Politics & Policy

O’Care: The Truth Was Evident

As far back as 2010, we knew this would happen.

Back in the summer of 2010, soon after the Affordable Care Act was passed, I looked out the window of my medical office to darkening clouds and thought of that apocalyptic moment in the movie The Terminator when Sarah Connor looks to the future and says, “A storm is coming.”

I knew back then that President Obama’s promise that patients would get to keep their doctors was propaganda, because health insurance doesn’t work that way. Your decision to choose me as a doctor is based on my participation in your plan or your personal decision to pay my out-of-network fees if I don’t participate.

And from the beginning, the new law promised to restrict out-of-network benefits and shrink networks. No way you could be guaranteed to keep me as your doctor.

Keep in mind I can afford to keep you as a patient only if I can continue to participate in a plan that pays me less and restricts the tests and treatments I can order. Doctors everywhere knew that any insurance scheme that broadened coverage while increasing the regulation of services would be impossible to work with.

Which is why it comes as no surprise that in 2013 — with the main provisions of Obamacare being shakily implemented — a new poll by the New York State Medical Society finds that 44 percent of doctors aren’t participating in Obamacare and that 23 percent aren’t taking patients from the health exchanges.

Doctors have always tried to escape from the tightening noose of overly restricted health insurance whenever they have had the financial means to do so. The fact that the new law didn’t anticipate this is a catastrophic flaw.

When Obamacare passed back in 2010, touting the expansion of Medicaid as a core feature, doctors were dropping out of Medicaid by the droves. A physician survey as far back as 2005 revealed that fewer than 50 percent of physicians were accepting new Medicaid patients.

The problem extended to all health insurance: Surveys from New York State before Obamacare passed revealed that more than 10 percent of doctors were dropping out of the top HMOs, and the Medicare Payment Advisory Commission reported back in 2008 that close to 30 percent of Medicare patients looking for a primary-care doctor couldn’t find one.

The more people are insured, the more “comprehensive” the coverage, the less doctors are paid per patient, the more difficult it will be to keep your doctor.

The idea of keeping your insurance plan was also more presidential propaganda and never realistic. In fact, as far back as June 2010, the IRS, the Department of Health and Human Services, and the Department of Labor released an 83-page draft of regulations for the new law that placed restrictions on whether existing plans would meet the new Obamacare requirements and could be grandfathered in. The draft’s own midrange estimates predicted that 66 percent of the insurance plans offered by small employers and 45 percent of those offered by large employers would no longer be legal by 2013.

And the numbers were no better for individual policies. The draft estimated that between 40 percent and 67 percent of individual policies would relinquish their grandfathered status by failing to comply with the new regulations. This report — from the government itself — was widely covered on TV and in print, by me and many others. There was simply no way that HHS Secretary Kathleen Sebelius and President Obama didn’t know about it, yet the myth about keeping your plan was perpetuated until just this week, when it became clear that close to 2 million Americans have already had their policies canceled.

What a mess. The federal government may be able to build bridges and (sometimes) to fight wars effectively, but its officials are certainly not experts in the health-insurance business. If President Obama recognized that a segment of the population was underserved in terms of health care, he could have suggested hiring the doctors and building the clinics to serve them. Instead, he has moved America in the direction of the Canadian system, where there are several-month waits for basic technology, and emergency medical care is often inadequate.

Will you be able to keep your doctor? No, you won’t. He or she may soon be replaced by a nurse practitioner or a physician’s assistant or even by a clerk who tells you to “have a seat.” Will you be able to keep your insurance plan? No, you won’t. It will be replaced by a plan that covers more health care in theory but gives you less in reality, for higher cost.

America’s trademark ingenuity could have created something better if only partisan politics, propagandists, and rhetoricians hadn’t gotten in the way.

— 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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