Saturday, April 28, 2012

Physicians Alone in Political Wilderness

The present is never tidy, or certain, or reasonable, and those who try to make it so, succeed only in making it implausible..All of it , the prescient and the cockeyed, always arrives in a promiscuous rush, and most men in power, sorting through it, believe what they want to believe, accepting what justifies their policies while taking out insurance, whenever possible, against the possibility that the truth may lie in their wastebaskets.

William Manchester,  The Last Lion: Winston Spencer Churchill, Alone, 1932-1940, Little, Brown, and Company, 1988

April 28, 2012 -  Many, if not most,  physicians are feeling alone and uncertain in the political wilderness,  with Democrats and Republicans unable to decide  about the future of the health system,  whether to cut 27% from Medicare payments to physicians, or  what will happen if the Affordable Care Act is constitutional,  in part or as a whole.
To muddy the waters further,  a leadership vacuum exists among physicians.   Physicians distrust the AMA because it backed Obamacare, even now when Medicare may be in its death throes. Physicians wait to see  if the Supreme Court rules against some or all of the health law’s  provisions, and if the electorate in November ushers the ruling party out.  
Right now, for the next 6 months, the nation’s health system is adrift,  impatiently waiting for reform solutions from a divided political system.  They wonder: how much of the health reform law is destined for the political wastebasket.
Today only 15% to 17% of physicians belong to the AMA, despite its current recruiting drive.  And a corporate transformation of American medicine is underway,  as more physicians become employees of institutions,  and as they pledge their allegiance and owe their careers  to corporate bosses and the missions of those institutions.
Congress, meanwhile, fiddles. It cannot make up its schizophrenic partisan mind what to do about physicians, even though 19 members of Congress are now physicians.  
  •  It knows more physicians will bolt from Medicare if the 27% cut in physician pay goes through. 
  •  It knows  incoming Medicare recipients,  which are entering the system at the rate of 10,000 to 12,000 a day, will revolt if they cannot find a doctor to care for them. 
  • Yet it knows if Congress honestly reimburse physicians or cancels the hated SGR formula,  those acts will add some $300 billion to the national deficit, already as staggering $16 trillion and growing.     
  • And yet, if it accepts the Ryan budget, which basically puts Medicare on vouchers and Medicaid on block grants to states,   it will trim funds to federal programs, in effect,  “ending Medicare as we know it,” thereby infuriating and alienating its liberal base.   
  •  And yet, if nothing is done, federal programs will go bankrupt.
What to do?  Let the Supreme Court and the electorate decide.  And whatever they decide,  agree the solution resides in some sort of public-private partnership, not in one or the other.  We are a center-right capitalistic nation.   So let us give two cheers, but not three cheers, for capitalism..
Tweet:   American physicians are demoralized and uncertain about their future, as the political system fiddles and dithers about physicians’ fates.

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