Sunday, December 16, 2012

Who Shall Care for the Sick, Will Obamacare Survive, and Does  Voters’ Opinions Count?
Opinions cannot survive if no one has a chance to fight for them.
Carl Gustav Jung (1875-1961), The Magic Mountain (1924)
December 16, 2012 - In my opinion, the medical profession will not survive as it now exists and our current health system will lie in tatters if Obamacare remains intact as it is now constituted.
I do not come lightly to these conclusions.
I have been writing about health reform since my 1988 book (And Who Shall Care for the Sick?), in 2592 Medinnovation blog posts, and in 11 other books, and in my new book, The Physicians Foundation – A New Voice for Physicians.
My books include:
A Collection of Editorials from Minnesota Medicine: 1975-1982 (1983)
And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota (1988)
A Managed Care Memoir: A Physician’s Whistle-Stop Journey, 1988-2003 (2004)
Hello Health-Care Consumer: The Transformation of the Patient-Doctor-Hospital-Health Plan Relationship (2004)
Voices of Health Reform – Interviews with Health Care Stakeholders at Work (2005)
Sailing the Seven “C’s” of Hospital-Physician Relationships: Competence, Convenience, Clarity, Continuity, Control, Cash, and Competition, with James A. Hawkins (2006)
Innovation-Driven Health Care: 34 Concepts for Transformation (2007)
Navigating the Maze of Health Coverage and Access: A Quick Guide for Physicians (2008)
Obama, Doctors, and Health Reform: A Doctor Assesses the Odds for Success (2009)
The Pros and Cons of Accountable Care Organizations (2011)
The Health Reform Maze: A Blueprint for Physician Practices(2011)
Physicians, Parodies & Poems (2012)
The Physicians Foundation: A New Voice for Physicians (2013)
Central Theme of Writings  
Given the reform zeal and mindsets  of managed care and Obamacare advocates,  medicine is no longer an attractive profession, and a physician shortage of unprecedented magnitude is at hand.  
Why Become A Physician
Why become a doctor if your every decision is questioned or directed by outside managerial or bureaucratic experts, if you emerge from medical school with a $200,000 debt , if you face the threat of a malpractice suit with every patient you see, if you cannot afford expenses of complying with federal regulations.  And what can you  do if the government establishment haughtily and unilaterally rejects every alternative you suggest. 
Physician Recommended Alternatives
These alternatives include:
1. Increase competition by allowing individuals to purchase health insurance across state lines.
2. Equalize the tax treatment of money spent for health insurance by employers and individuals.
3. Encourage the Health Savings Account qualified High Deductible Health Plan (HSA qualified HDHP) model as the basic structural health insurance model across the entire spectrum of health insurance options by broadening allowable use.
4. Promote transparency in medical costs.
5. Encourage medical liability reform.
6. Transform Medicare into a defined contribution program.
7. Restructure Medicaid to assist low-income families to purchase health insurance.
8. Encourage pooling.
The Obamacare Alternative
Instead of these market -based and physician-suggested alternatives,  we read the following alternative suggested by The  New York Times, a staunch Obamacare supporter: “Well-trained health care workers can do some jobs as well or better than doctors, and for much less money.”
The Times suggests these workers are:
·         Pharmacists

·         Nurse practitioners 

·         Retail clinics personnel

·         Trusted community aides

·         Self-care by patients

While I agree non-physicians have important indespensible roles to play, I do not believe they are a sufficient solution.
The Times professes that the health reform law addresses the system’s current problems with these steps. (Italics mine).
--It provides money to increase the number of medical residents, nurse practitioners and physician assistants trained in primary care, yielding more than 1,700 new primary care providers by 2015 ( This is a drop in the bucket considering there is a shortage of at least 50,000 primary care providers already.
--It provides bonuses for up to five hospitals to train advanced practice nurses and has demonstration projects to promote primary care coordination of complex illnesses, incorporates pharmacists and social workers in some cases  (again a drop in the bucket, considering that there are 5000 hospitals in the process of being cut by 40% under Obamacare over the next decade).
--It offers financial incentives for doctors to practice primary care – like family medicine, internal medicine  and pediatrics – as opposed to specialties  ( incentives being 10% more in pay for primary care when the primary care-specialty income shortfall is 100% or more).
Will Obamacare Survive?
This all comes at a time when Pollster Scott Rasmussen says “Health Care Law Is Still Fighting for its Life.”
Here are a few things Rasmussen has to say:
Having survived the Supreme Court and the November elections, President Obama's health care law now faces an even bigger hurdle: the reality of making it work.”
“Implementation of any massive new program requires cooperation, something the health care law can't count on.”
“Overall, just 28 percent believe the health care system will get better over the coming years, while 50 percent expect the opposite. “
“This skepticism might not matter except for the fact that the law counts on the cooperation of states to implement the federal plan. However, the Dec. 14 deadline for states to sign up showed that fewer than half the states are willing to go along.”
“The federal government will have to run the exchanges in those states, a task few believe it is prepared to handle. The timetable is challenging, to say the least. These exchanges must be ready to accept patients by Oct. 1, 2013, and be fully operational by Jan. 1, 2014. If that's not enough, the federal exchanges will need to rely on cooperation from state agencies in places that have officially refused to cooperate.
Last March, I wrote that the health care law was doomed regardless of what the Supreme Court decided. That still appears to be the case. With the re-election of the president and a Democratic Senate, formal repeal is not going to happen. However, the realities of implementation will provide many avenues for ongoing resistance. Some will be financial, as businesses and others evaluate their options. Some will be legal, as a number of cases continue to work their way through the courts. “
“But the biggest challenge is more basic. Voters want more control over their own health care choices than either the status quo or the president's law allows. But 74 percent think everyone should also have the right to choose between expensive plans that cover just about every imaginable medical procedure and lower-cost plans that cover a smaller number of procedures.”
Tweet: Obamacare does not allow consumers to choose between high cost Obamacare plans and low cost private plans, thereby raising costs for all.

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