Wednesday, September 23, 2009

A Pair of Crystal Balls

I have a pair of crystal balls. I do not say this to imply I lack manhood. Or that my predictions for the future are fragile.

I say it because I feel crystal clear about two of my frequently voiced personal prognostications:

One, that the doctor shortage will precipitate a monumental political crisis because baby boomers, who are accustomed to having things their way, suddenly find in 2011 that they will be having a hell of a time finding a doctor;

Two, by 2013, or thereabout, that Obamacare, if it goes through as Obama wants it to, will result in another political crisis - perceptions of decreased quality, concern over exploding premium costs, and a revolt on the part of seniors, young people, and the business community because on increased costs secondary to individual mandates, business mandates, and increased taxes on the middle class.

These crises will be made worse by a widespread revolt of doctors, who will protest they cannot make it on the basis of Medicare and Medicaid rates. As a forerunner of the doctor revolt, we shall see events like the MillionMedMarch, scheduled for October 1 in John Marshall Park in Washington.

As these events unfold, it will become increasingly clear, my two crystal balls forecast, that doctors are essential for the delivery of health care and that consumers will demand access to a personal doctor, not some surrogate.
To reinforce the message contained in my crystal balls, I reprint the following article from the New York Post by Marc SiegelM.D, a New York City internist, who more than 50% of doctors no longer accept new Medicaid patients and 28% don’t take new Medicare patients. It may be the government could mandate that doctors accept patients covered by government, but that would be a form of tyranny.
September 23, New York Post

Why Doctors Hate Obama Care


TWO-thirds of doctors "oppose the proposed health-care plan," reports an Investors Busi ness Daily/TIPP poll. Almost half would "consider leaving their practice or taking an early retirement" if "Congress passes its health-care plan." Many of my colleagues feel like we're already struggling -- nor are we prepared to take care of tens of millions more patients.

An Association of American Medical Colleges survey predicts a doctor shortage of 150,000 (at current rates of population growth) by 2025 if universal health insurance is adopted. The doctors we do have would be overwhelmed with far more patients than we could realistically take care of. We'd have to work under huge time pressures, and the service we could deliver would decline.

Those who didn't quit would have to learn to "game" the new system by seeing more patients, doing more procedures, providing less care per patient and becoming less accessible for health-choice discussions.
Is this what President Obama has in mind when he promises that everyone will get to keep his or her doctor?

All the current health-care bills are unfair to doctors. Even Sen. Max Baucus' "moderate" bill (like the other bills) includes cuts to Medicare and Medicaid that would directly affect hospitals and doctors: How far does Congress think it can cut our reimbursements before compromising care, if not driving us out of business?

More than half the nation's doctors now don't accept Medicaid, a 2005 Community Tracking Physician survey found. The Medicare Payment Advisory Commission reported this year that 28 percent of Medicare patients looking for a primary-care doctor had trouble finding one. This scarcity will only get worse if reimbursements are cut further and more doctors opt out.

For those who stay in, it will be harder to practice the more services are cut. Baucus even proposes doing away with Medicare payments for motorized wheelchairs. How am I going to help my paralyzed patients then?

Nor are Baucus' "co-ops" much improvement over the "public option" of the House bills. Consider the existing paradigm of a health co-op: Group Health, the Seattle outfit with half-a-million patients. It's known as "Group Death" by many patients and doctors, for its low-quality care and long waits.

Nor do any of the bills provide anything to address the issues that infuriate doctors about the current system: No tort reform or any other real effort to address outrageous rates for malpractice insurance. (Many surgeons and obstetricians pay more than $100,000 per year.) No mechanism to screen out nuisance lawsuits before they can be brought; no penalties for frivilous suits, even though doctors end up winning the vast majority of cases that go to trial.

The American Trial Lawyers Association -- big donors to the Democrats -- have vetoed any such relief.

In short, doctors fear "health reform" because it's not really about health care; it's about catering to the prejudices of the politicians and the lawyers who've already made such a mess of our health-care system

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