Stanley Feld M.D.,FACP,MACE
There is a widespread discrepancy between the opinions of organized medical group leaders in the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and practicing physicians. AMA, AAFP, and ACP are part of organized medicine.
These organizations supported the healthcare reform law in 2010 and continue to support the legislation. I believe they have taken this position because they want a seat at the table as implementation of the legislation moves forward. President Obama has not paid attention them so far and there is little evidence that he will in the future.
In March of 2010, Speaker of the House Nancy Pelosi famously said, "We have to pass the [health care] bill so that you can find out what is in it."
Most physicians are starting to realize the implications of President Obama’s Healthcare Reform Act (ACA) (Obamacare). They are terrified about the implications for the practice of medicine.
Organized medicine is still not disenchanted with President Obama’s Healthcare Reform Act. Charles Cutler, MD, chair of the ACP Board of Governors said recently, "The medical community recognizes that so much of the ACA is good."
Dr. Cutler is out of touch with the thinking of the practicing community. It is important for the public to know what practicing physicians are thinking.
In a January 2011 poll of practicing physicians conducted by Thomson/Reuters and HCPlexus. “Seventy-eight percent of physicians said the ACA (Obamacare) would negatively affect their profession, 74% predicted that the law would make physician reimbursement less fair, and 58% believed it would hurt patients care.”
President Obama’s healthcare team does not want to recognize that the shortage of primary care physicians become worse as a result of Obamacare. The Healthcare Reform Act makes no attempt to decrease the present shortage. Sixteen million new enrollees in Medicaid will not be able to find a physician.
A recent membership survey by the Texas Medical Association (TMA) of Texas physicians reports that “59% of Texas physicians have an unfavorable opinion of Obamacare. Texas physicians described their feelings as disappointed (78%), anxious (74%), and confused and angry (62%).
A nationwide survey conducted by The Physicians Foundation last fall produced the same negative results.
Physician disapproval of President Obama’s Healthcare Reform Act is consistent among all medical and surgical specialties. Practicing physicians know it cannot work.
The Thomson/Reuters and HCPlexus survey showed that only 11% of primary care physicians thought Obamacare would have a positive impact on their profession. Only 14% of pediatricians and psychiatrists were optimistic. The optimism for success among cardiologists and surgeons was at 3% and 4%, respectively.
Organized medicine should at least try to hear what practicing physicians thinking.
Forty-eight percent of the general public disapproves of President Obama’s healthcare plan. I believe it will equal the disapproval ratings of physicians once the public experiences the full impact of this terrible law.
President Obama has tried to maintain public support by increasing benefits in the first two years of implementation of Obamacare before the 2012 elections. After 2012 the impact will be felt. It will be too late by then. The infrastructure will be built and money will be wasted. In 2013 and 2014 there will be increased taxes, decreased access to healthcare and decreased choice of care as a result of the Healthcare Reform Act.
President Obama promised a bonus to primary care physicians. The reality is the bonus is insignificant. I suspect with a 29.5% decrease in reimbursement scheduled to go into effect on January 1,2012. It will not only offset the bonus but decrease reimbursement significantly.
President Obama promised organized medicine a “Doc Fix.” Most believe the promise is bogus in light of the budget pressures.
No one is talking about the upcoming debate to make participation in Medicare a condition for renewal of medical licensure. President Obama is going to create a larger physician shortage than already exists with this move.
Accountable Care Organizations(ACOs) introduces another avenue of uncertainty. The process for providers to qualify for ACO status is costly. ACOs are going to increase the cost of healthcare rather than decrease the costs. ACOs will put physicians at risk for patient outcomes. Physicians will be penalized if outcomes are poor. Physicians know that clinical and financial outcomes not only depend on their care of patients but also the patients care of themselves. Few physicians are interested in assuming the patients’ responsibility for this risk. ACOs will fail.
The burden of mandated insurance is a clear attack on the states’ sovereignty and budgets. It is also a clear attack on individuals’ freedom to choose. I believe it is unconstitutional. It will be a few years before the Supreme Court rules on the issue. Mandated insurance only increases the uncertainty and ability to maintaining a medical practice.
Just as the federal government is supposed to be a government by the people for the people and not ignore the will of the people, organized medicine should not ignore the will of its constituents.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone