You’ve heard from senators, the President, and now Hollywood about Obamacare. Now you need to hear from physicians who are living it, exactly how Obamacare will affect what happens to you behind the closed doors of your doctor’s office. We physicians are so busy trying to keep our heads above water that far too few are speaking out. So here I go.
WHY MOST PHYSICIANS HATE OBAMACARE
First, most physicians across the country hate Obamacare. They don’t just dislike it; they hate it because the war is personal. And think what you like, it’s not about the money; it’s about forcing us to practice bad medicine. We are getting squeezed, manipulated, and treated like we are stupid and “dumbed-down.”
The whole premise of Obamacare is that we physicians can’t run our practices efficiently so we must be told how to do so. During the past few years, we have been “instructed” on how to care for you better by insurance company employees and government officials who have no medical background. These folks have no clue about illnesses or what even the simplest medical diagnoses are.
Recently, one insurance employee who was overseeing “quality of care” in our office had to ask my husband (an internist) what things like “myocardial infarction” and “hyperbilirubinemia” were. Yet, she was passing judgment on the physicians in our office regarding the adequacy of their care for patients with these illnesses. I’m not kidding.
Here are a few more “Obamacare helps” that the six physicians in my practice are experiencing. You need to know this, because your doctor experiences them too.
1. We have been given list upon list of new “rules” to help us be better doctors to you. Remember, the rules are written by business people who know nothing about medicine. One of these “rules” was that we needed to change the name of our practice from being a medical practice to being a “patient centered medical home.” Yup, we got our names wrong, so to be better doctors to you, we had to change them.
Thus, we were given a 10-inch thick manual of rules we needed to follow in order to get the task done. We had to hire one new full time staff person just to implement the changes. Oh, and our costs went up, but we did become a PCMH as they said. While she did that, we continued to see patients.
2. We were given an exhaustive new list of diagnoses to choose from. If we fail to pick one from the list (we didn’t write the list, of course; the non-medical folks did), then we won’t be reimbursed by the insurance companies. God forbid we examine you and write down what is wrong and then give you a treatment plan. Too simple the government says. Good medicine? You decide.
3. We no longer get paid for our service. You think we decide how much to charge for an office visit? Nope; insurance companies do. They have decided to set our fee schedule and then “withhold” our fees until they decide if we took good enough care of you.
Of course, they have a list to check in order to decide if we did well or poorly. For instance, if all of my pediatric patients are immunized on time in my practice, then insurance will pay me what they decide I should be paid.
But, if my patients either decide to wait on immunizing their children (maybe the child has a cold) or even not immunize at all (we are one of the few medical practices that actually gives parents the choice), then we don’t get paid. It’s our fault if you choose to wait. Yup, that’s right, if you choose not to immunize your child and I talk to you for an extra 15 minutes about why immunizations are important, I don’t get paid.
4. Medicare sets all pay schedules, and they have been dropping over the past few years. Once Medicare sets a fee schedule, other insurance companies follow suit so our reimbursements have been plummeting.
Is your family doctor talking about quitting? He may well be and here’s why: he can’t make ends meet. We are told that we need more expensive equipment like electronic medical records which cost hundreds of thousands of dollars each year and our reimbursements are falling.
We cut staff, take less pay home, and still, many can’t make it. Really good physicians are retiring too early because they are losing money. You may not hear about this because we in primary care are getting the cuts first. The cardio thoracic surgeons and the like are still fairly well protected, but just wait.
5. The insurance companies—most importantly, the government ones like Medicaid and Medicare—are in bed with the drug companies. Have you ever wondered why you can get Lipitor, but not Zocor, for example? The reason is simple. The government tells drug companies that if they scratch their backs, they’ll return the favor. Who cares what’s best for you? The government just wants to seal the deal with the drug company. That’s why they tell you and us what medicine is “best” for you; it’s all about the deal.
6. Obamacare has nothing good to offer the poor. Believing that Obamacare must exist because the poor in America don’t have adequate care is a rouse. Find me a physician or hospital that will turn a sick person down. You won’t because we aren’t trained that way. Caring for all men and women is drilled into us from day one.
My husband ran our free clinic in town for 15 years. He volunteered his time and found numerous other physicians to do the same. Some patients were taken into private practices of the volunteering physicians to be seen for free on a continuous basis. He got drug companies to donate medicines and the poorest of the poor got all the care they needed. Until recently.
Our local hospital administrators (not physicians) decided to take the clinic over and they bought big new office space, insisted on computerization and more expensive upgrades (none of which improved patient care) and drove the costs of the clinic through the roof. Suddenly, the patient population changed. No longer were the poor coming (I don’t know where they went). Instead, younger patients—many in their twenties and thirties—came to the clinic asking for pain killers and marijuana for their back pain.
The drug companies have quit donating medicines and many of the doctors have stopped volunteering because the clinic has paid nurse practitioners. Think what you may; but the truth is, the quality of care has gone down because physicians felt hamstrung. They were discouraged from doing what they felt called to do.
The concerns I’ve laid out here are just for starters, but you must know one simple and enormous flaw in the Obamacare system: the more non-medical people that come between you and your doctor, the worse you will be taken care of. Period. The sad part is that the wrong people are speaking out because the folks who really know what’s happening, the physicians, are too busy trying to survive. Meanwhile, you, the precious patients lose out.
Forget what politicians, the President and Hollywood say. We know how to take care of you. They don’t. We are the ones who want to keep our eyes on you, our patients, and they are forcing us to adhere to codes, manuals, and red tape.
TV SITCOMS AND STARS WILL SOON PROMOTE OBAMACARE
Hollywood is being seduced to amp up the appeal to you so be very, very wise. The California Endowment is a private foundation, which just gave Hollywood $500,000 to weave promotions about Obamacare into television shows. Why? Because they believe that it is through sitcoms that you receive your knowledge about health care! Seriously, they think that you, too, are that stupid.
If you watch The Simpsons and a character says that Obamacare is a good thing, they believe that you will listen—to a cartoon! Have you been adequately insulted yet? Here’s what a recent article from ABC News online said about this venture, “We know from research that when people watch entertainment television, even if they know it’s fiction, they tend to believe that the factual stuff is actually factual,” said Martin Kaplan of the University of Southern California’s Norman Lear Center, which received the grant. So if Homer says that he likes his new insurance program, since you think he’s cool (though unreal), you will still be influenced because somehow he is able to speak truth. Honestly, you can’t make this up.
Your health is serious business and your doctor has devoted his or her life to helping you. Say what you will about physicians, but 95% have their hearts in the right places. They are in medicine because they really care. The problem is, the giant of Obamacare will drive the great ones away because their hands are being tied tighter and tighter. Don’t let this happen.
Turn off Homer and talk to the real deal—your own doctor—and find out what he’s experiencing because it will directly affect you. Don’t just listen to me; listen to him. And then please, speak out.
