by Martin Light
In the 1970s I worked in the financial division of a major university medical center and saw the beginnings of how doctors and hospitals had begun to be shackled and bludgeoned by excessive regulations and made to subsist on declining reimbursements. Prior to that time doctors and hospitals could actually expect to be paid for their technical life-saving skills and expertise on a fee-for-service basis but today both are paid/reimbursed pennies on the dollar for those same services.
Folks, it isn't going to get any better but only worse unless Obamacare is killed by a spike driven through the heart of it.
Since the Social Security Act of 1965 was signed into law on July 30, 1965, by President Lyndon B. Johnson as an amendment to then existing Social Security legislation, doctors and hospitals have seen their incomes slashed. Medicare was created to provide healthcare for the elderly and Medicaid (MediCal in California) was to do the same for the poor, however, these two programs substantially expanded the role of the federal government into the process of how doctors and hospitals were to be paid. For example, the Omnibus Budget Reconciliation Act of 1989 made several changes to physician payments under Medicare by introducing the mandated Medicare Fee Schedule which set reimbursement rates for services provided by doctors. Up until then doctors and hospitals had been charging fair fee-for-service prices just like other highly trained technical experts. Imagine taking your seriously ill family vehicle to the auto mechanic and expecting him to accept pennies on the dollar for skills you don't have but desperately need.
Over the years as doctors continued to serve Medicare and MediCal patients while being paid less than before, they have had to do something to make up for the loss in revenue in order to stay in business. Although Medicare was never meant to be used as a guide for private health insurance payment schedules, insurance companies and health plans have been basing their rates of payment on those of Medicare. As a result, doctors have had to painfully suffer the loss. They can't even write the loss off. The services basically never happened! This is legalized theft and any physician with fiscal responsibility and a moral sense of the need to keep his craft capitalized knows it. But, doctors attack disease and don't fight in this arena because it would seem uncaring. They simply suffer quietly, but please recognize they still care intensely about us. The proof, they keep working, but it's making less and less sense. It appears that they are having a harder time believing in themselves.
No matter how much we pay for private insurance, their payment to physicians is either slightly above Medicare rates (for better insurance companies) or BELOW Medicare rates. It is not uncommon for some insurance companies to pay 10-20% LESS than Medicare.
So, when the federal government pays artificially low prices, costs radically go up for everyone else.
Physician friends tell me that initially they started out being reimbursed by Medicare at 90 cents on the dollar but then as the reimbursement rate dropped below 40 cents on the dollar they were forced to close their practice. Many are angry and disgusted at the federal government and insurers trying to make them practice unsafe medicine in order to save money.
I believe doctors have been oppressed by insurers and the federal government, i.e., Medicare and it's time to let them get back to the basics of practicing medicine as they've been trained to do and to be paid accordingly. It is time to get BIG government and BIG insurance out of the doctor and patient relationship.
There is a lot that we as patients don't know about the system of paying physicians and the practice of medicine. If you have a chance during a future office visit with your doctor ask him/her a question or two about how they feel about practicing medicine today. Here are a few sample questions to select from to get the conversation going:
Can you take a few minutes to educate me as regards your feelings about how much you get paid for your work?
Do the insurance companies I pay every month for my and my family's health assist you or not in keeping us well?
Do you feel the insurers really care about us?
Are you worried that if you speak out against the insurance companies, you could be black-balled out of town?
Do you think we the patients are getting what we deserve?
Do you need the government to regulate hospitals you practice at?
If you get sick, do you think you will be taken care of the way you have always taken care of us?
President Obama, in a speech to the American Medical Association (AMA) in June, 2009, stated that one of the biggest crises facing America's healthcare system is ~ a shortage of primary care doctors. As reported in a June 20, 2009 Washington Post article Obama declared that healthcare reform should "do more to reward medical students who choose a career as a primary care physician."
If there is a shortage of doctors today before Obamacare is fully implemented think of what it will be like after thousands of physicians retire or stop practicing medicine because they can't make a living doing what they were trained to do.
In closing, Obamacare threatens to worsen our nation's shortage of doctors and therefore the overall quality of healthcare.
(This is a continuation of the discussion about healthcare begun by Patrick Wagner, MD, in his articles which appeared in the June and July issues of the CABPRO News.)