Health Care Reform: The Worst is Yet to Come

Do you see or do you observe? Most readers have likely given just a glancing glimpse of the photograph to the left, which I took during recent vacation in Costa Rica. Most, including me, would have recognized that the photograph is a tree, and then moved onto the riveting text. While this identification would be correct, it would not be the whole story. Look more carefully, and see if you overlooked a finding on the photo during your cursory review of it.

The health care reform plan, now law, also has many camouflaged elements that were not visible, even to the informed public. In the coming years, as the layers are peeled back, there will be many surprises for the public and for the medical profession, which I hope and pray will remain a profession.

The Patient Protection and Affordable Care Act was signed into law in March 2010. No, it won’t be repealed, despite some shrill populist campaigning to do so from the political right. I also doubt that the judiciary will turn it back, despite efforts to do so in nearly 2 dozen states. Nevertheless, public support of the bill will steadily wane as its provisions and costs become apparent in the coming years. It remains my view that the plan will cost much more than predicted, and will deliver much less than we have been promised. When this inevitable result occurs, the nation will collectively develop acute carpal tunnel syndrome from the wild finger pointing we will all be engaged in.

Here are some highlights of coming attractions.

No permanent SGR reform. Congress is still kicking the can down the road, year after year. Let me use a fancy gastro term to describe this phenomenon – no guts.

A ‘physician compare’ website will provide the public with results from the government’s Physician Quality Reporting Initiative (PQRI) ‘quality’ measurement program, which we practicing physicians deride as a sham that wastes time and money and fails to assess true medical quality. I’d like to think that I practice high quality medicine. Unfortunately for me, none of the things that I hopefully do well can be measured. What is easy to measure, however, doesn’t really matter.

Mandatory deductions in Medicare reimbursements will begin in 2015 to physicians who do not submit acceptable PQRI data to the government. Physicians must participate in this bogus program, or we will be docked. Another fine example of your overtaxed dollars hard at work.

Requires that an imaging service (e.g. CAT scans or MRIs) with physician ownership advise patients that the imaging services can be obtained elsewhere and provide them with a written list of other available imaging centers. This latter provision is bizarre. Would we expect any business to provide the customer or client with a written reference list of competitors? When I stop by Starbucks for some overpriced and bitter coffee, I don’t expect them to hand me a list of other coffee bars down the street. Perhaps, my own gastroenterology (GI) practice should prominently list all other GI practices within 5 miles of our office in our waiting room.

Seniors currently enrolled in Medicare Advantage programs (25% of all Medicare participants) are about to be cut loose when the government cuts payments to these private programs. Of course, benefits to these seniors will be cut accordingly. Many will be forced over to traditional Medicare at higher costs because of high Medigap policy costs.

Allots relative pocket change to examine alternatives to current medical malpractice litigation. In other words, we are going to study the problem. While we’re at it, let’s commission another study to confirm that the earth is a sphere and not a flat plain.

Independent Payment Advisory Board is a 15 member cabal that will wield great power to control Medicare costs. They are prohibited from reducing member benefits, rationing care, increasing premiums or raising taxes. So docs, what is the one remaining pool of cash that these guys have access to? See photo below.

Of course, I could write, “Wait, there’s more!”, but you get the idea. Thirty-two million citizens are to be given medical coverage, half of of these under the strained and sagging Medicaid program, when we don't have sufficient primary care power to meet current needs.  Who will see these patients?  Can physicians afford to incorporate large volumes of Medicaid patients into our practices?

I acknowledge that many supporters of the health care reform legislation truly believe that it will serve the public good, or at least initiate a process that will ultimately deliver true reform.  I don't agree with them.  While there will be fewer uninsured Americans - a most worthy outcome - it is not clear that they will have ready access to quality medical care. Is it worth lowering the quality of our medical care system in order to cover more individuals?  Many would privately agree with this compromise, but would never say so in front of a microphone.
While it is politically palatable to confiscate and redistribute physicians' incomes, imagine the tsunami that will develop when the patients are fleeced and controlled.  The truth is, similar to the taxes paid by the wealthy, that even if all physicians' incomes were appropriated, it would do nothing to address the cost escalation spiral.  Who will tell patients the truth that the era of endless medical care and treatment will be euthanized?  Look what happened when the apolitical USPSTF issued some modifications on mammography guidelines.  Does the public really believe that they will be left whole afterwards?  Once the medical profession, Pharma, insurance companies, et al are dumped into the wood chipper, then the public will be targeted.  Physicians are the low hanging fruit, but be assured that your government will reach the top of the tree.

I feel like we are all stumbling through the rain forest, during a downpour with crackling lightning overhead. We can’t see where we are going, and we can no longer find our way back to where we began the journey. The ground is slippery and we reach for a branch to steady ourselves. Of course, we didn’t see the viper wrapped around the branch, although he found us. The most dangerous predators are those we cannot see, the lurking in the shadows, ready to strike even though our government guide has assured us that it is safe to pass.