Actually, there are many of us who have read the entire text of the Senate bill which the House essentially passed last night. As someone who was in politics before coming to medicine a little later in life, I refuse to listen to anyone's "opinions" on legislation if they are simply spouting off party talking points they heard on talk radio or FOX/MSNBC.
One thing most people don't appreciate is that while there are a number of specificities in this (and many other pieces of) legislation, the bill mostly contains generalities. A bill is nothing but a framework that must be interpreted by lifers in government agencies, which is where we get most of the specifics. This is what populates the Code of Federal Regulations (CFR). It's the final text of the relevant sections of the CFR that become enforceable. The vast majority of the health care reform bill are directives to set up this exchange or that body, all of which remains to be interpreted by the folks working for HHS and other departments.
This is the primary reason why it remains to be seen what impact this sweeping bill will have on our specialty. One potential positive (and "potential" here is used somewhat meekly) is that the bill contains language suggesting that the feds as a payer may utilize some sort of evidence basis for its recommendations as to proper (reimbursable?) care. Now, what this will mean will depend on the HHS folks who interpret this language? National standards? Or cost-benefit analysis?
This could be a boon for Rad Oncs like myself. I only treat heme patients and am one of the largest users of RIT in the country. Still, only a small fraction of the patients who could be helped are referred because of the economics of the situation (med oncs can't charge for largely worthless maintenance rituximab, a category 2B recommendation if they send the patient to me for RIT). Consolidative RIT for low-grade NHL is a category 1 recommendation, it's much cheaper than maintenance rituximab, it's more convenient for the patient, and it doesn't burn the anti-CD20 bridge for the eventual future relapse. National standards based on evidence and cost-utility analyses could serve Rad Oncs very well in this and other clinical scenarios. On the other hand, private practice Rad Oncs probably would not continue to be reimbursed for ridiculous 20-fraction courses of XRT for bone met palliation either (not that that would be a bad thing).
The future is uncertain, and therein lies the principal weakness of the legislation. It's not bad because of death panels (don't exist), socialized medicine (doesn't do that either, people need to pick up a dictionary every now and then), or other red herrings pushed by opponents. The principal weakness is that in the end, it's STILL not PHYSICIANS making decisions on behalf of patients, simply replacing one payer for another in many cases. Nothing will change until the people in charge of defining rules, recommendations, and statute are physicians themselves.
