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However, Lynam says there are a lot a good things about reform including improved access to healthcare, which is particularly important in communities that have historically had health problems, and providing coverage to the uninsured. In 2008, North Shore-LIJ provided $250 million in uncompensated and charity care to patients who could not afford to pay for their hospital visit, he said.
One concern, however, is how the bill will affect the reimbursements that hospitals receive from Medicare, Medicaid and private insurers, which they, like others in the healthcare industry heavily rely on in order to survive.
“We realize we have to do our fair share in order to have a rational healthcare policy,” Lynam explained. “But there needs to be an emphasis on individual responsibility.”
Many health problems that affect Americans are self-inflicted, he noted, such as those that stem from smoking, eating and drinking excessively and not getting enough exercise. In fact, 75 percent of healthcare costs can be attributed to treating people with chronic diseases such as asthma and diabetes, he said recommending that the president support a national wellness campaign to encourage individuals to adopt a healthy lifestyle.
“Overall, it sounds good — to make health insurance available to everyone,” said Dr. Hari Shukla, a physician with the Children’s Medical Center in Flushing and a clinical professor of pediatrics at New York University. “I don’t know how good the quality of care will be, and I’m sure some services will have to be cut in order to provide for everyone else.”
It is also not clear whether the final version of the bill would place a cap on malpractice insurance, which often causes health insurance rates to increase, according to Shukla. For some doctors, fear of being sued causes them to perform unnecessary tests. For example, a patient complaining of a headache, may be given a CAT scan. Shukla says 23 states, including Texas, have already placed caps on malpractice insurance and are doing very well.
Shukla also worries that the bill would make things difficult for small businesses, which would be required to provide insurance to their employees, but may not be able to afford it.
The healthcare bill must now await Senate passage of a companion measure, though it is unclear just when that will happen. After it passes the Senate, the two bills will have to be combined into one and voted on again before it can become law.
Dr. Rodger Hans, a podiatrist with Astoria Advanced Foot Care and Sunnyside Family Footcare doesn’t believe the bill will make it past the intense scrutiny it will be subjected to by the Senate.
“It’s a specious bill — to claim that more healthcare services will be offered to everyone and they are going to save money at the same time,” Hans said. “They are basing it on being able to reduce fraud and abuse in the system, but if they couldn’t do it before, what makes them think that they are going to be able to do it now?”
Hans asserted that the money will have to come from an increase in taxes or a reduction in the reimbursement received from insurers.
“Americans should have healthcare insurance, but you can’t just give it away,” he said.
Hans, who reported seeing his malpractice insurance more than double over the last three years, from $20,000 in 2007 to $41,000 in 2009, says one of the most important aspects of healthcare reform is tort reform, which he says was hardly discussed during the creation of the bill.
Tort reform is a term used to describe changes to the legal system which would either limit the circumstances under which injured people are allowed to sue, limit the amount of money they can receive, or both.
Hans said he doesn’t want payouts to be limited for people who deserve them, but would like a better vetting process to ensure that people aren’t allowed to sue “just because they feel like it.”
“Overall, it will be a disaster,” Hans said of the bill as it is currently written. “Hopefully, they will get tort reform and illegal aliens paying into the system.”
Stephen Mills, the president and CEO of the New York Hospital Medical Center of Queens, generally supports the healthcare reform bill because he believes that it creates avenues for better access for those people who need coverage and will promote competition among private insurers, which he says is “a good thing.”
However, he did have some concerns.
Mills says the bill does not ensure that hospitals will receive the capital they need to improve infrastructure and technology so that they can provide state-of-the-art care. Like Hans, he noted that it doesn’t address increasing malpractice insurance costs which he called “a tremendous burden.”
Another key concern is cost. Mills says the money to pay for the plan will have to come from providers — doctors and hospitals — along with increased taxes, and that the budget will not remain neutral as President Barack Obama has said it needs to be.
“I don’t believe the savings are going to keep up with the costs of healthcare reform,” Mills said. “They will need to pay for it with new money.”
Over the course of the first five years, Mills believes the bill would restrict the ability to expand programs. Moreover, the public option, which is the most important ingredient, according to Mills, will be a sticking point as the bill seeks to gain Senate approval, he says, and will ultimately be excluded from the final version in lieu of a more modest plan.
Caryn Schwab, the executive director of Mt. Sinai Queens, like Mills, said that reform is necessary, but has reservations about H.R. 3926.
“This is a historic time in our nation’s history and expanding coverage for millions of Americans is something we are very supportive of,” Schwab said. “It has taken a long time and a lot of attempts over the years to move us in this direction.”
But, she added “We are not convinced that we will do better under the bill because we have many people who are generously insured under Medicaid. So the question becomes how many more would be insured under the bill?”
Undocumented immigrants wouldn’t be covered, and they make up a significant amount of patients in Queens and throughout the city, according to Schwab.
Leonard Guttman, assistant vice president of intergovernmental relations at the city’s Health and Hospitals Corporation, which represents Queens Hospital Center and Elmhurst Hospital, shared Schwab’s concerns and said the Senate version of the bill would not allow illegal immigrants to purchase coverage through the health insurance exchange, a stipulation Guttman called “extremely draconian and mean-spirited.”
More than two dozen other Queens doctors who were contacted for this article did not return repeated calls.
