ObamaCare: Game On for Physicians

The health care fix is now set to be law.  The federal government stepping into administration and provision of medical services is creating a lot of uncertainty and concern among those of us that provide health care service.  We know that there are inequities, cost issues, and other problems with the current system.  But there is a lot of angst involved in thinking that the government is up to the challenge of appropriating control over one sixth or more of the economy, especially when we see how government has managed what it attempts to control now.


Patients suffering from illness desire accurate diagnoses in a timely fashion with the best treatment options available.  The massive bureaucracy of the Affordable Care Act ensures none of this, sacrificing the above in an attempt to ratchet down costs and increase the availability of care to the uninsured...or so the law is advertised.  Perusing the bill shows that it is more a bureaucracy to ensure the expansion and power of government.  Nowhere has thought been given as to how we physicians can be made to feel like partners in the success of "ObamaCare."  Nowhere is the patient the focus of the bill, unless you count the fantasy that care is provided "free of charge."


The current insurance-based system has, at least to some extent, market forces that patients use to drive their decision-making.  The system works for most Americans.  We are now being asked to trust that government can better handle administration and payment.  Trading freedom of choice in health care for the security of government payment for that care, to paraphrase Benjamin Franklin, will result in us having neither freedom nor security.


Even if we liken ObamaCare to one of government's greatest successes -- putting a man on the Moon -- we find that ObamaCare falls far short.  NASA had world-class leadership, intelligence, planning, and ingenuity, not to mention bravery.  ObamaCare can claim none of the above.  It is an embarrassing mishmash of progressive group-think, foisted upon us by anointed ones whose "best for all" theories are sure to prove laughable in practice.  And thinking that government will make care more affordable?  Really?  Does anyone doubt that actual costs will skyrocket, services will be less available, quality will decline, treatment options will be limited, rationing will occur, and innovation will go away under ObamaCare?  Does anyone doubt that good practitioners will leave the field of medicine or that prospective physicians will choose to pursue other careers?


Health care delivery, at least as Americans have come to expect, is extraordinarily expensive.  This fact cannot be ignored.  Making an accurate diagnosis often requires costly special testing and equipment.  It requires the patient to accurately describe his symptoms and have interpretable physical signs for a physician to correctly identify.  Unfortunately, many patients unintentionally obfuscate the history of their illnesses.  Many physicians may focus on the wrong symptom or misinterpret the wrong physical sign when addressing that patient.  There is an art to medicine, like it or not.


The architects of ObamaCare expect non-physician health care providers, ostensibly working at local pharmacies, to be able to take some of the patient load.  Those of us who work as physician subspecialists find this disturbing.  We already know that smart, experienced, caring doctors make the wrong diagnoses fairly frequently.  If anything, costs could be saved by making the right diagnosis the first time.  For that to occur, we would need more subspecialists with our expensive tests and equipment, not more buffers in the way of access.  We subspecialists also have better ability to address each illness with specific testing.  Too often, justification for testing everything that could possibly cause a symptom is made to "protect us from lawsuits."  This habit blow up costs considerably.


Lawsuits drive up the cost of health care more than any other item.  Physicians, hospitals, pharmaceutical companies, and medical equipment manufacturers are playing a game of "Legal Lotto" in every encounter with a patient.  Yet tort reform is not even whispered in this legislation.  Why does the public think a new drug costs more than a billion dollars to come to market?  Why does a week in the ICU cost $500K?  Well, it isn't due to physicians' pay.  If we truly care about cost, we have to address this elephant in the room.


ObamaCare was passed because the populace thought that the law would make health care "free."  One easily comes to the logical conclusion that we are therefore deserving of the harsh reality check that emerges from such a fantasy.  The shoddily formed abomination that is ObamaCare is now with us.  It is a Frankenstein monster that, despite its heart being in the right place, will kill our children.  It is a classic example of "being careful what you wish for."


As a doctor, I am not going to prescribe a treatment that I know will not work.  For patients' sake, I am not going to fill a prescription that I know will not be effective.


As someone who works in health care in America, and as someone who is a health care consumer, why should I trust the government in administration of my care?  The same government that runs the Post Office and Amtrak, the same government that has declared war on poverty and drugs and has failed spectacularly, simply cannot be trusted to care for me, my family, and my patients.  It seems like the wrong prescription has been written for a disease that has better chances for cure through smarter options than through purely government ones.


We physicians have a vested interest in this political game of power.  Our businesses, our employees, and our patients do as well.  ObamaCare may wind up destroying the best health care in the world.  Reinventing a private market solution after this destruction will be impossible.


To those who voted for this monstrosity, you should have thought of us when constructing this legislation.  Treat us as a commodity at your own peril.


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