Sunday, February 17, 2013

Health Reform Paralysis
Paralysis – what happens when an unstoppable forces meets an immovable object.

February 19, 2013 – It’s Sunday.  I spend Sunday mornings reading The New York Times to see how The Times thinks we should change and reshape American culture.
Two pieces concerning  the paralyzing issues of our times caught my eye.
One was the lead editorial “The Real Cost of Cutting Government.”  The theme was that cutting government spending by 5% to 8% will be an unvarnished disaster for the American public and the American military. Presumably we should spend money we don’t have, raise taxes, or borrow it from the Chinese.  The unstoppable  force here is government spending, and the immovable object is Republican opposition.
Second was Thomas L. Freidman’s “How to Unparalyze Us.” What’s paralyzing us, avers  Friedman, are economic uncertainties and worries.  He points out that Tim Cook, Apple CEO, is sitting on $137 billion in cash but won’t spend it because of future uncertainties.  The result is a no-growth economy.  The solution, according to Friedman  is a Grand Bargain with more government spending on IT infrastructure and early childhood education, with fiscal restructuring of  our tax code and slowing of entitlement spending. GOP opposition is making President Obama’s agenda stoppable.  Both sides, declares Friedman, should meet in the middle to restore confidence and certainty to make Obama’s plans movable.
As I read these two pieces,  I thought of physicians caught in the middle.  Government, the unstoppable force in the form of Obamacare, proposes to cut their reimbursements by 40% over the next ten years, yet at the same time, practice expenses, an immovable objects, are rising at 3% to 5% a year, easily exceeding 40% over ten years.
For physicians,  these conflicting forces pose a paradox  – what to do?   As Walker Ray, MD, vice-president of the Physicians Foundation, explained in an interview I conducted with him about the results of survey with 630,000 physicians ,
“ I agree with physicians who say they are unsure where we will be or how we will fit in three years. Ninety-two percent of physicians in this survey agreed with that statement. Only 2.7% strongly disagreed. There is tremendous uncertainty, and uncertainty always invites anxiety and lack of confidence. “
Tweet:  Two paralyzing forces - government spending without money in the bank - and GOP opposition creates economic uncertainties and worries.




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