Stupak on health care: Quality-based outcomes should replace fee-for-service system

By Michele Bourdieu

WASHINGTON, D. C. -- U.S. Congressman Bart Stupak held a telephone press conference for Michigan reporters Thursday morning, July 23, just before heading off for another meeting on health care reform, as members of the U.S. House of Representatives work toward consensus on legislation that will meet President Barack Obama's challenge to "try to encourage changes that work for the American people and make them healthier."

Those were President Obama's words during his press conference held Wednesday evening, July 22, when he tried to explain to the American public that, if the health care system is not changed, the skyrocketing costs of health care could prevent the federal government from controling the increasing deficit; and more and more Americans could lose their health insurance, adding to the 47 million who are presently uninsured.

Stupak, like Obama, favors a choice that will include a national health plan, but he said he was not completely satisfied with HR 3200, the main topic of discussion and debate in Congress this week.

A senior Democrat on the House Energy and Commerce Committee, Stupak is among a small group of House Democrats working with House leadership to help bridge the divides that exist within the Democratic Caucus on health care reform legislation.

"Most of the work has been health care, health care, health care," Stupak said. "My main concern is cost containment. How are you going to pay for this?"

The proposal before the Energy and Commerce Committee, he explained, according to the Congressional Budget Office, could cost more money in the next 10 years, as well as jobs. He and many of his colleagues find this "Medicare plus 5 percent" unsatisfactory as a proposal for a national plan, since it would just perpetuate the fee-for-service system, which, as President Obama has said, is broken.

In his talk Wednesday night, Obama said doctors and medical experts should be making decisions based on what works.

"That's not how it's working right now," Obama said. "Right now doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there."

Stupak further explained how the fee-for-service system should be replaced by quality-based outcomes.

"So instead of providing doctors and hospitals with reimbursement based upon utilization, or fee for service as we call it, why don't we provide reimbursements to doctors and hospitals and health care providers through quality -- quality-based outcomes," Stupak noted. "Many of those quality-based outcomes have actually been developed in the Midwest -- and the northern Midwest."

(Obama has mentioned the Mayo Clinic and the Cleveland Clinic, which he visited today, as models that "free doctors, patients, hospitals to make decisions based on what's best for patient care.")*

Regional variations in Medicare reimbursements

Stupak gave examples showing Medicare reimbursements vary from one region to another, with the average Medicare patient in the country receiving about $8300, while in some parts of the country it's as high as $16,000. In Northern Michigan, he explained, the reimbursements are mostly below the national average. The Marquette area average is about $6100, compared to about $6600 in the Traverse City area.

"We're below average," he said.

Stupak questioned why all Americans can't be reimbursed the same for health care, based on the same quality throughout the country, in order to lessen utilization, not increase it.

"I would not want to see any kind of health care plan which actually hurts our reimbursement rates in the Upper Peninsula or northern Michigan. What I want to see is reimbursement rates based upon quality, based upon out-patient outcome, not who does the most testing. That's not the way we should do national health care. That's the broken system."

To a question on whether the new legislation would decrease Medicare benefits, he answered that the new plan would actually help senior citizens more by covering preventive testing (physicals, mammograms, etc.) 100 percent and by filling in the "donut hole" some seniors face in prescription drug coverage.

"The other thing I want to see is public disclosure," Stupak added. "If you're going to the hospital or a doctor's office, why don't you know ahead of time what it's going to cost you?"

He gave an example of one of his constituents for whom a cortizone shot cost almost $3700.

"That's just outrageous," he said.

People should be able to look on the Internet to find out the cost of a health care treatment and to check a quality-based index as well. This public disclosure would help bring down costs, Stupak noted.

Insurance companies are exempt from anti-trust laws, Stupak said; and for years he's been trying to get rid of that exemption in order to increase true competition. In the past few years the cost of health insurance has increased 78 percent, while real wages have only gone up 4.5 or 4.6 percent, Stupak added.

Stupak wants "conscience clause" added to bill

Stupak, who is anti-abortion, also said he was concerned about the "conscience clause" which means doctors and health care providers who are opposed to abortion do not have to perform it or be associated with it.

"That conscience clause is conspicuously left out of this legislation," he said, "and I'll be working to put it back in. And also I do not believe we should be using public funds for abortion."

In reply to a question on the conscience clause, Stupak said it was not "make or break" for him. He would look at the totality of the package.

Finally, Stupak said he would not play partisan politics with this important issue of health care reform. He is hopeful that both Democrats and Republicans can work together on this issue.

"If an amendment makes sense, no matter who offers it -- Democrat or Republican -- in committee, that helps provide affordability, accessibility and quality of care, I'm going to support it," he said.

Stupak said he would also be involved next week in an investigative hearing in Indianapolis, Ind., on insurance companies rescinding people's private insurance policies once they get sick -- based on what the insurance companies call "post-marketing review."

The companies insist they have a right to do this. The only way to stop this practice would be if there were a national health care plan, since you can't take the plan away.

Stupak said while he receives calls from people in states all over the country -- people who admit they were asked by special interests to call and ask for a vote for or against health care reform -- he believes his constituents are engaged in the health care issue -- on both sides. Many of those who have health insurance are afraid of losing it, and those who don't have health care are in favor of national health care.

"This is a pretty complicated issue," Stupak said.

Later today, Thursday, Stupak made this statement on the health care negotiations:

"It has been a frustrating week for those of us eager to pass a health care reform bill that provides quality, affordable, and accessible health care coverage for all Americans. But today I have seen the best progress yet toward addressing some fundamental concerns a number of House Democrats and I have raised with the proposal.

"We are engaged in productive discussions with House leadership in the hopes of reaching an agreement that will address regional discrepancies in Medicare reimbursement rates that will be used as a model for the public health care option. Tackling this issue is critical to reforming our health care system in a manner that emphasizes quality of care over quantity of care and in providing cost containment measures health care reform must provide."

*Editor's Notes: You can read the transcript or watch the video of President Obama's press conference Wednesday, July 22, on the White House Web site.

This is the second in a series of articles on the health care reform issue. See also our July 7, 2009 article, "Finland's health care, new bills in Congress, residents' views explored at local Health Care Forum."

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