Twelve months after passage of the Patient Protection and Affordable Care Act, all there is to show for it is that is has put the American healthcare system in jeopardy. Instead of providing a framework for the future, Obamacare has succeeded in creating chaos and uncertainty in the healthcare marketplace. Stuck in the middle are the physicians who have to watch helplessly as bureaucrats, who know precious little about what is involved in delivering quality care, tinker with issues sometimes concerning life and death.
Our system has its flaws, but when it comes to cancer treatment or the management of complex medical problems such as trauma or medical innovations, all other nations lag behind the United States. President Obama tried to convince America that our system was unsustainable and that his plan would fix the biggest problem that threatens healthcare delivery — costs.
We now know that that is not true. His plan costs more money than our nation can afford an estimated $3 trillion over the next decade. And the President’s prophesy of unsustainability promises to become a reality – not because of inaction but as a direct result of his healthcare plan.
The new healthcare law profoundly affects doctors and their patients as the law moves into further implementation phases in the next few years.
For example, the prospect of cuts in Medicare reimbursement has already created a terrible access problem for seniors. The uncertainty about Medicare reimbursement to physicians is already forcing many doctors to stop seeing new Medicare patients. Seniors now find it difficult, if not impossible, to find a primary care physician.
In 2010, payments to physicians were suspended for as long as 45 days, not once but twice. For doctors who primarily see Medicare patients, this was devastating and forced some to downsize or close their doors. More cuts to Medicare are expected this year and in 2012.
The new law is also taking another step to bring the private practice of medicine to the brink of extinction. For years, hospitals have lobbied Congress and state Legislatures to make it illegal for doctors to own hospitals, surgery centers, labs or imaging centers. Now, the new healthcare law creates the concept of Accountable Care Organizations or ACOs or super HMOs aimed at cutting costs and restricting care through clinical integration.
As a result, hospitals are buying physician practices and doctors are becoming hospital employees. In turn, patients are being controlled by hospitals just as they were by insurance companies two decades ago – leaving them few choices and undermining the doctor-patient relationship. According to The Wall Street Journal, more physicians now work for hospitals than themselves.
The most troubling part of the new healthcare law is that it grants ultimate authority for many clinical decisions to the Secretary of Health and Human Services. She has control over 159 new agencies, boards and commissions. It is already a compliance nightmare for many doctors thanks to HIPA, OSHA and a host of other rules. Now things are getting worse.
What does all this mean for physicians? Simply that it may not be worth being one any more. In turn that’s very bad for patients. Good luck finding a doctor when you really need one. The only privilege that your government insurance card will offer you is the opportunity to wait in line. When you get to the front, you may not like what’s being offered.
Scherz is a pediatric urological surgeon at Georgia Urology and Children’s Healthcare of Atlanta. He serves on the faculty of Emory University Medical School and is president and cofounder of Docs4PatientCare.