Wishard doctor hopes for health care reform

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Indianapolis - President Barack Obama spoke to the nation Wednesday night pushing his health care proposal, and there's one local doctor who thinks his patients will benefit from reform.

The president wants to end the health insurance industry practice of refusing coverage to people with pre-existing conditions or dropping customers when they get sick, and to limit premium discrimination based on gender and age. The proposal also seeks to cap out-of-pocket expenses, eliminate extra charges for preventive care and eliminate the 'donut-hole' gap in coverage for prescription drugs.

The plan would create an exchange to allow people without insurance and small businesses to compare plans and buy insurance. People could also get tax credits if they had trouble buying health insurance, as would small businesses. The president also said he supports a public health insurance option to compete with private insurance companies, although he indicated in his speech that he would be willing to sign a bill that didn't include a public option.

Critics say they don't want a government-run health care program and fear it would ultimately cost too much. "The American people have spoken. They do not want the government-run health care plan paid for with $800 billion in tax increases that Democrat leaders in Congress are advancing," said Rep. Mike Pence (R-IN) in a statement issued after President Obama's speech.

In the meantime, millions of Americans (that number is disputed by political parties, although it ranges anywhere from 30 million to 46 million) continue to go without health care.

In the Wishard emergency room, the staff covers 110,000 patient visits a year. About 40 percent of them are uninsured. The balance is mostly on Medicaid or Medicare. Doctors say these patients often delay care.

"When you have care delayed because of lack of insurance or you're unable to get on Medicaid - it's very hard to get on Medicaid in Indiana, especially in Marion County, so patients don't have Medicaid. Often my patients die before they ever get Medicaid," said Dr. Greg Gramelspacher, Wishard Hospital.

Obama's proposal seeks to bring coverage to all Americans. A congressional amendment not in Obama's original plan would require you to get health insurance - no more gambling that you will stay well and don't need it and you are going to stay healthy. It's similar to the requirement in Indiana that you need car insurance if you are going to drive. There would be exceptions for those who are in the lowest income levels.

The president promises to enact change without adding to the deficit. According to the Associated Press, House Democrats offered a bill that the Congressional Budget Office said would add $220 billion to the deficit over 10 years. But Democrats and Obama administration officials claimed the bill actually was deficit-neutral. They said they simply didn't have to count $245 billion of it - the cost of adjusting Medicare reimbursement rates so physicians don't face big annual pay cuts.

The long-term prognosis for costs of the health care legislation has not been good. CBO Director Douglas Elmendorf had this to say in July: "We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."

"I think the tax implications will be significant and I think it's a story that will affect everybody, some positively, many negatively," said Bill Terando, Butler University associate professor of accounting.

Terando says repealing President George W. Bush's tax cuts would increase the tax rate to 36 percent. That's up three points for families making more than $357,000 a year. Any earnings over that would be taxed at 39.6 percent. Your income may go up if the value of your health insurance is added on to your tax bill.

"Your gross pay may be $10,000 but then there are additional benefits that may be provided by your employer that don't really come through your paycheck," he said.

Small businesses providing insurance could get tax breaks. They are changes Dr. Gramelspacher believes will benefit his patients. His training is nearly complete before a coast to coast bike trip where each mile is dedicated to a Wishard Palliative Care patient - the list of names totals 3,000 patients that he says passed before reform could reach them.