In Massachusetts, where 97% of us have health insurance by mandate since 2006, we have learned a few things about health care reform.

We have learned that universal coverage does not mean universal access to a doctor.  The Massachusetts Medical Society reports that there is a critical shortage of family physicians and severe shortage of internal medicine doctors.  Seven physician specialties are also operating in critical or severe physician labor markets.

A recent study by the Robert Wood Johnson Foundation showed that 75% of non-emergency ER visits occurred because a regular physician was not available after hours, and half of these visits occurred because a timely appointment was unavailable.  With more than half of all the doctors trained in Massachusetts leaving the state, citing the practice environment and low salary levels, and one out of every four currently practicing doctors considering a career change, it does not appear that access issues are going to improve soon.

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Rationing Medicare will not require clandestine meetings in smoke filled rooms. Simply reduce physician reimbursement to below the cost of delivering quality care, and free market forces will take care of the rest.

Medicare has already begun the process of backdoor rationing. Facing overwhelming budget shortfalls, Medicare needs to trim its books. Washington found a clever solution: eliminate the billing code for “physician consults.”

As a hospital physician, I often admit Medicare patients with chest pain or shortness of breath. If my patient needs urgent help from a cardiologist, I call a colleague for assistance.

Until December 31, 2009 the cardiologist could charge a “physician consult” fee for getting out of bed, coming to the hospital, and evaluating a patient with a potentially life threatening problem. Medicare paid $195.76 for this middle-of-the-night work (the same rate as when done during the day).

By eliminating the “physician consult” billing code, Medicare now advises the specialist to charge for a “hospital admission.” For two more months, Medicare will pay $175.67 for this service. However, without a change in current law, the physician’s reimbursement for a “hospital admission” will drop to $141.63 on March 1. This is why the “Doc Fix” is so important for working physicians and their Medicare patients.

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Earlier today Minnesota Governor Tim Pawlenty explained to BigGovernment.com readers how the Baucus health care plan is a prescription for higher taxes and higher premiums.

In keeping with the theme that good perspectives and ideas often come from the states, 33 state-based think tanks came together this morning to announce a health care reform alternative to ObamaCare.

“President Obama and other supporters of government-run health care like to proclaim that there’s no alternative to their plans,” said John Tillman, CEO of the Illinois Policy Institute. “Our patient-centered reform package offers a clear alternative that puts patients, not bureaucrats, first.  It protects the doctor-patient relationship, offers viable solutions for the uninsured, and keeps medical care affordable for all Americans.”

Patient-centered health care reform:

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