While some needed reform will be accomplished by the nationalhealth care restructuring bill, the complex new laws may bereaching too far without shoring up the basics, said some membersof Brookhaven’s medical community.

Dr. Ed Moak, of the Moak-Massengill Clinic, welcomes the comingchanges that will expand health insurance coverage for children andestablish high-risk insurance pools, but worries that a massiveexpansion of Medicaid will cause runaway funding problems thatcould ultimately dilute the quality of health care in America. Hedoubted the $940 billion price tag on the reform act would beenough to pay for the massive expansion – especially to Medicaid -fearing that doctors and their patients would ultimately be theones who suffer if the delicate formulas break down.

“This has been born out in the history of Medicare and Medicaid -as expenses have risen in those programs … reimbursements tophysicians have consistently decreased,” Moak said. “There has tobe fair reimbursement, and in the current scenario, that’s just nothappening.”

Though many more Americans will have health care, health care willbe damaged, Moak predicted. He said the potential of fallingreimbursements will force physicians to either take on morepatients – in which case quality decreases – or move out of privatepractice into salary-based systems like hospitals, where therevenue generated by optional services makes those institutionsbetter-equipped to handle the losses.

An exodus of private physicians in a time when an additional 32million Americans will have newfound health insurance woulddefinitely create a strain on the national health care system,which experts say is already short by 50,000 physicians. Whenphysician shortages are coupled with rising costs and fallingreimbursements, either corners will have to be cut or taxesincreased, Moak said.

“The concern that I have and colleagues I’ve talked to have is thatexpenses will continue to mount due to the bureaucratic expensesbecoming more and more immersed in the administration of a widerpool of government-covered insurance patients, as well as theadministration costs of more and more regulation, almost like apublic utility,” he said. “There will have to be, at some point, acost threshold whether either taxes will have to be raised or therewill have to be significant cost-cutting.

“Historically, cost cutting has occurred at the hands of theproviders,” Moak concluded.

Brookhaven Internal Medicine’s Dr. Bryan Calcote said he wasapproaching health care reform with an open mind, and he too foundmany things to like about the coming changes. He was encouraged bythe potential of more Americans being able to see a doctor,especially with the Baby Boomer generation set to enter theMedicare rolls over the next few years.

But the sweeping legislation may have overlooked essential aspectsof health care, Calcote said, and should be considered a work inprogress.

“There’s still some issues that really probably have been kickeddown the road for now,” he said. “The reimbursement and malpracticeissues haven’t really been addressed and there’s still going to beproblems in the future.”

Calcote said Medicaid has had its share of successes, but theprogram has also run into plenty of failures.

The doctor pointed out that many health care providers simply don’taccept Medicaid patients, and the number of providers who turn awayMedicare patients is likewise growing. He fears the growing splitcould lead to a system that would bitterly defeat the very spiritof health care reform.

“What’s worrisome about this is I would hate for it to be kind oflike a two-tiered system,” Calcote said. “I’m afraid it will becomewhere the people with money will be able to pay for their medicalcare, and (other physicians) will take those who accept Medicare.The coverage is positive – health care for the poor, older anddisabled. But we want it to be better quality health care,too.”

On the administrative end of the spectrum, King’s Daughters MedicalCenter Chief Executive Officer Alvin Hoover is also worried abouthow hospitals will cope with expanded Medicaid rolls.

Mississippi’s Medicaid funding formula has been broken for yearsand was fixed only last year when hospitals consented to a $60million assessment. Likewise, Hoover said the American HospitalAssociation struck a deal with President Barack Obama to give upsome Medicaid and Medicare reimbursements to help pay for healthcare reform.

If Medicaid and Medicare costs go up, Hoover is afraid KDMC andother hospitals will be asked to give up more reimbursements, or betargeted for another tax.

“All of that negotiation was based on yesterday, not today withhealth care reform,” he said. “My concern is that all the pieces,when you put them together, are going to have a negative impact onhospitals.”