PROCEEDING BOLDLY

Do not give in to evil, but proceed ever more BOLDLY against it.

Wednesday, April 21, 2010

Physicians and Hospitals that Love ObamaCare

Author's note: the following is an entirely reworked version of an earlier post.  So great are the differences I have decided to republish rather than simply revise the original.  I apologize for any redundancy.

The American Medical Association and the American Hospital Association are both enamored of the Obama administration's quest to socialize medicine.  This position would seem curious, given the large majority of clinical physicians is strongly and vocally opposed.  As the primarily academic and administrative members of these organizations might explain, it's that they care primarily for patients, society, and the "greater good," while practicing physicians harbor impure motives.  Narcissistic illusions of superior intellect and education are believed to bestow the right to rule others.  After all, greedy clinician worker drones cannot be expected to understand the fantastic intricacies of their queen's beloved policies.  But as we subjects know all too well, the opposite is true.  Isolation in palaces and ivory towers prevents accurate observation of the realities of the world outside.  Instead these "leaders" imagine the world as they wish it to be, scheming ever more elaborate strategies in a futile yet disastrous attempt to shape it to their will.  The roots of this pathology can be traced to misguided belief in the good government fairy, insatiable lust for notoriety and power, and economic ignorance.  Their most outrageous claim is the pronouncement that ObamaCare is going to be good for physicians and hospitals.

To anyone with one foot even toeing the ground, this assertion is obviously either the most short-sighted or fraudulent analysis you're likely to encounter this side of the Congressional Budget Office.  Physicians who accept government payment, particularly those who are hospital-based, will have long felt the boot on their faces.  Our government masters have already forced hospitals and their physicians to provide care for all comers with no payment or consideration whatsoever -- the granddaddy of all unfunded mandates.  In the majority of cases where payment is bestowed, the amount is dictated by government.  For the remainder, the amount typically is calculated as a fixed percentage of the government rate.  In order to receive its gifts, the government requires care for its patients only in the way its bureaucrats decide, regardless of science or evidence, under threat of reduced or withheld payment, thereby forcing hospitals to hire sizable armies of unproductive clipboard carriers to monitor and enforce compliance.  Government has oft availed itself of the "right" to unilaterally change its terms at any time and in any way to benefit itself and its favored constituents, without regard to hospital or physician interests.  One recent example is the refusal to pay or reduce payment for hospital readmissions within thirty days, though these are common and generally no fault of hospitals or their physicians.

These dreaded measures are largely a consequence of government collaboration by these same delusional individuals and their elevation to the bureaucracy.  So it should come as no surprise that they cheer loudly when their masters cobble together a whole new set of diktats numbering nearly 2000 pages, sending hospital lawyers, accountants, and compliance officers scurrying to research the implications of labyrinthine references to an additional 100,000 or so impenetrable pages of US code.  They thank the government for forcing patients to purchase ridiculously comprehensive policies few if any would ever pay for themselves, and for expanding government "insurance" that will continue to pay pennies on the dollar.  They ignore the greater long-term consequences, which most anyone can see as follows:

The complete evisceration of private insurance companies and the payments received from them.

When insurance companies can't deny coverage or charge more for customers with preexisting conditions, their costs will necessarily skyrocket.  They have only two ways to survive -- either raise premiums or reduce payments.  Healthy individuals will have no need to pay the necessarily outlandish premiums, preferring to pay the much smaller yearly fine, then purchase insurance only after becoming ill.  Many businesses likewise will opt for the fines.  Even their fairly high-earning employees will qualify for government subsidy if not expanded Medicaid, particularly if they have a family.  The incentives will lead to the transformation of many private insurance customers to self-pay (generally equivalent to no pay) or government-pay.  In order to stay afloat serving an increasingly ill customer base, the insurance companies, unable to raise premiums sufficiently, will be forced to institute ever more draconian rationing schemes.  The result will be decreased reimbursement and revenue for hospitals and physicians.  To sum up, fewer privately insured patients and less payment on behalf of each, perhaps not immediately, but inevitably.  One popular financial commenter even sees making a fortune shorting the insurance companies in the coming years.

An explosion of demand from the population of newly government-covered patients.

