A Doctor’s Oath

by Marc Siegel
Government may be poised to mandate that all doctors participate in Obamacare.

For me and many other doctors like me, taking care of you has never been about the money. I have always considered it an honor and a privilege to be allowed personal entrance into the private world of your mind and your body. It is very satisfying for me to be able to offer my medical knowledge and experience to help you, my patient. This is why no matter how much or how little you or your insurance company pay me to see you, I will continue to do so. I will not abandon you because the reimbursement I get for your office visit is constantly diminishing or because I will soon get a bundled or quality-of-care payment rather than a fee for the service. No matter what the insurance scheme, I will struggle to lower office overhead to compensate for continued loss of income.

But Obamacare may not allow me to continue taking care of you, no matter how altruistic I am. The real problem with Obamacare’s narrow networks on the state exchanges is not doctors like me dropping out; it is insurers deciding not to add us to their new networks in the first place. Don’t get me wrong. No doctor in his or her right mind is eager to accept the reduced fees that Obamacare offers, and there is every reason to believe that the new policies will cut our reimbursements to the bone. But the reason that I don’t participate in the individual market’s GHI, HIP, or Empire Blue Cross plans is that these insurers have decided not to include my university’s network of doctors.

The cost of keeping us connected to our patients is far too rich for Obamacare’s blood. And for those insurers, like Oxford, United, and Aetna, that do include me via my university plan, I worry that these networks won’t include the orthopedist or kidney specialist or brain surgeon I am used to referring to, further jeopardizing my patient’s quality of health care. Can you imagine searching unsuccessfully for a brain surgeon to remove a growing tumor? This is the hideous future of the state exchanges: limited care provided by limited networks of physicians. Remember the “capitated” HMOs of the 1990s? Obamacare is a reprise of this failed model. The word “capitated” should really be “decapitated.”

The individual market is just a taste of the future — the same problems are sure to surface when the Obamacare business exchanges are up and running. And as businesses drop employees’ health coverage or make them part-time, so that more individuals resort to the state exchanges, the numbers of patients who are used to seeing me but no longer can will increase dramatically.

Many of my fellow physicians are concerned that as Obamacare collapses without the good doctors to support it, the government will have no choice but to mandate that all doctors participate. There is already a precedent for this. With Medicare and Medicaid, you are either all the way in or all the way out. There is no middle ground. As a participating Medicare provider, I cannot refuse to see a Medicare patient, though I can certainly delay an elective visit when my office schedule is full. An AMA survey in 2010 found that 17 percent of doctors were restricting the number of Medicare patients in their practice. Can you blame them? With reimbursements falling and restrictions rising for performing complex procedures on elderly patients with multiple medical problems, what doctor would rush to see them?

Many of my brethren feel that the same problem will soon exist for Obamacare. This is many doctors’ worst nightmare. You see, Obamacare is a multi-headed beast — it involves too many insurers for such an across-the-board mandate to be effective or workable. Recently, I decided to drop out of an insurance network that was paying me only $25 per visit and was refusing to pay for flu vaccines.

I can’t imagine losing the right to drop out of a bad insurance network any more than I can imagine what would happen if the new Obamacare insurances could be forced to include the best doctors.

The health-insurance situation is bad enough without adding any more mandates.

— Marc Siegel, M.D., is an associate professor of medicine at the NYU Langone Medical Center and medical director of the center’s Doctor Radio. He is a member of the Fox News Medical A Team and the author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health.

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