Obama Has Lost the Doctors
If you have a nail to hit,
hit it on the head.
David Lambuth, Golden Book on Writing(1923)
July 5, 2012 - Daniel Henninger of the Wall Street Journal
has hit a nail on the head with his July 5 Op-Ed “Obama’s Lost Tribe – Doctors.”
Lost in the shuffle over Obamacare, and the
Supreme Court decision validating its existence are doctors. The media and the talking heads seldom
mention us. The AMA has abandoned us by
supporting Obamacare. You seldom hear
our voices above the din and the confusion .
However, one thing is evident. Obama has lost
Most of us, two-thirds at least in multiple surveys, fear for our futures, the quality of medicine, our relationships with patients. We talk openly and often about not entering practice or leaving medicine.
And why not? We spend 11 to 15 years preparing for a medical career, forsaking 11 to 15 years of income and investing $500,000 to $1 million in educational debts.
For what? To become servants of distant, impeneratable,unknowing, unknowable, and unknown government and third party bureaucraccies. The fatal conceit of central planners is they think they can substitute their knowledge for knowledge on the ground.
We do not believe in Obamacare. It downgrades doctors. It downgrades our incomes.
It downgrades our
autonomy. It downgrades our authority. It
downgrades our clinical judgment. It forces us to consider quitting medicine or
becoming voiceless employees or indentured servants of government. It
relies on outcome-metrics,
economometrics, and geometrics – rather than on the sick seeking relief
from their doctors. It's about volume of patients seen, not compassion for each one seen.
Here is Henninger's piece in its entirety. The italics are mine
Obama’s Lost Tribe - Doctors
By Daniel Henninger, July 5, WSJ
“Back at the at the dawn of ObamaCare in June
2009, speaking to the American Medical Association's annual meeting, President
Obama said: ‘No matter how we reform health care, we will keep this promise: If
you like your doctor, you will be able to keep your doctor. Period’ ."
“But will your doctor be
able to keep you? Or will your doctor even want to keep you, rather than quit
“For the longest time now,
since the day one of the Affordable Care Act, we have been having arguments
over the mandate to purchase health-care insurance, requirements that insurance
companies accept policyholders regardless of health, and price discrimination
in insurance policies.”
“And of course this past
week, the Supreme Court—or something resembling the Supreme Court—outputted a
decision on the tax status of the insurance-purchase mandate, the states'
obligation to pay for Medicaid and as a bonus, the Commerce Clause.”
“Have you noticed what got
lost in this historic rumble? Doctors. Remember them?”
“ObamaCare has been a war over the processing of insurance claims. It
has been fought by institutional interests representing insurance, hospital and
pharmaceutical firms. The doctor-patient relationship, or what used to be
called "the practice of medicine," has sunk beneath these waves”
“Barack Obama, a savvy pol,
understood from the start that rationalizing payments claims through the maw of
these private and public bureaucracies was not what the average person thinks
of as "health care." To any normal person, health care means that
when you or yours get really sick, the doctors and nurses who attend to you will
push all else aside to give you medical help.”
Thus, the constant Obama
chorus that you can "keep your own doctor." No one knows better than Barack Obama that his law sends the nation's
doctors on a voyage into an uncharted health-care world in which they are just
along for the ride with their patients.
“A Wall Street Journal
story the day after the Supreme Court ruling examined in detail its impact
across the "health sector." The words "doctor,"
"physician" and "nurse" appeared nowhere in this report.
The piece, however, did cite the view of one CEO who runs a chain of hospitals,
explaining how they'd deal with the law's expected $155 billion in compensation
cuts. ‘We will make it up in volume,’ he said.”
“Volume? Would that be another word for human beings? It is now. At
Obama Memorial, docs won't be treating patients. They'll be processing
"volume." And then, with what time and energy remains in the day,
they'll be inputting medical data to comply with the law's new Physician
Quality Reporting System (PQRS), lodged in the Centers for Medicare and
“Here's the Centers' own description
of what PQRS does: ‘The program provides an incentive payment to practices with
eligible professionals (identified on claims by their individual National
Provider Identifier [NPI] and Tax Identification Number [TIN]) who
satisfactorily report data on quality measures for covered Physician Fee
Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS).’”
“We're all pressed for thinking time these days, but the one group we
should make sure has time to focus on what's in front of them is doctors
treating patients. Instead, they'll also be doing mandated data dumps for
far-off panels of experts.”
“Doubts, even among
believers, have begun to emerge about what ObamaCare could do to the practice
of medicine. A remarkable and important piece by Drs. Christine K. Cassel and
Sachin H. Jain in the June 17 Journal of the American Medical Association
directly asks: ‘Does Measurement Suppress Motivation?’”
‘The question raised by the
article is whether imposing pay-for-performance measurements on individual
physicians does more harm than good: "[C]lose attention must be given to
whether and how these initiatives motivate physicians and not turn physicians
into pawns working only toward specific measurable outcomes, losing the complex
problem-solving and diagnostic capabilities essential to their role in quality
of patient care, and diminish their sense of professional responsibility by
making it a market commodity.’ “
“This is an important
piece, because Dr. Cassel is part of the intellectual foundation for the
measured-directives movement. The saying that comes to mind reading these
misgivings is that it's better late than never to notice that the core
relationship between doctor and patient is being eroded. Except that in the
wake of Chief Justice Roberts's upholding of the Affordable Care Act, it's too
late and we're beyond never.”
“Mitt Romney needs a way to
talk about health care in America. This
isn't just a fight over insurance companies. It's about the people at the
center of health care—doctors. The
Affordable Care Act will damage that most crucial of all life relationships,
that between an ill person and his physician. Barack Obama's assertion that
we all can keep our doctors is false. You could line up practicing physicians
from here to Boston to explain to Mr. Romney why that is so. “
Tweet: The health law and Supreme Court ruling
overlooked and downgraded doctors and lost their support and reason for
existence in the process.
Drs. Cassel and Jain have already stated publicly that Heninger is misinterpreting their article, and that they fully support the ACA. Here's a paragraph from the response they sent to the WSJ:
"We have no misgivings about the appropriateness of measuring physician’s performance – we believe it is important, vital, to improving the quality and safety of health care in this country. It is unfortunate that Mr. Henninger chose to use our analysis on how to improve physician measurement as a way to demonize the ACA and cause unnecessary fear for patients. The ACA will not damage the relationship between ill patients and physicians – in fact it will allow more patients to get the care they need."
While we're at it, Henninger suggests that the PQRS is a "new" creation of the ACA, but it was actually initiated in 2006 (under President Bush and a Republican Congress) and made permanent in 2008 (under President Bush and a Democratic Congress).
When Henninger doesn't get even these basic facts right (and, let's be honest, I had the info on PQRS' history with a single Google search), how much credibility can his analysis have?
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