While hospitals see a large number of self-pay patients currently, many who have minimal if any apparent concern for their unpaid bills, there are an even larger number of uninsured who do not seek hospital services because of their inability to pay.  The responsible poor, once covered by a government plan, will seek care en masse.  As has already been observed with Medicare and Medicaid, when government relieves them of their sense of personal responsibility and their perceived costs go to zero, patients will present repeatedly with conditions for which many would not even consider seeing a physician.  The number of patients with the entitlement mentality will rise dramatically.  To avoid below cost payment, physicians' offices that have the option to refuse them will do so, just as they are doing in ever increasing numbers with Medicaid already.  As a result, hospitals will be essentially the only provider of services to these individuals, and at much greater expense than could be achieved in the primary care setting.  The costs for these newly covered patients will dwarf all projections.

Reduced reimbursement and increased headaches for Medicare patients.

In order to pretend that ObamaCare will actually save the government hundreds of billions of dollars over the next ten years though covering an additional thirty million individuals, the schemers must at least claim to pull savings and efficiencies out of their hats.  Of course, there are also outrageous, business-destroying tax increases.  The primary target of the efficiency buzz-saw is none other than the much beloved "keep your government hands off my Medicare."  The average recipient with this attitude will be unlikely to appreciate having half a trillion dollars' worth of benefits slashed.  These profound Medicare savings are prophesied, despite the imminent retirement of the baby boom generation and resultant explosion of Medicare enrollment.  If the busybodies are ever in doubt, their calculation is easy -- the potential votes of nearly fifty million beneficiaries eclipse those of hundreds of thousands of physicians every time.  The flaming hoops they will hold for us to jump through will be ever higher and tighter.

Continued demand from uninsured patients who have no intention to pay, many with ulterior motives, with no recourse for physicians and hospitals.

Government analysts acknowledge the bill will leave millions without coverage, yet these patients will continue to seek medical services on which hospitals and physicians will take heavy losses, even after ObamaCare is fully instituted in 2014.  In their minds, a large number of uninsured already have been relieved of responsibility, either having no scruples against medical theft or mistakenly believing their tab is covered by government.  For a significant minority, the lure of a "free" pregnancy test, addictive prescription drugs, or a warm bed and meal will continue to generate elaborate, fictitious medical complaints.  In order to protect against bogus claims of malpractice, expensive diagnostic testing will continue to be performed.  Common sense solutions such as malpractice reform are not seriously considered.  Even the most basic of measures such as Ron Paul's perennial "Treat Physicians Fairly Act" will never be allowed to emerge from legislative committee.  The government is utterly broke, is continuing to become ever more broke, and is looking for ways to steal more revenue.  Increasingly they will target "evil" businessmen and "rich" individuals such as physicians.

And finally, but perhaps most importantly, a fundamental shift in the doctor-patient relationship from partnership to the gatekeeper-gatecrasher model.

As noted in the Investor's Business Daily column "20 Ways ObamaCare Will Take Away Our Freedoms," for physicians "the Secretary of Health and Human Services is authorized to use your claims data to issue you reports that measure the resources you use, provide information on the quality of care you provide, and compare the resources you use to those used by other physicians. Of course, this will all be just for informational purposes. It's not like the government will ever use it to intervene in your practice and patients' care. Of course not."  This provision is the camel's nose under the tent for ever greater control over physicians' practices.  Order too many tests, see your payments cut.  Continue to do so, be required to attend reeducation seminars or see your license suspended.  Of course, patients won't particularly enjoy the new model either.  They are unlikely to be understanding when the physician doesn't order the testing they demand or admit Grandma whenever she becomes a burden.  Most won't express anger towards their sugar daddy government, they'll shoot the physician messenger, resulting in more angst on the job, more complaints filed, more administrative headaches responding to said complaints, and ultimately defending more lawsuits.

