Health Policy

Doctors oppose health care reform.

Scottsdale – If you are a patient, you have to wonder why so many doctors oppose health care reform. An article in Investors.com reports the result of a recent poll of  physicians and the results are not good for the future of medicine. In fact, the poll indicates that two out of every three practicing physicians oppose the medical overhaul plan under consideration in Congress. An even greater concern is that hundreds of thousands of physicians would think about shutting down their practices or retiring early if the legislation is approved.

This poll contradicts the claims the White House and the American Medical Association — both which suggest the medical profession is behind the proposed overhaul.

In my opinion, there are several reasons why physicians oppose this reform. Most doctors have their patients best interest in mind. Physicians believe that they and their patients are the best people to make decisions about an individual person’s health care options. If a government plan is created, there is no doubt that a significant portion of the decisions will be made by the bureaucratic machinery designed to manage such a  system.  Those critical medical decisions will have a huge impact on individual patients life and potentially their doctors too. After looking at the current 2,000 page bill before Congress, you can be sure that the bureaucratic machine that has been conjured up is of colossal proportions. The most significant goal of the current legislation is to lower the costs of health care. Most likely, the bureaucrats will opt to provide the least costly options for patients while avoiding the expensive ones. The costs will matter and it will not matter to the bureaucrats whether the procedure they approve is the best indicated medical treatment for the patient.

Physicians fear that non-medical personnel in charge of managing decisions will force their patients to accept less costly therapy that, in some cases, may be less than optimal and even worse, could be below the standard of care. The proponents of the reform would argue that the system is not designed to provide less than standard care. However, it is inevitable that in such a large health care bureaucracy, whether intentional or not, some patients are not going to be diagnosed or treated in a timely manner as they attempt to access health care through all the “natural red tape” that is typically associated with government-run programs. Delays in diagnosis or treatment is what I and others have predicted will be the number one cause of morbidity and mortality in the population if this bill is enacted. If this occurs, physicians will be left out of the decision making process and will be powerless to protect their patients, but will likely be blamed for poor outcomes. This chain of events will increase the likelihood of malpractice suits and increase the costs of practicing medicine in America.

Another reason for opposing this current legislative reform is the significant lower rates of reimbursement for hospitals and physicians. For instance, the Senate Bill requires physicians to accept below Medicare reimbursements for services in the later years of the plan. This is required in order to keep the overall costs of the bill around 900 Billion. Expenses for doctors and hospitals, on the other hand, are going to continue to rise as much as 40 percent while reimbursements drop. The most likely outcome is that physician practices and hospitals will not be solvent under this plan and many will have no other choice than to close their doors. Already hundreds of hospitals have shut down during this economic downturn. If this continues, then a crisis the likes of which has not  been seen in this country will occur with regards to access for specialty care and possibly even for general medical care that will devastate the population.

Diminishing reimbursements will also contribute to the access crisis by lowering the number of doctors graduating medical schools. This will lead to less and less physicians available in the future to replace retiring physicians and the crisis will get worse as we get older. The fact is that medical school is expensive and a lower reimbursement will cause many new graduates not to be able to pay loans back for a  lot longer period that previous generations. This and other financial pressures will make medicine even less attractive to future generations.

There is no significant tort reform in the legislation. This compounds the problem tremendously. Physicians already fear that they will not be able to influence the bureaucratic decision-making process, that they will no longer be able to advocate the best treatments for their patients, and that they will not be able to protect their patients once a decision on how to proceed with care is made by the managing personnel. As the new medical environment evolves under this plan it will likely become more dangerous to practice medicine for the average physician. As other doctors retire or move on, the remaining physicians will have to see more patients in less time, receive less reimbursement for more work, and take more risks with less rewards. Eventually, this will leave doctors in a vulnerable position of being overworked, underpaid and unhappy. Physicians already live in fear of litigation and without the ability to protect their medical practice and life-long investments many will be pushed out of the business.

More than 800,000 doctors were practicing in 2006, according to government statistics. Projecting the poll’s finding onto that population, 360,000 doctors would consider quitting if the legislation goes through as planned.