Once again, everyone is talking about healthcare, largely thanks to the historic events which took place in the Supreme Court last week. The public has been showered with speculation about what will happen if the mandate is struck down, or if the entire law is overturned or if the law remains intact. Although this is a quintessential legal affair, it is curious that once again, those most closely enmeshed in the trappings of this conundrum- the physicians who deliver healthcare- don’t seem to have a voice, so as if to imply that they are insignificant bystanders.
Most physicians now agree that Obamacare will not help them care for patients any better than before its passage and will instead harm them. The architects of this law brilliantly front loaded it with “goodies” that make it popular with many Americans. Keeping “kids” on your health insurance until they are 26 or preventing insurance companies from dropping patients with pre-existing conditions can make people forget that the cost of a family health insurance policy has risen on average by $2100, not dropping $2500 as promised by President Obama. The promise of “free preventive health screenings” should concern everyone, because unfortunately, Americans will once again learn that there is no such thing as “free”. There is a cost attached to everything, especially healthcare.
Most doctors might think it reasonable if everyone had healthcare insurance, but that is not what Obamacare is about. The essence of this law is that every American must purchase a health insurance policy that the Federal government approves of. That means that the government defines what is in the policy, what will be covered and what will not, and who will be allowed to deliver that care and under what circumstances.
The legal argument that has become the foundation for the defense of the individual mandate is that there is cost shifting, which is created when uninsured individuals show up in the emergency room for care. The contention is that we all pay for this, and that universal coverage will put an end to this problem.
The irony is that Obamacare itself is an elaborate cost shifting scheme. It shifts $500B out of Medicare to pay for the 159 new federal bureaucracies that have been created under this law. The 80 million people who are going to be put on Medicaid will shift costs to the 50% of Americans who still pay taxes and will absorb the healthcare costs of those who pay nothing. Obamacare is an income redistribution scheme.
The tenor of the proceedings in the Supreme Court last week creates hope amongst physicians that Obamacare will be overturned. Anything short of that will fail to halt the events currently underway that are eroding the foundations of the medical profession. Built into Obamacare is reduced compensation for physicians, increased regulation, unrealistic demands, and no relief from medical liability abuse.
All actions always have consequences- whether intended or unintended. The result of Obamacare will be less doctors working, which means that the guarantee of increased access to healthcare is a false promise. Your insurance card will only provide a place in line. It means that the Patient Centered Outcomes Research Institute will decide what treatment you will get. It means that the Secretary of Health and Human Services will tell your doctor how to practice medicine.
On this current path, the private practice of healthcare will disappear within the next 10 years, as physicians sell their practices to hospitals, afraid that they can no longer afford to stay in business. More than 50% of doctors now work for hospitals. Obamacare suspends antitrust regulations so that hospitals can consolidate doctors’ practices into a single entity- an accountable care organization (ACO). Under such an arrangement, the doctors work for the ACO and not for the patients.
There already are rumblings coming from Washington suggesting that physician licensure needs to be nationalized in an attempt to compel doctors to see patients on Medicare and Medicaid and avert the mass exodus that is expected when reimbursement rates are slashed in the coming years.
Most doctors still believe that there is some hope for them and for their patients. This would require a Republican President, Senate and House of Representatives, and a repeal of Obamacare. The prospect of a helping hand from the Supreme Court is something that was not counted upon, but which would be most welcome.
Dr. Hal Scherz is the founder and president of Docs4PatientCare and organization of physicians dedicated to protecting the doctor patient relationship – http://www.docs4patientcare.org