My patients have trusted me from the beginning to inform them about the new health-reform law. Such conversations are taking place in doctors offices across the country. Patients everywhere are finding out that their doctors are not happy. And patients know that if we are having trouble, it will impact the care that they receive.
Now that the health-reform law is under attack from many sides, there is a growing opportunity for doctors and patients to have their protests heard. As a practicing primary-care physician, I say Obamacare is facing a perfect storm.
First, there is an ongoing court battle to determine the law’s constitutionality. This legal challenge, now at the federal appellate court level, is sure to reach the Supreme Court of the United States, the question being when, not if. The Obama administration is clearly in no rush to see this happen, because if the court rules against them, it will have a major impact on the 2012 election. By 2014, most of the features of the bill, including the individual mandate, will be instituted, the Independent Medicare Advisory Board will be in place, and millions more patients will be signing up for Medicaid or receiving subsidies for individual private policies or paying penalties. Once our health-care delivery system is significantly altered by these provisions, it will be much harder to repeal or remove them.
In terms of the individual mandate, Obamacare’s biggest deception remains the euphemistic use of the term “health care” in place of “insurance.” For Obamacare is not only unconstitutional in compelling a patient to buy a product, it is also suspect from a public-health perspective since having insurance does not guarantee access to health care. The inability of universal health insurance in Massachusetts to stem the flow of ER visits because of a shortage of both specialists and primary-care doctors directly debunks this myth.
If the federal government believes it must ensure health care for all as a public protection, much as a mandatory vaccine protects the public from an emerging disease, then the government must do so by providing the doctors, nurses, and clinics to deliver this care. Doctors have long understood that health insurance of all kinds interferes with — rather than promotes or enables — the practice of medicine.
Obamacare in its current form will also have catastrophic economic consequences. A new McKinsey report indicates that at least a third of businesses will cut their employee health benefits as the so-called Affordable Care Act takes hold. The number expands to 50 percent for those business owners who are most familiar with the bill. There are several reasons for this. Premiums are soaring and many businesses would rather pay the penalty than shoulder these costs at a time when the economy is still struggling. The draft regulations that accompany the new law mandate the kind of low deductible, low co-pay insurance that leads to higher premiums than businesses can afford. It would have been much smarter to move toward a higher deductible insurance in the workplace that encourages people to pay out of pocket for non-essential services or to utilize tax-friendly, flexible-spending, and health-savings accounts; but Obamacare is rendering these lower premium insurances obsolete.
Technology will inevitably be imperiled by an insurance system that covers every cough and sniffle and is over-expanded to cover the 30 million plus people who lack it. As costs skyrocket, federal bureaucrats will tighten their belts, and committees and boards like IPAB will restrict services. The problem with this approach is that it not only compromises quality of care, it also hamstrings doctors who believe that medicine is an art, where different treatment choices work for different patients. This is becoming more and more apparent at a time when our most effective — and expensive — new treatments are targeted therapies that respond to genetic abnormalities. Since everyone’s genetic signature is different, approaching illness and treatment from this perspective defies the one-size-fits-all insurance model that Obamacare perpetuates.
Doctors will flee, not only because of shrinking reimbursements amid the ever present worry of frivolous malpractice suits, but because our options for treatment will become so restricted that we will no longer be able to practice effectively.
You will get to keep your doctor, provided that he doesn’t restrict his practice or retire. In the meantime, I would suggest you ask him what he thinks about Obamacare.
— Marc Siegel, M.D., is an associate professor of medicine at NYU and the medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical contributor and the author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health.
editor’s note: This article has been amended since its initial publication.