Sen. Corker spoke with Nashville Medical News in late June 2009 regarding his views on healthcare reform.

 

Corker: By the time this is in print, it is likely there will be some type of healthcare reform bill out of the Senate. First of all, most Americans are happy with the service they receive as Medicare beneficiaries. Many people rate the program highly. However, we have some built in problems. The most pressing problem is financing the program. Each year we face a drastic cut in payments due to the SGR (Sustainable Growth Rate – ed.) formula. Next year, doctors are facing a 21 percent cut. Obviously, we have to solve that problem.

 

I feel the best way to deal with Medicare financing is to have a bipartisan group put forth a solution that can only be voted on "up or down," period. There can be no amendments. This is the only way to make the tough decisions for the long term. One of the issues, and I think most physicians agree, is that Medicare pays people to do things. There is just tremendous utilization. The system is set up such that physicians and hospitals are reimbursed by doing things. The desire of policymakers is to figure out a way for physicians to get back in the business of more fully caring for people, by spending time with people and not necessarily needing to order tests to make a living.

 

Generally speaking, we know Medicare is not sustainable. We know there are issues both on the delivery side and the financing side. Change needs to be through pilot programs and strong leadership at CMS over an extended period of time. I am concerned that a group of Senators and House members are making decisions about delivery that could hugely affect the provider community, without having hands-on experience. I hope meddling doesn't create counter-productive results.

 

Corker: Most people feel SGR will be addressed in this healthcare debate. The president wants to sign a bill by the middle of October. His goal is to have legislation by August 7. I think this is an artificial deadline. There are complex issues we have not even begun to address. We recognize the January 1^st SGR deadline. However, if we deal with healthcare as a whole this fall, we may also deal with the SGR piece.

 

Unfortunately, some of the proposals that have come forth only deal with SGR for a limited period of time, which is not responsible. There is a proposal to deal with SGR and not play budgetary games. We cause physicians and other providers each year to have a sense of panic because they don't know what their reimbursement rates are going to be.

 

There are some of us that believe a great way of dealing with healthcare reform would be to focus first on the 46 million Americans who lack insurance. We could then take a little more time on the Medicare piece. Certainly we need to deal with SGR before January 1. However, for a long-term fix, we need to take more time and get it right. My guess is that the Obama Administration wants to do it all at once. I have concern that major mistakes will be made if we rush through this legislation.

 

Corker: I am concerned about a public plan. The Lewin Group studied this issue and estimated that a public plan would result in 119 million people migrating from employer-sponsored insurance. Eventually, no private plans would exist. We can deal with the issue of the 46 million people who don't have health insurance. Let's face it, some people in that category make over $75,000 a year and choose not to buy insurance. However, many people work for small companies or are self-employed and do not have health insurance. I think the government can serve as an organizer and implement tax policy to make insurance more affordable.

 

Currently, if an employer provides health insurance, this benefit is 100 percent tax free to the employee. If the employer doesn't provide insurance, there are no tax benefits to obtaining coverage. One consideration is to limit the employer exclusion to $7,500 for individuals or $15,000 for a family. This would generate revenue to help subsidize those people at lower income levels. Another consideration is eliminating the employer exclusion altogether and providing a tax credit to families and individuals. People are actually given cash, in the form of a refundable tax credit, to purchase coverage. The Federal government could then act as an organizer.

 

Another proposal is to pool small businesses and individuals for insurance purposes. For instance, the state of Tennessee could be consolidated into a large group with protection for consumers. Such protection could include guaranteed issue and no pre-existing conditions. People could then purchase coverage from a cafeteria of plans that are offered by private insurers. Most of the uninsured could gain coverage simply by government acting as an organizer but not as a deliverer of health benefits. Many people are concerned that a huge public plan would lead to rationing and create bureaucratic nightmares. Most people want to keep the health insurance they have. The type of organization and tax policies I've talked about would allow people to keep the health insurance they have but also be able to migrate into other plans. This approach, in all likelihood, creates a more competitive atmosphere and lower costs.

 

(See Nashville Medical News, December 2008 – a conversation with Congressman Jim Cooper (D –TN) ed)

Corker: I have spent a lot of time with Sen. Ron Wyden (D-Ore.). There are still some problems in his bill. However, I do appreciate the focus on exchanges that create competition between plans. That's something I certainly have embraced. I was in a meeting with Sen. Wyden this morning and I think he offers a great deal to the public debate. His bill is not perfect. We've got a bill that is not perfect, but all of these things add to the debate. One thing Ron and I have in common is we would like to see healthy competition in the marketplace and individuals more involved in their healthcare decisions.

 

Corker: I think it has to happen. There's no question that physicians around this country rightly order multiple tests in cases where they are concerned that without doing so they might end up in a lawsuit. Defensive medicine in that regard actually can be harmful to patients. It is damaging as it creates spiraling costs in healthcare.

 

California has laws to limit liability. Texas has some great legislation related to tort reform. I hope that healthcare reform will move beyond special interest groups, move beyond ideology, and do things that are meaningful. Most people in this country realize that some type of tort reform is necessary. As I campaigned around this state, I saw a tremendous lack of OB-GYN services, driven by physician concerns about liability.