Medical Association and the American
Hospital Association are both enamored of the Obama administration’s
quest to socialize medicine. This position would seem curious, given
the large majority of clinical physicians is strongly
and vocally opposed. As the primarily academic and administrative
members of these organizations might explain, it’s that they care
primarily for patients, society, and the “greater good,” while practicing
physicians harbor impure motives. Narcissistic illusions of superior
intellect and education are believed to bestow the right to rule
others. After all, greedy clinician worker drones cannot be expected
to understand the fantastic intricacies of their queen’s
beloved policies. But as we subjects know all too well, the opposite
is true. Isolation in palaces
and ivory towers
prevents accurate observation of the realities of the world outside.
Instead these “leaders” imagine the world as they wish it to be,
scheming ever more elaborate strategies in a futile yet disastrous
attempt to shape it to their will. The roots of this pathology can
be traced to misguided belief in the good
government fairy, insatiable lust
for notoriety and power, and economic
ignorance. Their most outrageous claim is the pronouncement
that ObamaCare is going to be good
for physicians and hospitals.
To anyone with
one foot even toeing the ground, this assertion is obviously either
the most short-sighted or fraudulent analysis you’re likely to encounter
side of the Congressional Budget Office. Physicians who accept
government payment, particularly those who are hospital-based, will
have long felt the boot on their faces. Our government masters have
already forced hospitals and their physicians to provide care
for all comers with no payment or consideration whatsoever —
the granddaddy of all unfunded mandates. In the majority of cases
where payment is bestowed, the amount is dictated
by government. For the remainder, the amount typically is calculated
as a fixed percentage of the government rate. In order to receive
its gifts, the government requires care for its patients only
in the way its bureaucrats decide, regardless of science or
evidence, under threat of reduced or withheld payment, thereby forcing
hospitals to hire sizable armies of unproductive clipboard carriers
to monitor and enforce compliance. Government has oft availed itself
of the “right” to unilaterally change its terms at any time and
in any way to benefit itself and its favored constituents, without
regard to hospital or physician interests. One recent
example is the refusal to pay or reduced payment for hospital
readmissions within thirty days, though these are common and generally
no fault of hospitals or their physicians.
measures are largely a consequence of government collaboration by
these same delusional individuals and their elevation to the bureaucracy.
So it should come as no surprise that they cheer loudly when their
masters cobble together a whole new
set of diktats numbering nearly 2000 pages, sending hospital
lawyers, accountants, and compliance officers scurrying to research
the implications of labyrinthine references to an additional 100,000
or so impenetrable pages of US code. They thank the government
for forcing patients to purchase ridiculously comprehensive policies
few if any would ever pay for themselves, and for expanding government
“insurance” that will continue to pay pennies on the dollar. They
ignore the greater long-term consequences, which most anyone can
see as follows:
evisceration of private insurance companies and the payments received
companies can’t deny coverage or charge more for customers with
preexisting conditions, their costs will necessarily skyrocket.
They have only two ways to survive — either raise premiums or reduce
payments. Healthy individuals will have no need to pay the necessarily
outlandish premiums, preferring to pay the much smaller yearly fine,
then purchase insurance only after becoming ill. Many businesses
likewise will opt for the fines. Even their fairly high-earning
employees will qualify for government subsidy if not expanded Medicaid,
particularly if they have a family. The incentives will lead to
the transformation of many private insurance customers to self-pay
(generally equivalent to no pay) or government-pay. In order to
stay afloat serving an increasingly ill customer base, the insurance
companies, unable to raise premiums sufficiently, will be forced
to institute ever more draconian rationing schemes. The result will
be decreased reimbursement and revenue for hospitals and physicians.
To sum up, fewer privately insured patients and less payment on
behalf of each, perhaps not immediately, but inevitably. One popular
financial commenter even sees making
a fortune shorting the insurance companies in the coming years.
of demand from the population of newly government-covered patients.
see a large number of self-pay patients currently, many who have
minimal if any apparent concern for their unpaid bills, there are
an even larger number of uninsured who do not seek hospital services
because of their inability to pay. The responsible poor, once covered
by a government plan, will seek care en masse. As has
already been observed with Medicare and Medicaid, when government
relieves them of their sense of personal responsibility and their
perceived costs go to zero, patients will present repeatedly with
conditions for which many would not even consider seeing a physician.
The number of patients with the entitlement mentality will rise
dramatically. To avoid below cost payment, physicians’ offices that
have the option to refuse them will do so, just as they are doing
in ever increasing numbers with
Medicaid already. As a result, hospitals will be essentially
the only provider of services to these individuals, and at much
greater expense than could be achieved in the primary care setting.
The costs for these newly covered patients will dwarf all projections.
reimbursement and increased headaches for Medicare patients.
