After the debate has ended and the lobbyists have moved on to their next clients, health care will be left the way it started, a physician and a patient sitting in a room trying as best as they can to prolong health and forestall sickness. Fortunately the many victories and losses claimed by both ends of the political spectrum will not change this shared pursuit.
So then why has reform that promises to get millions more in a discourse with their doctors been so polarizing? Making sure more Americans have health insurance can only be a major victory, right? Too bad the medical establishment is not celebrating. In fact, the mood in those exams rooms is downright morose.
In tens of thousands of exam rooms all over the country physicians are struggling to make sense of the 2,000-plus pages of the reform bill. A recently released poll of more than 2,000 physicians, conducted by Athenahealth and Sermo, is alarming. The poll, part of a broader Physician Sentiment Index, indicates that 79% of physicians are less optimistic about medicine since the passage of health care reform. Fifty-three percent indicate they will consider opting out of insurance plans with passage of the bill. Worst of all, 66% indicate that they will consider opting out of all government-run programs. The same reform bill that will provide "care for all" may drive away more physician caregivers than attract previously uninsured patients. What a predicament that would be.
Many may find the data from the poll puzzling. How could physicians be so pessimistic about a bill that clearly has so many positives? For one, the bill addresses none of the issues most consistently ranked by physicians as the most critical for lowering costs and improving access. Tort reform, streamlining billing and payment, and fixing the flawed government formula for calculating physician reimbursement are given little, if any, serious attention.
What physicians knew then and certainly know now is that instead of fixing these issues, the government will be forced to take the path of least resistance to save money (that is to say the path with the least special interest resistance). That means reducing physician reimbursement, just as the country is counting on even more physicians to be available.
Physicians knew the health care bill had a "gotcha" buried deep inside. The only way it could be called "budget-neutral" was to implement significant reductions in physician payments. So just as we are hoping more physicians become available to treat the influx of 31 million more patients, the government is implementing a massive reduction in physician reimbursement (a 21% reduction in physician reimbursement went into effect April 1 after several years of no adjustments for inflation, meaning physician reimbursement has been declining for several years already).
In a moment of complete legislative hypocrisy, the proponents were touting one health care bill that included cost estimates that assumed a massive reduction in payments while another bill moved its way through Congress that would reverse those cuts (the bill reversing the cuts was ultimately defeated, meaning the cuts did go into effect). At some point, basic supply and demand will kick in, and there will be insufficient physician resources for treating patients.
But what of the much-touted American Medical Association's support for the bill? The AMA, which counts less than 10% of its $300 million dollars in revenue from physician membership dues (the rest comes from a government sanctioned monopoly whereby the AMA sells the billing codes upon which the entire health care system relies) had little choice but to endorse the bill, lest the government retract its exclusive license on billing codes. Again physicians know what the public does not: Less than 15% of practicing physicians are AMA members, so any AMA support is more a reflection of the AMA's financial interests than what physicians in this country truly want. This is a situation that proved opportunistic to proponents of the bill but could prove painful for America's health care system.
Indeed this might be a pyrrhic victory. Health care without active physician participation is no health care at all. Many physicians are investing in electronic health records and billing technologies that alleviate some of the huge administrative brunt that threatens the independent medical office and enables them to fare better in the uneven fight with insurers. These technologies do hold great promise in ensuring these projections remain just that, projections, and not reality.
But still, as the Athenahealth-Sermo poll shows, many physicians are ultimately faced with the choice of opting out of government insurance programs or going out of business. A significant number of physicians are realizing they cannot stay in business--let alone remain independent--if they continue to accept artificially low government reimbursement rates.
Many states are recognizing this impending crisis, and rather than addressing the causes of medical inflation are resorting to an "easy," short-sighted fix: Make participation in state and federal insurance programs a condition of medical licensure. Far from a theoretical proposition, Massachusetts' health care system is so over budget that the state legislature is considering a bill that would mandate physician participation, in effect making physicians state employees.
Can anyone say socialized medicine?
Daniel Palestrant, MD, is founder and chief executive officer of Cambridge, Mass.-based Sermo, the largest online physician community, where more than 112,000 physicians collaborate to improve patient care.
Thursday, April 29, 2010
Why Physicians Oppose The Health Care Reform Bill