1. Joseph Borrelli, Jr., MD Panel: John Ruth, MD Dana Seltzer, MD

2.  Doctors are either truly/theoretically happy about 32M more Americans who are about to have health insurance ◦ We are in a caring profession  Yet, every doctor has a right to worry about their own livelihoods and medical practices  Some doctors see the health care bill creating benefits and opportunities, while others don’t: Particularly for Specialists Thomas N. Ahlborn, MD President Medical Staff at Valley Hospital Ridgewood, NJ

3.  Internists will be paid adequately,  Insurers will have to accept people with pre-existing conditions  Insurers will not be able to drop people when they become really ill (no cap)  Subsidies for people who don’t make enough money to pay for their own health insurance Thomas N. Ahlborn, MD President Medical Staff at Valley Hospital Ridgewood, NJ

4.  Changes in Insurers responsibilities will increase their expenses – transferred to others with increase premiums  Costs will be huge ◦ 32 million more Americans will be insured  Looming 21.2% Medicare cut would create even more problems  Nothing in the Bill to control medical expenses Thomas N. Ahlborn, MD President Medical Staff at Valley Hospital Ridgewood, NJ

5.  New Medicaid patients at Medicare rates ◦ New potential business opportunities for primary care physicians  Funding issues and controlling costs  Lack of tort reform ◦ Increased defensive medicine and thus costs ◦ Continued chaos in the Medicare reimbursement rates  (i.e. looming 21.2% cut)  Lack of true healthcare prevention efforts ◦ Although, Ins. Comp. will now be forced to pay for screening colonoscopies and mammograms Thomas N. Ahlborn, MD President Medical Staff at Valley Hospital Ridgewood, NJ

6.  Millions of Americans will be added to the Medicaid program ◦ Medicaid rates will be raised to Medicare levels for:  General internists,  Family physicians  Pediatricians, ◦ …an effort to encourage medical students to go into primary care areas in underserved areas of the country Thomas N. Ahlborn, MD President Medical Staff at Valley Hospital Ridgewood, NJ

7. Thomas N. Ahlborn, MD President Medical Staff at Valley Hospital Ridgewood, NJ  Medicaid reimbursement will not rise to Medicare rates  “Medicaid is Medicaid” ◦ …and in those systems where specialists (Ortho Surgeons) are reimbursed by the hospitals for “unfunded care” they will be paid Medicaid instead. ◦ Specialists may “choose” to see very few or none of these patients = problem

8. Thomas N. Ahlborn, MD President Medical Staff at Valley Hospital Ridgewood, NJ  New business models for primary care physicians ◦ PA’s, NP’s in order to see more patients ◦ Using health care providers who make less than physicians  Inner-city practices may spring up…  Payment, instead of unpaid charity care…  More primary acre doctors will be trained…

9.  Legislation calls for a 3.8% Medicare Part A (hospital insurance) tax on UNEARNED INCOME for those making more than $200,000 (you)… ◦ Investment capital gains ◦ Capital gains – selling your house!!!  Cut in Medicare reimbursement (21.2%) ◦ “Healthcare bill is budget neutral” Thomas N. Ahlborn, MD President Medical Staff at Valley Hospital Ridgewood, NJ

10. Thomas N. Ahlborn, MD President Medical Staff at Valley Hospital Ridgewood, NJ  Fails to lessen the number of lawsuits brought against doctors by plaintiffs and their lawyers looking for a quick jackpot  Defensive Medicine – jacks up the cost of healthcare

11.  The Healthcare Bill as proposed will have…. ◦ Huge implications for practicing physicians  Particularly specialist = orthopaedic surgeons ◦ Extremely expensive for our country and us…  Paid less (21.2% Medicare cut)  Taxed (3.8%) on those making >$200,000 ◦ Do little to improve the quality of care and hold down cost of care