In order to
pretend that ObamaCare will actually save the government hundreds
of billions of dollars over the next ten years though covering an
additional thirty million individuals, the schemers must at least
claim to pull savings and efficiencies out of their hats. Of course,
there are also outrageous, business-destroying tax
increases. The primary
target of the efficiency buzz-saw is none other than the much
beloved “keep your government hands off my Medicare.” The average
recipient with this attitude will be unlikely to appreciate having
half a trillion dollars’ worth of benefits slashed. These profound
Medicare savings are prophesied, despite the imminent retirement
of the baby boom generation and resultant explosion
of Medicare enrollment. If the busybodies are ever in doubt,
their calculation is easy — the potential votes of nearly fifty
million beneficiaries eclipse those of hundreds of thousands of
physicians every time. The flaming hoops they will hold for us to
jump through will be ever higher and tighter.
demand from uninsured patients who have no intention to pay, many
with ulterior motives, with no recourse for physicians and hospitals.
analysts acknowledge the bill will leave millions without coverage,
yet these patients will continue to seek medical services on which
hospitals and physicians will take heavy losses, even after ObamaCare
is fully instituted in 2014. In their minds, a large number of uninsured
already have been relieved of responsibility, either having no scruples
against medical theft or mistakenly believing their tab is covered
by government. For a significant minority, the lure of a “free”
pregnancy test, addictive prescription drugs, or a warm bed and
meal will continue to generate elaborate, fictitious medical complaints.
In order to protect against bogus claims of malpractice, expensive
diagnostic testing will continue to be performed. Common sense solutions
such as malpractice reform are not seriously considered. Even the
most basic of measures such as Ron Paul’s perennial “Treat
Physicians Fairly Act” will never be allowed to emerge from
legislative committee. The government is utterly broke, is continuing
to become ever more broke,
and is looking for ways to steal more revenue. Increasingly they
will target “evil” businessmen and “rich” individuals such as physicians.
but perhaps most importantly, a fundamental shift in the doctor-patient
relationship from partnership to the gatekeeper-gatecrasher model.
As noted in
the Investor’s Business Daily column “20
Ways ObamaCare Will Take Away Our Freedoms,” for physicians
“the Secretary of Health and Human Services is authorized to use
your claims data to issue you reports that measure the resources
you use, provide information on the quality of care you provide,
and compare the resources you use to those used by other physicians.
Of course, this will all be just for informational purposes. It’s
not like the government will ever use it to intervene in your practice
and patients’ care. Of course not.” This provision is the camel’s
nose under the tent for ever-greater control over physicians’ practices.
Order too many tests, see your payments cut. Continue to do so,
be required to attend reeducation seminars or see your license suspended.
Of course, patients won’t particularly enjoy the new model either.
They are unlikely to be understanding when the physician doesn’t
order the testing they demand or admit Grandma whenever she becomes
a burden. Most won’t express anger towards their sugar daddy government,
they’ll shoot the physician messenger, resulting in more angst on
the job, more complaints filed, more administrative headaches responding
to said complaints, and ultimately defending more lawsuits.
has seriously studied this bill, or even listened
to those who champion it most, realizes it is an intentional
stepping stone towards the ultimate socialist goal of national single
payer, e.g. the British or Canadian model. ObamaCare is designed
to fail, simply so the government can swoop in and “save” us all
through ever greater control in the future. Patients, be prepared
22 months for your MRI, to die
while awaiting bypass surgery, and to enter
yearly lotteries for the chance to “win” a government-employed
primary care physician, all in the name of fairness. Physicians,
be prepared for government employment if you wish to continue work
in your chosen field, providing “care” you abhor. It will be at
a salary chosen by your masters, guaranteed to be a fraction of
the former income you worked decades and invested hundreds of thousands
of dollars in order to earn. It likely will be less than that of
the bureaucrats who will be running your life even more from now
For those of
us who can see clearly what lies ahead, we must prepare ourselves.
Opt out of government programs such as Medicare and Medicaid while
you still have a choice. Cancel membership in the AMA. Join and
support organizations that defend our right to practice medicine
voluntarily, such as the American Association of Physicians and
Surgeons. The AAPS website
is a good educational resource, including on opting out of Medicare,
and their monthly newsletter
(free online) is the medical publication I most look forward to
receiving. Educate yourself, your colleagues, and your patients.
Look for ways to move your practices away from hospitals.
Begin exploring other careers. Cut back your current lifestyle and
save aggressively while you can. Invest for the inevitable dollar
meltdown and economic
collapse. Resist. Push
back. Government and our alleged representatives in medical
societies have already constrained our practices in ways that we
never would have consented. We are now in the final rounds of a
fight for what is left of our profession — one we have only been
losing for decades. Let us and our patients hope that we all have
what it takes to turn it around.
Scott [send him mail] is
an emergency physician practicing in the Southeast. He likes tinkering
with electronic gadgets, getting in over his head with home improvement,
and dogs. He blogs at Proceeding