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<<   作成日時 : 2009/07/13 00:38   >>

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主役となれない議会内の医師たち
画像 医療制度改革の努力が続けられる中で、上下院に16人いる医師たちは、リングサイドの席に座ったまま試合終了時間になってしまいそうである。
 医師としてはそれぞれ違った経験を持ち、法案がどうあるべきかについての合意を得ることができない。「医師は非常に個人主義である」とテキサス共和党で産科医のMichael C. Burgessは言う。議会には、共和党11人、民主党5人の医師がおり、上院に2人と下院に14人いて、このうち医療法案に関連する3委員会に7人が所属している。
 全ての医師議員が、不充分な保険や無保険のため苦しむ患者を知っている。2006年選出のウィスコンシン民主党のSteve Kagenは、アレルギー専門医で症状が悪く学校にも行けないシングルマザーの2人の子どもを診たが、処方した薬が買えないため、試供品を与えた。長期的には、公的な保険プランが必要だと考えている。アーカンソー民主党Vic Snyderは、薬の請求書を見て返却してきた患者を診たことがあるが、公的プランには賛成しかねている。
 共和党の医師議員たちは結束して公的保険プランに反対している。Burgess医師は、保険会社と連邦政府による干渉が医師を疲れさせていると言う。税額控除により自ら保険管理をする方がよいと考えている。
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For Doctors in Congress, Little Harmony on Health Care
http://www.nytimes.com/2009/07/12/health/policy/12docs.html
By ANDREA FULLER
Published: July 11, 2009

Andrew Councill for The New York Times
Representative Michael C. Burgess, left, a doctor, and his legislative director, James Paluskiewicz.


WASHINGTON ― In the struggle to overhaul the nation’s health care system, 16 physicians have ended up in ringside seats ― as members of the House and Senate.

Representative Steve Kagen is one of 14 physicians in the House. There are two in the Senate.

But they have taken different lessons from their experiences in medicine, and they do not agree on what a bill should look like.

“Doctors are very individualistic,” said Representative Michael C. Burgess, Republican of Texas and an obstetrician. “We all think we’re right.”

Of the doctors elected to Congress, 11 are Republicans and 5 are Democrats. Two serve in the Senate and 14 in the House, 7 of whom are on the three committees preparing a health care bill.

Both Democratic and Republican doctors can recall patients who had inadequate insurance or none at all.

Representative Steve Kagen, a Wisconsin Democrat first elected in 2006, was an allergist whose patients included two asthmatic children of a single mother who were so ill that they could not go to school. He wrote prescriptions, but a few weeks later, the children returned to the office still suffering.

“She unzipped her bag, and she pulled out the same prescriptions,” Dr. Kagen said. “She said, ‘I went to the pharmacy, I could see the medicine my kids need and I can’t afford to buy it.’ ”

As a short-term solution, Dr. Kagen gave her samples of the drug. He did the same with another patient, of whom he said: “She’s old but not old enough for Medicare, and she’s poor but not poor enough for Medicaid. She and her husband were too proud to beg.”

As a long-term solution, he says, the nation needs a public health plan to compete with private insurers.

Another Democrat, Representative Vic Snyder of Arkansas, had dealt with patients who could not afford medicine at his family practice before he was first elected to Congress in 1996.

“I’ve certainly had experiences of writing out a prescription for someone and either having the pharmacist call me up or having the patient tell me they saw what the bill for the medicine was going to be and just handed it back,” he said.

But Dr. Snyder remains hesitant about a public plan and is emphatic that it must preserve patient choice and pay for itself. He said he had positive experiences with Medicaid, however, calling it his practice’s “most efficient payer.”

“It’s not a deal breaker for me either way,” he said of the public plan. “I don’t know why it’s resonating so much with Democrats.”

Republican members of Congress who practiced medicine, united under the banner of the G.O.P. Doctors Caucus, oppose a public plan.

Dr. Burgess, who was first elected to Congress in 2002, is a member of that caucus and sits on the Energy and Commerce Committee, which is working on health care legislation. He remembers treating a patient who had difficulty giving birth.

“She was very, very sick and very, very dehydrated,” Dr. Burgess said. “She lost some blood in delivery.”

Dr. Burgess wanted to keep her in the hospital, but the medical director of her managed care company wanted her discharged. Dr. Burgess was able to persuade the company that she should not go home only after a lengthy argument.

Dr. Burgess, who reported having similar experiences with Medicaid, said, “Interference from both insurance companies and the federal government have really worn down the practicing physician.”

Dr. Burgess is open to tax credits or deductions that would help patients manage their own health care. He strongly favors a health savings account that would allow individuals to put away money tax free for medical care.

Representative John Fleming, Republican of Louisiana, who was elected last year, agrees. As a family doctor, he was familiar with uninsured diabetic patients who sought medical care ― in the emergency room ― only when they developed gangrene and sepsis. They would stay in the hospital for several days, costing the government tens of thousands of dollars.

Getting those patients insured with a public plan, Dr. Fleming says, is not the solution. He has seen physicians refuse to take Medicare patients because it compensates poorly, and he fears that doctors would turn away patients on a public plan if it offered inadequate compensation.

Rather, Dr. Fleming favors a tax credit or a tax deduction, measures that would give patients an incentive to “watch the pocketbook.” He says he is even open to an individual mandate that would make health insurance compulsory, much like automobile insurance.

“We seem to agree on everything,” Dr. Fleming said about his fellow physicians. “We agree on the fact that we need portability; we need to do away with pre-existing illnesses.”

But when it comes to a public plan, he said, doctors cannot seem to agree any more than other members of Congress.

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