Over dinner with an anesthesiologist friend, we discussed his new job -specifically his "on call" schedule. He explained that he needed to get one of his partners to take his next day on call, but that it shouldn't be a problem. In fact, he said that his partners vie for these call days. I was perplexed because this had not been my experience, so I asked him to elaborate. He said that the doctors in his group get paid according to how much they work, so they compete for extra call days.
In his former group, everyone was paid the same amount, regardless how much they worked. Hence, no one wanted extra call- it was a burden, and there was no incentive to work harder. By mid-afternoon, doctors attempted to remain inconspicuous so that they could slip out of the hospital unnoticed. In his new group, people volunteer to stay late and want to be sure that there are no patients still waiting for surgery before they call it a day.
There can be no better example illustrating the differences between a system which rewards hard work and personal responsibility versus one where all incentives are removed. Obamacare is emblematic of a system which destroys incentives to work and the reason why over 70% of physicians oppose it.
On our current path, hard work on the part of doctors is dis-incentivized. The $716 Billion being siphoned out of Medicare to pay for a new entitlement program, largely comes out of the pockets of physicians working to provide care to seniors. And then there is the Independent Payment Advisory Board (IPAB).
The IPAB is the most insidious of the 159 new agencies created under Obamacare. This board of 15 is unlikely to have any practicing physicians on it, but is charged with controlling Medicare spending by cutting payments to doctors if spending exceeds certain targets. Since they are not subject to Congressional oversight, it will be impossible to contest their decisions.
Both McKinsey and the Congressional Budget Office reported that businesses faced with the choice of high healthcare costs or modest penalties for failing to provide health insurance to employees, would choose the latter. Millions of employees will be "dumped" into the government healthcare option; Medicaid for all- the failed government plan which provides “insurance” for indigent patients. Reimbursements are so low, that only 30% of doctors are currently seeing new Medicaid patients.