Thursday, July 31, 2014

Private Practice Future Under ObamaCare

Government is certainly all pervasive. But is truly strong? Is it only big?

Peter F. Drucker (1909-2006), “The Sickness of Government,” chapter in The Age of Discontinuity, Harper & Row, 1967-1968

Governors’ mansions and state legislatures, in the courts, among health care providers, and most importantly, around the kitchen tables of ordinary Americans. Battle lines are being drawn in the Congressional and state races for the 2014 mid-term elections to be held on November 4, 2014. Majority control of the House and Senate in the U.S. Congress and thirty-six Governors’ seats are at stake. Practicing physicians are on the frontlines of the ACA debates.

Kathy Means and Ken Monroe, "The Patient Protection and Affordable Issue Beyond the Horizon into 2015", The Physicians Foundation, White Paper, 2014

As is my wont, I have been reading two things at once – one is a 1967 book by Peter F. Drucker, the imminent social and management theorist, The Age of Discontinuity (1967): the other is a 44 page white paper,” The Patient Protection and Affordable Care Issue Beyond the Horizon into 2014, Part II” by two well-known and widely respected Physician Foundation consultants, Kathy Means and Ken Monroe,

• I will let Drucker speak for himself, “There is mounting evidence that government is big rather than strong; that it is fat and flabby rather than powerful, that it costs a great deal but does not accomplish much..In the seventy years or so between the 1890s to the 1950s, mankind, especially in the developed countries, was hypnotized by government. We were in love with it and saw no limits to its abilities or good intentions. It promised: “Utopia is here – all that is needed is to take everything away from the “wicked, selfish interests.” Once they had been eliminated, the right course of action would emerge from “the facts” and decision would be rational and automatic, and would be turned over to government…The British, in adopting the “free” health service believed that medical care would cost nothing. There are, of course, never enough rich people to carry the burden of any general service. The best we get from government is competent mediocrity. What is impressive is the administrative incompetence. Every welfare state reports the same confusion, the same lack of performance, the same proliferation of agencies, of program, of forms, and the same triumph of rules over results. “

What Drucker was saying, of course, is that government cannot be everything to everybody in a pluralistic society calling for specialized competencies among individuals and organizations. For examples of this incompetency, look no further than the disastrous launch, the rapid rise in health care premiums, and the coming bailout of health plans due to demographic miscalculations of who might enroll in ObamaCare exchanges.

• Fast forward to 2010 to 2014.the first 4 ½ years of ObamaCare – with its expansion of big government and the passage of a massive, complex health law which promised to offer coverage of everything for everybody, and a botched and incompetent implementation of, while retaining your doctor and your health plan, and lowering your premiums. One of its hidden premises was that we would have reform those “wicked” overpaid, under performing, fee-for-service physicians. We would reduce their pay by 30% or more, eviscerate those “overvalued codes,” introduce an elaborate coding system that would systematically decrease or bundle their pay, force them to work on salaries, attack the fees of overpaid specialists (e.g, cardiologists, orthopedists, radiologists, ophthalmologists), decrease reimbursements for imaging procedures and laboratory work, and restructure and restrain hospital fees and penalize hospitals in every way possible.

For more on the critical issues facing physicians, go to the Physicians Foundation website, and download “The Patient Protection and Affordable Care Issue Beyond the Horizon into 2014, Part II.”

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