma patient, spends a month in the ICU and is discharged with a $400000 medical bill? Who pays for that choice? One way or another it is the tax payers or the well insured. To ignore this side of the health care issue is to bury your head in the sand and pretend we live in the good old days when antibiotics and a little black bag were all doctors had at their disposal. It is not elective carpal tunnel surgeries that are weighing the system down.
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