Monday, August 13, 2012

What  A Physician Pragmatist Thinks  about  Real Health Reform
Pragmatism means accepting what’s real and making the best of it.
Wisdom Commons
August 13, 2012 –  I’m a pragmatist.  I believe people do what they have to do retain their positions and to advance their causes.  And much of what they do depends on the number of people who support their cause.
Take Obamacare.  Thinking about Medicare is a little like thinking about your mother-in-law.   As Milton Berle said, “Take my mother-in-law, please!”
·         Democrats support Obamacare because over 110 million Americans depend of Medicare and Medicaid programs to get their care.

·         Republicans oppose Obamacare because it puts government in control,  consumes 40% of the national budget,  raises taxes, gooses the national debt , and punishes business.

·         Seniors don’t know what to think – Obamacare cuts $716 billion out of Medicare (Romney’s latest estimate), effectively ending “ Medicare as we know it.” Yet RomneyRyancare proposes to change Medicare  into a voucher system,  presumably, guess what?  ending”Medicare as we know it.”
·         Some 60% to  70% of doctors oppose Obamacare because Medicare cuts come on the backs of hospitals and doctors and substitute bureaucratic judgment for clinical judgment.

·         Business persons sit on their cash and hiring budgets because of economic uncertainty and because they feel  “they built that,” not the government,  and  besides they distrust a government that denigrates them and discourages individual initiative .
What It Comes Down To
As a pragmatist, I believe  it comes down to free enterprise, liberty, and risk  vs. government control, social justice, and economic security. It comes down to private  prosperity vs. public  austerity.   As Winston Churchill so famously said, “The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal  sharing of miseries.”
For physicians, there are problems of public perceptions.
·         The public thinks of physicians as a rich privileged class. Even as hundreds of thousands of America’s 624,000 physicians directly engaged in patient care struggle to make ends meet and abandon the practice of medicine: 624,000 physicians against 110 million dependent on the government dole.  It’s no contest.
·         Gallup polls indicate   70% of Americans trust physicians.  They go to doctors because they need their experience and expertise (last year there were 956 million doctor visits).    Yet there is not yet any tangible evidence the public  is  aware of the looming doctor shortage, which will hit big-time in 2014 and 2015, when Medicare and Medicaid demand peaks and supply of physician shrinks.
In a Forbes Magazine article yesterday,  internist Mark Siegel, a fellow pragmatist,  captures the dimensions of the real life dilemma.
Will Your Doctor Quit? Obamacare Foretells Mass Exodus From Patient Care
Forbes Magazine,  August 12
A recent survey by the Doctor Patient Medical Association Foundation reveals that 83 percent of physicians surveyed are thinking of quitting because of Obamacare, and 90 percent feel that the U.S. health care system is now heading in the wrong direction.
This result is not a surprise; patients everywhere need to be concerned that Obamacare is putting an enormous new weight on the back of doctors who were already over-burdened.Move tMove down

This survey is not alone. Previous surveys by Athena, Sermo, Deloitte, the Doctors Company Survey, the Physicians Foundation, and IBD/TIPP have clearly shown that most doctors are unhappy with the direction of things, and a clear majority are opposed to the health care law. The Physicians Foundation survey in 2010 found that physicians view Obamacare “as a further erosion of the unfavorable conditions with which they must contend.”
Worse than our eroding fees and our perpetual fear of malpractice is the yoke we must work under. We want to help our patients but all too often the test or treatment we order is challenged by an insurer. This past week alone I had to argue for three life saving medications and four crucial tests that were initially denied.
Will doctors actually quit or just become more and more unhappy and dysfunctional? Most of us are locked into a career and a lifestyle that we can’t change. We have trained for many years to get to this point. Instead of quitting, most of us will continue to struggle along with the rising Obamacare regulations and restrictions with over a hundred new federal agencies and thirty-three new regulatory committees. We will accept lower incomes amid rising expenses while spending less and less time with our patients because frankly we have no other choice.
Will the best and the brightest continue to choose medicine as a career? Medical school admissions are down by 6% at a time when the Association of American Medical Colleges predicts a shortage of 160,000 by 2025. And the effective shortage of doctors who will work with Obamacare is far greater. Doctors who are already in practice will drop out of insurances, move to hospitals to work for a salary, or accept cash only. This trend will create a two-tiered system of health care and could be a knife in the back of Obamacare, which relies on physician participation with insurances and its expanded patient load to survive.
How’s that for President Obama’s continued assertion that you get to keep your doctor?
Those of us us who manage to remain in private practice and still accept insurance will have to struggle to survive. At a time of Medicaid expansion, consider that Medicaid pays us on average only 56% of what private insurance does. At a time when baby boomers are going to burst the britches on Medicare, consider that Medicare only pays doctors 81% of what private insurance does. Medicaid and Medicare patients are going to find it increasingly difficult to find a doctor regardless of what President Obama says to the contrary.
The time of greedy doctors is long past. Today’s doctors struggle to maintain quality of care, to continue to provide you the patient with the best treatments and technologies available. When we can no longer do this effectively it will be you the patient who suffers the most.
Marc Siegel MD is an associate professor of medicine at NYU Langone Medical Center and a member of the Fox News Medical A Team. He is the author of The Inner Pulse.
Tweet:  Pragmatic physicians are abandoning  private practice in droves: How will pragmatic voters react when they can no longer find a physician.

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