Medical Licensure Tied to Participation in Government Programs. A Game of Political Chicken

Watch for the federal government to restrict doctors from practicing, or possibly even criminalize them, unless they accept patients with insurance paying government-defined rates for medical tests and treatments...The new health law is overtly configured to cut payments for Medicare services by 30 percent over the next three years; by 2019, payments for senior-citizen care will be even lower than Medicaid. While government arrogantly assumes doctors will swallow government-dictated low reimbursements, surely more and more physicians will refuse to see patients under such health plans.

Scott Atlas, MD, professor, Stanford University Medical Center and senior fellow Hoover Institute, “Obamacare- The Sequel, “ Washington Examiner, September 17, 2010

In Massachusetts there is a pending bill in the state legislature to tie medical licensure to accepting patients in the Massachusetts state health plan.

I have written about this in previous Medinnovation blogs.

• August 28, 2010, Massachusetts and Indiana as Experimental Laboratories for Obamacare

• July 7, 2010, In Health Care, As Massachusetts and Harvard Go, So Go the Country

• April 25, 2010, Medical Licensure as a Condition for Seeing 34 Million Government Subsidized Patients

• April 16, 2010, Obamacare and The Physician Bloodbath

I will not rehash those blogs here.

Suffice it to say, after four years of its Universal Health Plan, Massachusetts faces a shortage of primary care doctors, over half its remaining primary care doctors have closed their practices to new patients, waiting times to see these doctors are the longest in the U.S., emergency rooms are more crowded than ever, and doctors are fleeing Massachusetts to more doctor-friendly places to practice like Texas.

Those on the progressive side of the political aisle boast that Massachusetts has the lowest number of uninsured in the land at 5.5% versus 17% for the rest of the U.S. That is unquestionable a positive. To counteract negative consequences of the law, progressives propose to make accepting government-subsidized patients a condition for getting a medical license.

Doctors are restless, not only about the medical licensure issue, but reform in general. Recent Physician Foundation surveys indicate 89% of doctors feel they were ignored when the reform law was created, 80% find practice unsatisfying, and 33% plan to stop practice in three years. Another one-third to one-half of those who remain in practice plan to cut back or cease seeing Medicare and Medicaid patients if the health law takes effect as proposed.

Political Chicken
Much of this strikes me as a game of political chicken.

Those espousing universal coverage say it is worth any price. Coverage for all is too important to be left to doctors. If doctors do not want to go along, we will make them go along. We will mandate that they see government-subsidized patients. Mandated universal coverage is a moral imperative. We will wring the neck of the doctors if necessary.

Doctors delivering the care respond: Wait just a minute. This is a free country, and we will see who we want to see. We can practice where we want to practice. We are not indentured government servants. If government fee structures are not enough for us to maintain our practices, we will exercise the option of not seeing government patients. Universal coverage is not a moral imperative when you consider the moral comparative, viz, universal coverage without universal access is meaningless.

As Winston Churchill said when Britain was told in 1941 it would have to go it alone or have its neck wrung, "Some chicken, some neck."