Small-government prescription for prez

To: President Bush

From: 2 doctors who care about their patients

Re: Fulfilling your promises on health-care policy

We know you've only been in office for one month, but we thought we'd
check in on how you're doing on health care. As physicians, we're
concerned about how changes in the health-care system impact the trust
between patient and doctor.

Your campaign promised greater choice in how people meet their medical
needs. You wanted to:

• Reform and strengthen Medicare to allow seniors to have more
  options, rather than simply pouring more money into the system;
• Provide tax credits to give low-income families more choices in
  health coverage plans;
• And most important, for government control to take a back seat to
  competition and real choice.

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As doctors who put patients first, we were excited that you supported
"a health-care system that is patient-driven, not government-run, that
leaves medical decisions in the hands of physicians instead of
insurance companies, and that offers more and better choices to
consumers."

But frankly, Mr. President, we're confused by some of your
post-election proposals that seem to contradict the vision you
articulated a year ago.

You said you wanted to stop pouring taxpayer dollars into the Medicare
system. But a federally funded, state-managed Medicare prescription
drug plan does that.

And wouldn't creating more community-based primary care sites and
expanding the National Health Service Corps put politics ahead of
medicine? This can't be good for patients.

So what are our humble suggestions? We encourage you to stick with
your earlier message that less government intrusion into health-care is
better and healthier for everyone. We favor lightening the tax and
regulatory burdens on both patients and doctors so that more voluntary
arrangements are created instead of government programs and their
inevitable mandates and counter-productive incentives.

Here are some ideas that would help you achieve your goals, based on
what we hear from patients:

1. Allow Medicare patients more freedom.

Just this week, USA Today reports that Medicare patients are having
trouble finding doctors to take them on as new patients. But, Mr.
President, this is not a new problem.

Three years ago, the Association
of American Physicians and Surgeons reported that many doctors
felt forced to restrict services to Medicare patients because of
hassles or threats from Medicare, and reimbursement that fell well
below the cost of providing the care. Last year, AAPS reported that
almost three-fourths (71 percent) of doctors made changes in their Medicare
practices to avoid threats of prosecution, including cutting down
services available to Medicare recipients.

The basic problem with Medicare is that the government wants to
control the lives of Medicare recipients and their physicians.
Medicare won't cover services that some low-level, non-M.D., government
bureaucrat decides isn't necessary. And further, federal regulations
prohibit seniors from avoiding the Medicare bureaucracy by paying
out-of-pocket for those denied services.

Mr. President, please reform Medicare to allow seniors freedom to
choose their medical services.

2. Eliminate penalties for doctors who provide the best care for their patients.

In 1996, the Clinton administration launched a campaign to criminalize
the practice of medicine. Not only is there now a $1,000 bounty to
Medicare patients if they report their own doctor on suspicion of
health-care fraud, but doctors can be sent to jail for doing the right
thing for their patients if the federal government decides they're
wrong. Obviously, this helped destroy trust between patient and
doctor.

Forget the threat of malpractice suits. We can tell you, Mr.
President, that doctors now fear capricious federal prosecution for
how they treat their patients; they are afraid to do the best thing
for their patients because federal prosecutors might come down on
them.

Please, Mr. Bush, review and reverse the impact of these draconian
measures that punish the best doctors and compromise patient care.

3. Give everyone the same tax break for medical care.

Mr. President, shouldn't every citizen receive the same tax break for
medical care spending, whether through an employer or purchased on
their own and whether spent on insurance or medical treatment?

The current tax code allows employers to take a tax deduction for
health benefits provided for employees. So most people are stuck with
a health plan chosen by their employer, even if the plan doesn't meet
their needs. If they want to pay directly or buy their own coverage,
they have to do so with after-tax dollars, at a much higher cost.

How about allowing everyone a federal tax deduction for health-care
spending? That would mean everybody could choose the best health care
for them and their family with the same tax advantage. It will help if
it was easier to set up a Medical Savings Account, a combination of
high deductible insurance for large medical expenses with a tax-free
savings account for routine medical care.

4. Get government out of the patient/doctor relationship.

The former administration apparently took the "It Takes a Village"
approach to promote government interference in every aspect of our
medical relationships.

You're reviewing the flood of regulations unleashed by the prior
administration. One that should be tossed out is the so-called medical
privacy plan from Health and Human Services. These 1,500 pages of confusing rules do little
to protect patients, and actually give more people the right to poke
around your medical records.

Another is the push for more government-mandated vaccinations for
children, that started with the 1993 "Vaccines for Children" program,
the Clintons' first move to pass government-controlled socialized
medicine. That failed, but we're still stuck with a bad policy.

You seem to be returning to the idea that government
assistance should be extended to those in special need rather than
extended to everybody, regardless of need. We like this "compassion"
vision as opposed to an "entitlement" vision.

Your critics may charge that most of your health-care proposals look
like baby steps, even though they are in a positive direction. But our
patients lost their freedoms in increments. By returning more control
to patients and doctors, you will help restore trust between patients
and physicians.

In doing so, you'll earn our trust as well.