Urologists' opinions on health care reform run the gamut

After months of debate, negotiation, and deal making, Congress passed health care reform legislation, and on March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. Even as the last vote was being tallied, efforts were under way to repeal the legislation, with opponents fearing that reform is essentially government takeover of the health care system.

Urology Times wanted to know where urologists landed on this spectrum of opinions. We found urologists who place themselves in each of the camps, but perhaps the largest group wishes someone could explain what the legislation actually means for them. (For some early insight, see, "Ready or not, sweeping health reform changes are coming".)

"There are individual points put out by the media, such as not allowing discrimination for pre-existing conditions. Of course, everybody likes the concept, but the bill could also fundamentally change the way medicine is practiced in this country by taking away the ability of patients to choose their own doctors, and mandating the kind of treatments doctors can offer patients-basically rationing health care.

"I'm disappointed they didn't communicate exactly what has been wrought here. If it's really good, then why didn't they tell everybody? To me it smacks of a government takeover of health care, restricting patients' rights."

In practice for 23 years, Dr. Agatstein, a clinical professor at UCLA, has mixed feelings about health care reform. He questions the need, but at the same time, suggests that if that the system were to change, why not implement something that already has been found to work?

"Ninety percent of Americans are happy with their health insurance, maybe 10% aren't insured, and everybody is coming to the U.S. for care," he said. "We are ruining a system that works for 90% of the people to help 10%. It's like throwing the baby out with the bath water.

"Why not expand Medicare? About 95% of every Medicare dollar goes to care, only 5% for overhead, versus 30% for overhead with [private] insurance companies. Maybe the money we'd save there would pay to provide care for the uninsured."

Change was needed

In Couer d'Alene, ID, Edward Ellison, MD, agrees that there's not enough accurate information being dispersed to make an informed decision about the bill, and right now, he's not going to worry about it.

"Change is needed because we can't afford to be where the current health care system is, but the legislation changed so often that I'm just keeping my nose to the grindstone and taking care of my patients," he explained.

"My job doesn't depend on who pays the bills. I'm going to continue to see patients. I'm not putting the mental energy into it other than not making any huge decisions as far as capital outlay and such."

A practitioner for 10 years who does primarily robotic surgery, Dr. Ellison isn't even overly concerned about the potential drop in reimbursement. He believes that will shake itself out.

"If they drop reimbursements drastically and doctors decide they are going to strike, then we'll see what the power of the electorate can do," he said. "Once those Medicare patients can't see their doctors, then you're going to see some real issues. I feel confident I'll always get reimbursed, so I'm kind of neutral."