Robert A. Hayden, DC, PhD, FICC
The election looms. We are being bombarded on paper, on television, on radio, and maybe in personal visits with ideas, pleas, promises, slogans, talking points, etc. It's like a movie that you would like to fast-forward to the end to get past the slow, laborious parts to see how it ends.
The health care issue is not the driver of this election, but it is a point of concern to the main issue, the economy. I have written on related topics a couple of times already, but I read a survey of doctors' opinions that deserves repetition and amplification. Please bear with me one more time. After the election, maybe this awful subject will be less relevant, and I can move back to something clinical.
If the Patient Protection and Affordable Care Act (PPACA, or Obamacare) stands, it will have tremendous impact on the economy. I am not an economist, so I will leave that to pundits. PPACA will have huge impact on health care itself.
The Doctor Patient Medical Association (DPMA) has released a survey of about 700 doctors that sought to find the impact of PPACA on their practices and plans to cope with it. In this survey, 83% of the docs said they would contemplate leaving the industry if PPACA were fully implemented.
About half (49%) in the survey said that under PPACA, they would stop accepting Medicaid patients, which where patients would find their coverage. Almost three quarters (74%) said they would stop taking Medicare patients or leave Medicare completely. About half said they would consider treating some Medicare/Medicaid patients free rather than deal with the government. I know personally that this already happens.
Two-thirds of physicians surveyed currently state they are just getting by or are operating in the red. I know of one local physician who orders medications for patients and administers them in his clinic, but Medicare does not even reimburse his cost for the drugs. What choices does he have? How long he can hold out under the existing circumstances? What happens to the patients he serves when he reaches his ultimate limit as a small business?
I wrote not too long ago about the trend of business interests gobbling private primary care clinics. The norm is that family medicine doctors, for example, are being bought out by hospitals in preparation for the Accountable Care Organizations (ACOs) that are incorporated into PPACA. In the DPMA survey, 95% of doctors reported being concerned that they are being swallowed by corporate medicine. This is related to other issues in the survey, such as the feeling among 85% that the patient-physician relationship is in a tailspin, and 65% say government involvement is most to blame for current problems.
Interestingly, the American Medical Association supported PPACA against the will of their membership. In the DPMA survey, 57% say the AMA has let them down. Evidence of this is the membership hemorrhage of the AMA as it loses its base of support, even as two-thirds of the delegates of this now irrelevant organization voted to support PPACA.
What does PPACA grant to patients? In a blog at Benefitspro.com, Kathryn Serkes, DPMA Chairman, says, "Doctors on the front lines clearly understand what Washington does not." "Government-mandated 'coverage' is not the same thing as actual medical care. Whether the mandate is overturned or stands, whether the Medicaid expansion is overturned or stand, we'll still have millions who need medical care."
Then, Serkes hits it on the head: "What PPACA does is increase patients' access to a piece of paper—that says they are 'covered' by insurance or 'enrolled' in Medicaid or Medicare," she says. "But paper promises don't translate to actual medical care when doctors can't afford to see patients at the lowball payments, and patients have to jump through bureaucratic hoops set up by the government."
And so we have gone through this very painful process of reinventing health care in the political process. We have polarized America. We have spent millions, if not billions, on lobbyists and lawyers, who are the clearest winners so far.
And those who are beneficiaries of PPACA will get a piece of paper.