Tuesday, January 28, 2014

Interview with Jane Orient, MD, Executive Director of Association of American Physicians and Surgeons

An interview is basically about one's point of view.


I conducted this interview because I am scheduled to deliver a talk on May 9 in Minneapolis before the Association of American Physicians and Surgeons.  I wanted to know how Doctor Orient thinks and where she stands on health reform issues.

Dr. Orient has appeared on some of the largest TV and Radio Networks in the country and her op-eds have been printed in hundreds of local and national newspapers, magazines, internet, followed on major blogs and covered in the Wall Street Journal and The New York Times.

Q: How long have you been executive director of AAPS?

A:  Since 1989.

Q:  What is your specialty?

A: I am a general internist is solo private practice in Tucson, Arizona.

Q: What is the mission of AAPS?

A:  We stand for the private practice of medicine.  We were founded in 1943.  The private practice of medicine means the physician is working for the patient’s good, not for the insurance company, not for the government, not for some population health ideal.

Q: How many members do you have? And what publications do you have?

A:  We have  5000 members. We publish the monthly AAPS News which can access at AAPS.org, and we have a monthly journal that is freely accessible on the website as well.

Q: How do you access the current health care landscape?

A:  It looks pretty desperate. We are seeing issues coming to a head that have been in existence since the 1940s when 3rd party payments were introduced.  These payments now cover 85% of medical services.   That means there is some entity like the government or insurance company that’s in charge of paying the bill.  They decide what the bill’s going to be, what they’re going to pay for, and increasingly, they’re intruding into the area of health care delivery.   

They’re not just content to pay the bill for all beneficial medical services. You can’t do that for everyone  because sooner or later you’ll go bankrupt.  If we no longer have the regulation of the free market, which is patients spending their own money deciding what something is worth, it will  all seems to come out of some collective bottomless pot.

Q: I gather you regard Obama Care as anathema.

A:  That’s a fair assumption.   ObamaCare just legitimatizes, exacerbates, and perpetuates the flood of problems we already have. It makes medical care cost two to three times as much as it should. That’s because of 3rd party payment and Obama Care.  It makes it more difficult to get back to the physician-patient relationship. 

The architects of 3rd party payment are opposed to the Oath of Hippocrates.   They think physicians should be working for the good of the collective rather than for the good of the patient.  They think that nobody should pay for their own medical care but everybody should be forced to pay for everybody else,  or whatever these mandarins or gurus think is legitimate.

A: And in the process, 3rd party payment demoralizes doctors and exacerbates the physician shortages?

Q:  Of course it does.  We physicians  can’t do our job.  We spend all of our time doing administrative busywork. We can be second-guessed at any point.  The insurance company can claw back what they paid us.  They can even send us to prison because we got the government’s stupid codes wrong.  

We can’t do this anymore.  We can’t do our jobs. We can’t do it right.  We are not willing to do things that are not in best interest of the patient.  So physicians are retiring.  Smart medical students or prospective medical students are being advised that smart people do not go into medicine to live a life of indentured servitude.

Q: Today three GOP senators – Burr of North Carolina, Hatch of Utah, and Coburn of Oklahoma – introduced a GOP alternative to Obama Care.   What do think of that?

A:  Well, there are already three or four of these bills. They’re all somewhat different.   They are ignore the option plan of Paul Brown, the Congressman of Georgia.   The GOP is assuming we’re going to replace Obama Care with something that’s not quite as bad. But all of thee plans  based on the same premises that got us here in the first place. 

Q: What do you think the political prospects for all of these proposals are?

A: At the moment, all these proposals are  dead in the water. Two people control government health care.   Senator Harry Reid can keep anything from coming to a vote, and President Obama can veto anything that interferes with his great achievement. 

Q: One alternative AAPS has focused on its direct pay for services in practices dubbed as concierge medicine, retainer medicine, cash only medicine, or hybrids of these approaches.  How would you characterize the state of this movement or the magnitude of it?

A:  AAPS does not "focus" on concierge medicine, which  has its problems.  Some concierge  doctor tries to collect from insurance.  The model may come under attack from insurance companies because doctors are being accused because of interference with the prepayment for an unlimited amount of service.

Basically, we believe there should be direct payment of patients to physician.  Payment should be expected at the time of service.  That’s an old fashioned idea. You give a service, and the patient pays for it.  You’re not promising anything in the future.  The patient decides if it’s worth it.  It should all be honest and transparent, just like at the grocery store or the computer store. 

Q: You prefer the term “direct payment”?

A: Yes.

Q; What is the scope of the direct payment movement? I understand your meetings have been well attended and are increasingly so.  And I understand physicians who have gone into direct payment are very enthusiastic, and most of their patients are satisfied with direct pay.

A:  Yes, we’re getting more and more phone calls. Our meetings are well attended, and there’s more and more press coverage.

 But there is timidity and fear as doctors make the switch to direct pay.   They think many of their patients will abandon them, and some will.  They fear liabilities and potential hazards.  The switch to direct pay without the 3rd party revenue stream often does cut into their incomes for a few months, but it also cuts back on their expense, particularly on a big staff arguing with insurance companies.  Many doctors are saying I work a lot less, but I’m happier.   I sleep well. I make less money, but I’m taking more of it home.

Q; On January 20, I read AAPS had sued the government.  What was that about?

A:  That was about the President’s decision to delay implementation of the employer mandate and continuing the individual mandate.  We have lodged a number of suits because the government’s mandates violate the constitution and separation of powers and the power to rewrite the law.

The law was clearly written so the employer and individual mandate go into effect at the same time. Now the employer may cancel their coverage and thrust even more patients onto the individual market, where policies and premiums are generally higher because there’s a smaller pool. In the first place, premiums will be higher for individuals, second, they will be much higher because of the Obama Care mandate and,  in the third place, and they will have to use after-tax dollars. And they will have to make twice as much money to pay the premiums. 

The Congress finally found  that  out when they agreed to have their employees go through the exchanges that their federal employee benefit had paid for with pre-tax dollars. Now they figured out they would have to use after-tax dollars if they go through the exchanges.  So they pleaded with the President to give them relief, and he did. 

The  Government now says government workers are like small-employer workers, if you can believe that. Senator Ron Johnson of Wisconsin is filing a lawsuit against the government for subsidizing government workers on health exchange plans. 

Q: You’ve painted a grim picture of what’s going on.

A: It is grim.  And a lot of Republicans have not painted an honest picture.  They’re pretending with  just a few little tweaks here and there we can fix ObamaCare. 

Q; One of those tweak is tax credits for all.  Do you agree with that?

A:  I don’t have a problems  with a tax-credit, but I do have a problem with a refundable tax credit because that is the redistribution of income.  The Republicans seem to have forgotten  the fundamental axiom of socialism: “From each according to his need, to each according to his need.”  So if you don’t make enough money, we’re going to make other people help you buy that insurance by giving you a tax credit. Everything the government gives is being  taken away from someone who earned it.

Q: As Margaret Thatcher so famously observed, "The problem with socialism is that sooner or later you run out of other peoples' money."

Q: Exactly.  I can see  you’re critical of both the Republicans and the Democrats on free market principles ?

A: Yes, at least to that particular idea refundable tax credits. I’m critical of anything that is unconstitutional, anything that causes  redistribution of wealth, anything that interferes with free markets.  

We need to have a true free market, and medicine that means direct pay of patients to physicians for services rendered without 3rd party payment or intervention into the patient-physician relationship.

Tweet:  The Association of American Physicians and Surgeons stands for private medicine, a true free market, direct pay of patients to physicians, no 3rd parties, and no  redistribution of wealth

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