Plenty of questions remain regarding health care reform

Sep 17 2012 - 5:57pm

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Dr. Doris Geide-Stevenson, chairwoman of the economics department at Weber State University and seen here in her office in 2009, says one question about health care reform is how it will impact the job market. (Standard-Examiner file photo)
Dr. Doris Geide-Stevenson, chairwoman of the economics department at Weber State University and seen here in her office in 2009, says one question about health care reform is how it will impact the job market. (Standard-Examiner file photo)

The nation has always faced a changing landscape of jobs with some sectors declining and others growing, requiring the workforce to change in order to match the emerging structure of the economy.

So how are things going to be any different with the looming health care reform, and what will it mean for the average citizen, employee and physician?

The United States has had a workforce that is more mobile than that of European countries, says Dr. Doris Geide-Stevenson, chairwoman of the economics department at Weber State University.

For example, a workforce that can easily move among industrial sectors and across geographic regions helps to keep unemployment rates and duration low.

"Until recently, the U.S. labor market has been able to accommodate these adjustments very well," she says.

"For example, in past recessions, the average duration of unemployment peaked at about 10 weeks, from an average duration of about five to seven weeks during periods of economic expansion."

Put differently, in the past, even during bad times, it would take an unemployed person, on average, 10 weeks to find a new job.

In contrast, since the end of the last recession, the average duration of unemployment has increased to just more than 20 weeks, she says. Because policy changes such as extension of unemployment benefits happened in previous recessions as well, it is hard to argue that it is just policy changes that resulted in a longer durations of unemployment.

"I take this data as evidence that it is much harder for an unemployed person to find a job than in the previous 50 to 60 years," she says.

"I speculate that part of this difficulty of finding a job stems from a decline in sectors such as construction, finance and real estate that has not been matched by growth in other sectors such as health services and education and by a reduction of worker mobility, due to the ongoing difficulties in selling homes."

Stevenson says there is a great deal of uncertainty surrounding health care reform.

While she says she is not an expert on the details of the Patient Protection and Affordable Care Act, it is clear that the law governing health care reform is complicated and became even more so after the Supreme Court ruling that lets states decide how to implement some changes pertaining to Medicaid.

"Thus, there is an uncertainty as to how each state will implement health care reform," she says. "There is uncertainty whether the Patient Protection and Affordable Care Act will be overturned after the November elections. The question is how these looming reforms will impact the job market."

A survey conducted on behalf of The Physicians Foundation asked 40,000 physicians their thoughts on health care reform. The survey offers a snapshot of how doctors responded to the health reform bill three to four months after it became law.

The survey, according to the foundation, makes it clear that physicians are dubious about how reform will affect the quality of care they are able to provide to patients, the financial viability of their practice and the long-term future of the traditional independent private-practice model.

Most physicians indicated they view health reform as a further erosion of the medical practice environment with which they must contend.

In addition, the survey suggests that "health reform, at least in its initial stages, has further disengaged doctors from their profession, with potentially negative consequences for both the medical profession and the quality and accessibility of medical care in the United States."

Among the findings of the survey, 67 percent of physicians described their initial reaction to the Patient Protection and Affordable Care Act as "somewhat negative" or "very negative."

With several months to consider the content and direction of the new law, 39 percent of physicians said they are now more negative about health reform than they were when it initially passed.

In response to reform, 74 percent said they would take steps to change their practice style in the next one to three years, and 69 percent said they no longer have the time or resources to see additional patients while still maintaining quality of care.

"The great majority of physicians surveyed believe the viewpoint of physicians was not adequately represented to policymakers during the run-up to passage of health reform," the foundation states on its website. Click here for more information.

Dr. Ronald Ruff, director of Imaging Services at Mountain Medical Imaging in Ogden, says no one can accurately predict the impacts and changes the Affordable Care Act will have on the U.S. health care system, with respect to either consumers or providers.

However, he says, it is possible to predict some trends, many of which have already started.

"In terms of consumers, the traditional employer-based provision of health care insurance is evolving," Ruff says.

"Due to the ever-increasing cost of the U.S. health care system, most employers can no longer afford to provide complete health care coverage for their employees through insurance."

Some small- and medium-sized employers no longer offer any health care benefits for their employees, leaving individuals to try to find coverage on their own, Ruff says.

Some companies are setting up their own clinics or contracting with providers who can provide such clinics that include primary care for their employees, Ruff says.

The motivation behind this trend is the idea that, by eliminating the insurance company or health care system, the company has more direct control of costs, particularly those associated with chronic diseases such as diabetes, hypertension, high cholesterol, heart failure, arthritis and cancer, Ruff says.

Health care consumers can start shopping for services much like they would shop for other commodities, he says.

Although limited information is available regarding health service pricing, Ruff suggests the next time you need a health service, you can begin by asking questions of your doctor.

Those questions include:

* Is the service or procedure really necessary?

* What are the alternatives?

* What choices are available in our community to obtain the service?

* What are the qualifications and expertise of the providers you recommend?

Research your problem on the Internet, or ask your physician for reliable Internet sites where you can gain additional information, Ruff says.

In addition, he says, you can call several providers and ask them for their cash price for the service you require.

Better yet, ask them for an estimate of your out-of-pocket costs based on your health insurance plan information, your deductible and the amount of your deductible you have already met during the current year.

"Many times, the provider will not have this information available, or they may tell you they cannot give you an accurate estimate," Ruff says.

"If pricing is not available, make them aware that you find this unacceptable as a consumer. This pricing transparency should be available from hospitals as well as other providers."

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