Congresswoman Nancy Pelosi spoke plainly and honestly when she said "You have to pass the bill to find out what's in it ". As we find out " what's in it" the level of frustration, disappointment, and anger has grown, especially since her statement openly acknowledges that ObamaCare was formulated and passed in the most opaque fashion ever done for a piece of major legislation. The element most obviously left out of the back-room deals was the physicians. So, my question is "What happens when you lose the good faith of the doctors"?
The common assumptions among the key players, the government, hospitals, and the insurance companies are that doctors will willingly work harder, order fewer tests, and treat more people with fewer complications, with vastly increased regulation and demand for documentation, all for a lower salary. The vast majority of doctors are very hard-working, highly ethical, highly intelligent and devoted to their professional practice and patients. It is this very truth that has lead the other elements of social engineering to believe that the doctors can and will do anything and everything needed no matter what the circumstances and no matter how limited the resources. Essentially, they can be counted on to work tirelessly and perfectly, and accept whatever recompense is offered. Unfortunately, the resources are a limiting factor and anyone with any common sense knows that not everyone can have everything. More importantly, if not critically, doctors will leave the profession rather than see their patients harmed by a broken system. Those doctors who are in business to see a 100 patients a day will remain. That is the nature of the incentives that have been designed. High volume, minimal patient contact, maximize profits.
In my practice this was the year that my colleagues who are my age began to retire in droves. By and large they collectively are fine physicians with many more years of excellent medicine in them. Rather than change the personal relationship that they have with their patients and allow third party entities to interfere with the doctor-patient relationship they have decided to leave. To date, this is the greatest tragedy of the so called Obamacare Affordable Care Act. The next tragedy will be the significant deterioration of the patient's access to care because of the lack of providers. Finding a doctor is getting difficult.
In the past, many physicians worked into their late seventies or even eighties. Their accumulated wisdom and skill and charity were valued by society and they took pride in their profession. In 2014, many colleagues have retired in their 50’s and 60’s. They no longer have the resources to care for their patients in a quality way, and they won’t change those patterns. Many cite the burdensome regulations and silly rules now in place that give Medicare, and Medicaid as well as the insurance companies the right to retroactively refuse payment for services. It is commonplace now to have to fight for payment for a legitimate service, well and successfully provided and “pre-approved”, just because of some nit-picking rule as judged by a bean counter.
Ezekial Emmanuel, MD, one of the ACA’s architects famously has answered, when asked, what will happen when the doctors refuse, “They will have to work, we will make them.”
Well the truth is that they don’t have to, and most have the resources to retire. What will be left is those doctors who are willing to cut corners, see a hundred patients a day and make up their income stream by volume. They will be the only choice and most likely you won’t even see them, rather a far less educated surrogate. Most of your surgery will be done by a technician and your medication handled by a computer and its formulary.
In Atlas Shrugged, a Dr. Tom Henderson (famous neurosurgeon) disappears suddenly, only to re-emerge as a happy “cash for service” physician. His soliloquy, once regarded as “over the top” is now a common sentiment among doctors. He elects to withdraw his expertise and good faith.
They will leave the profession and service that they love because they love it and will not be forced to practice bad medicine. When your treatment is not on the list of approved services, who will fight for you? Will that technocrat have your trust?