Tuesday, June 18, 2013

Second Thoughts by Physicians and Others on Obamacare
Among mortals second thoughts are wisest.
Euripedes (485-406)
Now that Obamacare is more than three years ago, people have had a chance to consider its various provisions,  and second thoughts are flowing in. Many of these second thoughts are expressed in a special section “An Exam on Doctors Pay” in yesterday’s Wall Street Journal.   I am disappointed such issues as “savings” from Accountable Care Organizations, deep cuts in Medicare pay, and bundled bills were not addressed, but entire section is worth reading.
The Journal runs six pro and con articles by experts on these six “crucial” issues and asks  these questions.
1)      Should physician pay be tied to performance? (
      Comment: I think not, since  no one knows yet  how to define performance, and studies to date have been inconclusive).

2)       Will companies stop offering health insurance because of Affordable Care Act?

  Comment:  Some have already, perhaps 10 million, but others may be waiting to turn   coverage over to government).

3)       Would Americans be better off on an organic diet?)
        Comment: I doubt it, but one man’s pesticide is another man’s fertilizer,  just as one woman’s wheat staple is another woman’s gluten-free food.)

4)       Should hospital residency programs be expanded to increase the number of physicians? 
      Comment: Yes.

5)       Should nurse practitioners be able to treat patients without physician oversight?
      Comment:  Yes, under certain circumstances, minor illnesses and routine complaints.

6)       Do the health benefits of neonatal circumcision outweigh the risks?
      Comment: I have no opinion, but “yes expert” says, “The benefits are many, while the risks are few,  and the “no expert” says, “It’s unnecessary, causes pain and reduces pleasure.”

What  interested me most about the WSJ's section was tucked in the back under the “The Best of the Experts” and was called “Insights From Our Expert Panel.” 
One question asked there was “In two years, what will doctors say about the Affordable Care Act? Here are their answers.

·         Fred Hassan, Chairman of Bausch & Lomb :  “Most doctors will feel the Act has resulted in decreased reimbursement while making them have to see more patients.  Many will also that ACA has decreased choices for patients while doing for tort reform.”

Comment:  Spot-on.

·         Leah Binder, president and CEO of Leapfrog Group, an organizations representing employer purchasers of health care:   “”Physicians will say they were blindsided by a private-sector phenomenon that completely transformed their practice : high-deductible health plans, the fastest-growing form of health plan. With HDHPs, employees need information on price and quality so they can shop for value.
Comment:  HDHPs are a good thing, but a bad thing.
·         John Sotos, cardiologist, flight surgeon, advisor to the television series, “House”: All true physicians will be applauding the ACA.  A true physician’s first concern is, and must be, the health of his or her patients.  Taxes, nanny-state worries and politics are lower on the list, and do not distinguish a physician from other members of society. Physicians must be physicians first, and taxpayers second.

Comment: Spoken like a true-believer in the goodness of government.

·         Peter Pronovost, anesthesiologist, professor at Johns Hopkins School of Medicine:  ‘Physicians will be frustrated that the ACA and meaningful use incentives have forced health-care systems to spend millions on electronic health records that hurt productivity, provide limited, if any, decision support and do little to improve patient outcomes.”

Comment: EHRs are vastly  overrated as a tool to improve health care and distract from the doctor-patient interaction.

·         Liz Feld, president of Autism Speaks:  Expanding access to health-care coverage was a noble mission.  The country will be sorting through how to afford the ACA;s implementation.
            Comment:  To quote Samuel Johnson(1709-1784), “The road to hell is paved with   
            good intentions.”

Tweet: The June 17 WSJ has a special on doctor pay.  Read it and form your own opinion.  I have mine.


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