The health care reform issue is incredibly complicated as it affects 100 percent of the people in the U.S. The sheer volume of paperwork, now more than 5,000 pages including bills and amendments, is overwhelming.

The past few months I have read almost 2,000 pages of legislation as well as several books on the issues. The senators and representatives have good ideas but really do not understand how the bureaucratic mess they are creating will adversely impact our nation.

I agree with many of President Obama’s ideas and do think we need reform, but not the bills under consideration.Senator Grassley of Iowa came the closest thismonth when he made the statement that this bill is going to lead to $1.8 trillion dollars in increased federal administrative costs, cause billions of dollars in increased taxes and fees for all Americans, and still leave 25 million Americans (that is1 in 12 Americans) without coverage.

I think there will also be a physician shortagewithin the next few years if these bills pass in current form, because of increased bureaucracy and low reimbursement rates that pay us less than our costs.

The surveyconducted atProvidence Medical Center in Anchorage,Alaska this week arose out of concern that many of my fellow MDs have said they would retireif this legislation passes in its current form. The results of the survey, which represents 11 percent of MDs in the Anchorage area, were as follows:

1) Only 18 percent of MDs said they could continue to practice if paid at Medicare rates

2) Fifty five percent of MDs said they would consider retiring or opting out if the current bills pass (only 30 percent of MDs said they would stay in practice with 14 percent unsure) (this is higher than the national survey that said 45% of MDs would retire or opt out.)

3) Fifty two percent thought Alaska should try and opt outif any of the current bills pass

4) Sixty percent of MDs have written to their U.S. senators and representatives, which is an incredible number of MDs that are concerned about this issue.

Senator Murkowski was right in her analogy of giving people a bus pass (i.e. insurance) but then not having bus drivers (physicians) to take them anywhere.

We do need insurance, Medicare, Medicare audit and malpractice reform.

We need to allow seniors to opt out of Medicare, keep their private insurance and have HSAs with money that is going to their secondary insurance companies now. Letting the seniors instead of the government or insurance companies be in charge would dramatically lower fraud rates and administrative costs and decrease taxes on all of us.

We need to allow seniors who want to pay their primary care MDsat their full rates be allowed to do so without physicians being accused of fraud. And MDs should be allowed to discount their rates on a case by case basis to uninsured/under insured patients without fear of fraud accusations as the rules are so confusing it is hard to know what is correct anymore. The whole Medicare reimbursement system needs to change!

MDs should be allowed to write off Medicare/Medicaid/uninsured losses like any other business loss.($47,000 last year for me alone)

Medicare rate auditors should not be paid on commission and allowed to extrapolate over the practice for any fraud (mistakes) they find. For a simple charting error Icould face a $10,000 fine on a visit I lost $68 dollars seeing the patient. This could then be extrapolated so I would face a $100,000 fine for a simple charting mistake. It is fear over these audits (because none of us is perfect) that have driven more MDs away from Medicare than anything else. These bills are putting $830 million towards fraud audits and $50 million to training new MDs. The priorities are all messed up!

Malpractice reform,with special courts made up ofMD and attorney panels need to be set up in every state along with caps on damages and uniform statutes of limitations.

We need insurance reform as President Obama has suggested, but I disagree with the publicoption as we already have many public options now, none of which are working well as they are bankrupting the country.We need national catastrophic insurance over 3 million for everyone paid for by taxes on soda pop, alcohol ,candy and tobacco all of which are contributing towardsa less healthy population. We need HSAs for everyone, and to make insurance companies nonprofit, or if they are for profit make them use 10 percent of their profits to provide low cost or no cost premiumsthe poorest in our nation. We need to eliminate pre-authorizations for medicines and radiology procedures, eliminate the “preexisting” clauses, allow portability, and have simple forms used by everyone to decrease administrative costs. I do not agree with single payer systems (I do not want a government or insurance monopoly)but do agree with limited clearing houses to reduce costs.

My overhead is $450/hour and if paid at Medicare rates for all patientsI would be bankrupt in months. Electronic medical records increased my costs and dramatically decreased the number of patients I was able to see when I tried themand I think physicians should be allowed to choose whether or not to do them in their own practices and not be mandated by the government.

We also need to increase medical school slots in Alaska and also residency slots as we will be facing big shortages soon.

What we need is less bureaucracy, fewer rules and regulations, more control in the hands of the patients and their providers, less taxes, and people to take more responsibility for their health and healthcare bills.

Ilona Farr, MD

Allowed: ktuu.com