Friday, April 16, 2010

Obamacare and Physician Bloodbath

Key words – Obamacare, bloodbath, mid-term elections, physician surveys, quality of care, physician reimbursements, physician access, physician shortage

We are Democratic pollsters who argued against the health-care legislation ["Democrats' blind ambition," Washington Forum, March 12] that the Obama administration chose to pursue. Instead, we advocated incremental health-care reform. With the passage of health reform, some harsh political realities have emerged.

Recent polling shows that despite lofty predictions that a broad-based Democratic constituency would be activated by the bill's passage, the bill has been an incontrovertible disaster. The most recent Rasmussen Reports poll, released on April 12, shows that 58 percent of the electorate supports a repeal of the health-care reform bill -- up from 54 percent two weeks earlier. Fueling this backlash is concern that health-care reform will drive up health costs and expand the role of government, and the belief that passage was achieved by fundamentally anti-democratic means.

Douglas Schoen and Patrick Caddell, “ How the Democrats Can Avoid a November Bloodbath,” Washington Post, April 16, 2010

When two loyal Democrats warn Obama of an impending “bloodbath” in November because of passage of health reform, it is big news.

What Schoen and Caddell did not mention was that a physician bloodbath that may follow could be part of the toxic anti-Democrat mix.

In the main, physicians do not believe there is much in Obamacare for them.

• Athenahealth and Sermo surveyed 1000 physicians across the land, and found 59% thought the quality of care would decline over the next 5 years, 54% said more government involvement would not improve care, and 83% and 81% respectively indicated they were having trouble collecting low Medicare and Medicaid reimbursements.

• In a Physicians Foundation survey of 270,000 primary care doctors, 60% said they would not recommend medicine as a career, and 78% said their colleagues suffered from low morale.

In interviews I conducted for Modern Medicine, and from other sources, I find increasing number of physicians leaders are advocating that practicing physicians either cease seeing or reduce services for patients in government programs or drop out of Medicare and Medicaid and private third party arrangements altogether and opt for private concierge or cash-only practices in which patients pay yearly fees for access.

According to Daniel Palestrant, MD, founder and CEO of Sermo, Obamacare does not meet any of the reform conditions physicians recommended. ) tort reform; 2) streamlined billing; 3) reform of health insurance; 4) simplified billing with more billing for prevention.

And as everybody knows, Congress is dithering and fiddling about fixing the SGR formula. As in 13 previous years, SGR called for Medicare physician cuts. This year SGR calls for a 21% cut, which would surely cause a massive exodus of physicians from Medicare and Medicaid programs – and a political bloodbath for Democrats.

Politicians will no doubt “fix” the SGR temporarily, but this band aid will leave a bad taste in physicians’ mouths for government manipulation of their incomes.

Government, of course, could and may mandate acceptance of government patients as a condition for medical licensure. But, as with individual and small business mandates for coverage, this mandate would be perceived as “anti-democratic” by liberty-loving Americans and would exaggerate the physician shortage.

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