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Townhall...
The New Health Law:
Bad for Doctors, Awful for Patients
By Jason Fodeman
While much has been said about the recently passed health care overhaul
law and a multitude of cogent arguments have been made as to why the
legislation must be repealed, lengthy debates have failed to adequately
address how the 2,800 pages will prevent patients from receiving the
medical care that they need and want. In fact, in some ways the federal
government already hinders the ability of doctors to provide their
patients with good care. These trends will no doubt worsen under PPACA.
In addition, new regulations and mandates will place unaccountable
regulators in between physicians and their patients.
Medicare’s physician reimbursement regimen is fraught with
underpayments and perverse incentives. During the health care debate,
supporters of PPACA praised Medicare’s ability to exploit its size to
obtain lower fees with providers. While it is true that Medicare can
bludgeon down physician fees, this is not one of the program’s greatest
strengths, but actually one of its greatest weaknesses. These
underpayments are ultimately shifted to patients in the form of shorter
visits, less doctor face time, quick hospital discharges, and
compromised care. Rather than reforming the government’s flawed
reimbursement regimen, PPACA merely expands its scope to more people.
PPACA establishes the Patient-Centered Outcomes Research Institute to
conduct research comparing the efficacy of medical and surgical
interventions. The potential harm from this depends how it is used.
Federal regulators could easily use this research to ration care by
financially punishing physicians prescribing these “less effective”
treatments. This research coupled with reimbursement changes could
easily pave the way for the government dictating to patients the
medicines, tests, and procedures that they can and cannot have,
regardless of willingness to pay and personal preference. This would
replace the professional judgment of physicians with rigid rules set by
regulators in Washington DC. This one-size-fits-all approach will limit
choice and result in poor quality care.
The soon-to-be established health insurance exchanges will also give
the federal government vast new control over physician practices. PPACA
states that starting January 1, 2015, a qualified health plan can
contract with a provider “only if such provider implements such
mechanisms to improve health care quality as the Secretary may by
regulation require.” Depending on the guidelines, this gives the
federal government unprecedented new authority over not just those
physicians accepting Medicare and Medicaid, but any provider accepting
any third party payer offered through the exchange. Of course quality
care is a good thing, but who should determine the definition of
“quality?’ Who knows best? This regulation seems to be based on the
notion that bureaucrats at HHS from afar know better than the doctor
actually talking to and examining the patient. This will coerce
physicians to practice medicine not the way they were taught, but the
way the government tells them. Ultimately, this too will lead to poor
quality, standardized care and restrict choice.
PPACA will strip away physician autonomy, drown doctors in bureaucracy,
and drain job satisfaction. As the profession deteriorates, older
doctors will retire while younger doctors will look to switch careers.
Many young people considering a career in medicine will pursue other
opportunities. The supply of providers will dwindle as demand for
services reaches an all-time high. Ultimately, the consequences of the
health overhaul law will be passed along to patients through restricted
access, long wait for appointments, and rationed care.
The United States boasts the world’s premier health care system. With
that said, of course there is room for improvement and efforts must be
implemented to control spiraling costs. A better prescription for
reform would be to build off the success of the current system while
targeting its inevitable shortcomings.
Ultimately, there are only two ways to lower costs. One approach
empowers bureaucrats to make tough decisions for doctors and patients.
This has grave ramifications on quality of care and choice.
Unfortunately, the administration chose to pursue this route. Yet,
patients would be better served if doctors were held more accountable
by transparency and choice, rather than bureaucratic fiat. A more
practical approach to lowering costs empowers and incentivizes patients
to be smarter health care consumers. This entails solutions such as
expanding health savings accounts, creating a national market for
health insurance, and leveling the tax playing field. These could bend
the cost curve down while simultaneously strengthening the
patient-doctor relationship.
The time has come for a long-overdue, honest discussion on not just the
impact that government will have on patients, doctors, and the practice
of medicine, but the impact it already has had over the past forty-five
years. The importance cannot be undersold as the Patient Protection and
Affordable Care Act is indeed bad for doctors, but it is always the
patient that suffers the most.
Read it at Townhall
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