Anyone who has seriously studied this bill, or even listened to those who champion it most, realizes it is an intentional stepping stone towards the ultimate socialist goal of national single payer, e.g. the British or Canadian model.  ObamaCare is designed to fail, simply so the government can swoop in and "save" us all through ever greater control in the future.  Patients, be prepared to wait 22 months for your MRI, to die while awaiting bypass surgery, and to enter yearly lotteries for the chance to "win" a government-employed primary care physician, all in the name of fairness.  Physicians, be prepared for government employment if you wish to continue work in your chosen field, providing "care" you abhor.  It will be at a salary chosen by your masters, guaranteed to be a fraction of the former income you worked decades and invested hundreds of thousands of dollars in order to earn.  It likely will be less than that of the bureaucrats who will be running your life even more from now on.

For those of us who can see clearly what lies ahead, we must prepare ourselves. Opt out of government programs such as Medicare and Medicaid while you still have a choice.  Cancel membership in the AMA.  Join and support organizations that defend our right to practice medicine voluntarily, such as the American Association of Physicians and Surgeons.  The AAPS website is a good educational resource, including on opting out of Medicare, and their monthly newsletter (free online) is the medical publication I most look forward to receiving.  Educate yourself, your colleagues, and your patients.  Look for ways to move your practices away from hospitals.  Begin exploring other careers.  Cut back your current lifestyle and save aggressively while you can.  Invest for the inevitable dollar meltdown and economic collapse.  Resist.  Push back.  Government and our alleged representatives in medical societies have already constrained our practices in ways that we never would have consented.  We are now in the final rounds of a fight for what is left of our profession -- one we have only been losing for decades.  Let us and our patients hope that we all have what it takes to turn it around.

6 comments:

  1. Isolation in palaces and ivory towers prevents accurate observation of the realities of the world outside.

    Something wicked and perverse hijacks every bureaucracy. I worked in Organizational Development at a large insurance company, and witnessed firsthand the ironic tension between organizations and those that the organizations supposedly serve. Pournelle's Iron Law of Bureaucracy says:

    "In any bureaucracy, the people devoted to the benefit of the bureaucracy itself always get in control and those dedicated to the goals the bureaucracy is supposed to accomplish have less and less influence, and sometimes are eliminated entirely."

    Been there. It is a fact. And that's what we're seeing with Obamacare.

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  2. Thanks for the comment. Will have to store Pournelle's Law in the memory banks for future use. It's a good one.

    ObamaCare will result in exponential growth of the health care bureaucracy in number and power, as you rightly note will be disastrous. It's no surprise that the bureaucrats tout it. But it takes a lot of gall to suggest that it's going to be good for doctors and hospitals.

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  3. The AMA is not an organization that represents physicians. Only 17% of docs in the US even acknowledge the existence of the AMA and most of these members have little to do with the organization. A handfull of Northern elites control the AMA and receive money from products that they sell. These products are procedure codes. In a bureaucracy, which is what medical care is to become, these codes are like gold.

    The Hospital Association loves the government. The government pays for everything and the hospital association shares this with the politicians. The average cost of a politician in Louisiana in 1990 was $10,000 per bill.

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  4. I can't help but find it a bit ironic - with the Flexner-ization of medicine - what did you doctors expect? I agree with your article in its entirety but lament the fact that I heard no hue or cry from your ranks when barriers to practice were erected giving you the privileged position you have enjoyed for so long. "Government giveth and government taketh away"...and now at last when physicians find themselves lacking control over their profession they will have a taste of what they have dished out for the past century to non-allopathic healers. It is unfortunate that it had to come to this for most of you to start complaining about the collusion...perhaps you personally would not want to erect barriers to practice for other healthcare providers - but I can assure you that most libertarians in name only (LINO) physicians I meet get in a huff when I mention I am a Nurse Practitioner - their libertarianism ends when the competition begins...

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  5. Sharon offers a protest to the Flexnerization of medicine. As an Internal Medicine physician, I sympathize.

    Prescribing drugs is a guild restriction which doctors, now nurse practitioners, and physician assistants, and soon psychologists in our state wish State permission to do.

    I encourage the opening of the market completely. Perhaps one can debate the controlled substances (DEA) as "dangerous drugs" - but let everyone simply go to the market and buy whatever labeled drug they wish. 50mg. of digoxin for the old ticker? That's cheap. 100 mg. of HCTZ? We got it on sale.

    But take away any LIABILITY issues from the customer, who will surely look for someone to sue when Dad's diabetes gets out of control.

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