Impact on doctors: There are three major points to consider here. First, America already has a shortage of doctors, particularly primary-care and family practice physicians. Even doctors are advising their own children to go into another profession. One of the biggest reasons for this has been the outrageous costs of malpractice insurance – in many cases $30,000/yr or more for generalists, $70,000-150,000 (or more) for many specialists – to help guard against lawsuits in an increasingly litigious society. As much as 25% of the money paid for health care is spent on ‘defensive’ medicine and documentation, which also takes up a lot of a doctor’s time. Unfortunately, there is no medical liability reform (aka ‘tort reform’) included in the Obamacare legislation to alleviate this. (By the way, some states have successfully reformed their tort systems, like Texas and Indiana, so there are workable ways to do this.)
The second point is that, under the proposed legislation, doctors will be paid much less. Currently, insurers decide (or negotiate) what percentage of full price they will reimburse a hospital, physician, pharmacist, or other health care professional for a particular drug, procedure, examination, test, or consultation. Such rates are typically about 50-80%. Put another way, the doctor must write off roughly 20-50% of the “list” fee (i.e., what someone without any insurance would pay). When your overhead already runs 60-70% of revenues, that really eats into your income, as well as the viability of your practice. In a 2008 survey conducted by The Physicians’ Foundation, 82% said that if proposed cuts to Medicare reimbursements went through, their practices would no longer be sustainable. But, it gets worse….
For programs like Medicare and Medicaid, the government unilaterally decides how much they will pay – typically 60-80%, but sometimes as low as 20%. In the TPF survey, 36% said Medicare reimbursements were less than their cost of providing care and 65% said Medicaid reimbursed less than their cost. (This is why many doctors are reluctant to take very many patients on government programs. Some simply don’t take them.) Plus, most managed care plans tie their reimbursements to Medicare’s fees, often paying providers just 20-30% more than Medicare does. Under Obamacare, the “public plan” would reimburse only about 5% more than the Medicare rates. The more people get put on this government-controlled insurance, the less doctors will be earning. Thus, one of the major incentives to go into, or remain in, medicine will erode away. (Especially when one considers the high debts one must pay off at the beginning of a medical career and the enormous insurance rates, overhead, etc., throughout one’s career.)
Here is an excerpt from a blog post by a board certified, private practice oncologist, that gives an excellent “insider’s view”.:
It’s quite simple, really: very hard work, and declining income. Private practice physicians have seen a fall of approximately 30% since 2004. Worsening economics are right around the corner. Given the extraordinary expense of chemotherapy and supportive therapies, combined with reimbursements that just exceed a wash, it will become impossible to deliver outpatient care in more than half the venues in the United States quite soon. And then, simply put, the senior physicians will quit….
Specialists, and underpaid generalists will hang it up years ahead of their planned exit from medicine in just about any system that the Obama administration is likely to devise. They’ll scarcely need to ration care: there just won’t be anyone around to deliver it. Government will kill the golden goose, and then blame it upon everyone and anyone else. As usual.
Is it any wonder that a cash-only system is being adopted by more and more medical practices? Not having to deal with insurance claims and related paperwork saves time and money. Will this even be an option in an era of government-mandated, government-structured health insurance?
In addition, the President has already been asking Congress to grant the Executive Branch – in the guise of an ‘independent’ advisory board – more power to recommend (dictate?) Medicare reimbursement rate modifications. These rates now vary from region to region, where local legislators often help decide what they will be. The proposed new board would end this practice, handing more control to the federal government.
Thirdly, there is a development that is only just now coming to light. When you think of people who belong to unions, you don’t usually think of doctors and other medical professionals. (Well, maybe nurses.) But, that may change. It seems some congressional friends of Big Labor slipped some “last minute” provisions in the proposed bill that will force hundreds of thousands of physicians, surgeons, and other health care workers to unionize. This will mean millions (billions?) of dollars in new union dues going to union war chests, to be spent on new bureaucracies to influence health care policies and negotiations, more corruption, and financing of the Big Labor political agenda. (Of course, unions will get favored treatment under the legislation, but not necessarily in the better interests of the average union member.) And if you object to Obamacare and/or compulsory unionization, you may find yourself on the wrong end of intimidation and other strongarm tactics of persuasion. (Just ask Kenneth Gladney, who recently spent a couple days in the hospital recuperating from a harsh beating at the hands of union thugs, when they found him handing out anti-Obamacare “Don’t Tread On Me” flags.)
So,… Obamacare is supposed to cover millions more people, but it does nothing to encourage people to go into medicine. Instead, it will cut costs by underpaying hospitals and physicians for their services. Plus, it will force health care professionals to unionize, thereby inserting more bureaucracy, corruption, control, and unnecessary expenditures into the mix. (Can we afford to have our doctors pressured or ordered to go on strike?) Hmmm. If, at the very least, you don’t see long waits and decreased quality of care in our future, you’re just not paying attention.
< to be continued… >