Sunday, April 25, 2010

Medical Licensure as a Condition for Seeing 34 Million Government-Subsidized Patients

From Daniel Palestrant, MD, founder and CEO of, a social networking company with 115.000 physician members headquartered in Cambridge, Massachusetts, comes this word. The Massachusetts legislation is considering making accepting government-subsidized patients a condition for medical licensure ("(More)Madness in Massachusetts, " The Health Care Blog, April 22, 2010). Palestrant's fear is that the Massachusetts Madness will spread to the rest of the nation.

Palestrant puts it this way,

“Lately I have been watching with complete horror the events playing out in my home state of Massachusetts. A bill currently under review by the state legislature will make participation in the state and federal Medicare/Medicaid programs a condition of medical licensure, effectively making physicians employees of the state. “

“This is particularly alarming because Massachusetts is essentially a leading indicator of what will happen in the rest of the country. Several years ago the state passed a series of laws mandating health coverage. Like the recently passed national health reform bill, the Massachusetts law did not address any of the well known causes of runaway costs, including tort reform, drug costs, or insurance regulation.”

Can Massachusetts Impose This Mandate on Doctors?

Is it constitutional? After all, America is a Democracy. Like other citizens, physicians have individual rights . Will the Massachusetts government risk imposing its power over the rights of private physicians and the will of the people?

A recent joint survey of 1000 physician across the U.S. by Athenahealth, another Massachusetts health firm, and Sermo indicates 59% of physicians thought the quality of care after Obamacare would deteriorate over the next five years while 54% said further government intervention would not improve care.

Then there is the election of Senator Scott Brown in Massachusetts. Exit polls indicate his opposition to Obamacare sealed his victory. As it turned out, of course, Brown’s opposition to Obama’s health plan was not enough to ward off the Obama health plan passage.

Furthermore, an average of these national polls – Quinnipiac, Associated Press. Rasmussen Reports, GWU/Battleground, FOX News, CBS News, USA Today/Gallup, Washington Post, Bloomberg, and CNN/Opinion Research – reveals that 52.8% oppose the Obama Health Care Plan while 40.0% favor the plan. Will the percentage of those against the plan increase when the public sees cost increases (Robert Pear, "Health Care Cost Increase is Projected for New Law," New York Times, April 23, 2010.

Pallstrant is not optimistic about physicians’ prospects for independence.

“We will no doubt see the same sequence of events play out across the country as the current versions of health care reform are implemented. The net effect of these laws is that it will make it close to impossible for physicians to stay in private practice. Patient access to physicians will suffer as more and more physicians retire and/or move to different states. “

These events raise a fundamental question. Does government, at either the state or federal level, possess the power to impose its laws over the will of physicians or the American people?

Not a Trivial Question

This is not a trivial question. It strikes at the core of the American democratic experiment – balancing the power of a collectivist government against the will of scattered individuals and ordinary people. Mandating doctors to accept patients in government programs represents a struggle for power of control of health care resources.

No one knows how this struggle will play out over the next ten years, but the midterm elections in November 2010 may indicate how the struggle will go and in what direction the country is headed.

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