Tonight I lament the premeditated murder of the greatest health care system ever created by mankind. The passage by the House of Representatives of the Obama-supported Senate reform plan marks a dark day in the history of medicine. I write these words not only as an American citizen, and not only as a conservative. I write them as someone who knows of what I speak — a physician.
There will be those that tell you that this plan was supported by physicians. They will cite its endorsement by the American Medical Association, the American College of Physicians, and various other medical organizations and affiliated corporations, such as those in the pharmaceutical industry. They will point to the doctors standing behind Obama — twice! — in their white coats during Presidential show-and-tells about why this travesty needed to pass.
What they won’t tell you about is the number of state medical societies, like the Texas Medical Association, as well as other specialty societies, which took a stance opposed to this legislation. These organizations collectively represent over 500,000 of the nation’s 850,000 physicians, well more than a simple majority. They won’t acknowledge the fact that the AMA only represents 17% or less of the “doctors” in this country; almost half of that number are medical students and residents who don’t know any better and join up only to get the AMA’s medical journals at a steep discount. They won’t explain to you that the AMA has been a puppet of the government since the early 1990′s in order to protect their monopoly on the CPT coding system that all doctors have to use to bill Medicare and insurance companies, the licensing of which provides the AMA over 70% of its income. (And I don’t think it is a coincidence that one of the earliest medical organizations to endorse the reform effort, the AMA, is headquartered in Chicago.) They won’t tell you about the new groups like Docs4PatientCare and the Doctor-Patient Medical Association that have sprung up to oppose this nightmare. They won’t tell you that most practicing physicians view this reform plan with disdain, and that many are reviewing their financial situation to see if early retirement is possible. They won’t tell you that most of us practicing physicians won’t believe those props Obama set up behind him wearing white coats are really doctors until we see their diplomas.
What they won’t tell you is that most physicians are like the majority of Americans and did not want this reform plan to pass. Why are we opposed to it? Mainly because we are afraid of what it will do to adversely affect the way we will be allowed to care for our patients.
I could carp endlessly about the political and philosophical reasons that this bill is an abomination. I could rant about the fact that it establishes health care as a right when it is not; that its call for an individual mandate for having health insurance is blatantly unconstitutional; that it will in some shady way provide coverage for illegal immigrants who should not even be in this country; that it will loosen or eliminate federal restrictions on funding of abortions (despite the issuance of some meaningless Executive Order); and that it will not even succeed at what is supposed to be its primary purposes, namely universal coverage and cost control. But I choose to leave that part of the diatribe to others and to other times. Here I am mostly concerned for what this plan will do to adversely affect the care I will be allowed to provide my patients that are covered under the provisions of the plan.
First off, the plan guts Medicare to the tune of more than $500 billion dollars over the first ten years. I haven’t heard the second ten year number, but I expect it to be greater than $500 billion. After at least two decades of governmental witch hunts after so-called fraud and abuse, few in the medical profession believe there is another $500 billion to be found in eliminating fraud and abuse. Most of us believe — no, know– that the only way to cut $500 billion dollars from Medicare is by either reducing payments for services over and above the 21.5% cut already scheduled (and twice stayed for this year alone) or by denying services outright. In other words, rationing. Most of my Medicare patients who have discussed the reform plan with me also recognize that the Medicare cuts in this bill will mean less health care for them — and this concerns them greatly. And as payment rates are reduced, progressively more physicians will drop out of Medicare altogether, creating an ever-growing problem for Medicare recipients of simple access to a doctor’s appointment, much less getting any health care services.
While we’re on the subject, please note that the pre-existing pending Medicare pay cuts of 21.5% this year, with further cuts to follow for six or more years into the future, are considered as some of the cost savings of this plan. The ten year cost of what the press is calling the “Doc-Fix” is now at $314 billion. Add that cost into the CBO estimates and the first ten years of the reform bill now costs over $1.25 trillion. But the Democrats plan to fix this (if they intend to at all) with a separate bill so that the price tag is not included in their plan, using even more deceit to disguise the true costs of their program.
No one knows better than us physicians just how onerous it can be to suffer under the yoke of an overriding bureaucracy. We have been dealing with this problem for many years, which means for most of us our entire professional careers. Every day I and all of my colleagues fight against the utilization management systems of insurance companies and Medicare/Medicaid to get permission to provide the tests, treatments and medications that our years of medical training and experience tell us our patients need. With each succeeding year, this struggle gets increasingly more difficult. Whereas in the past we would be able to win most of the points in this pointless game, now we are fortunate if we get approvals only 75% of the time. And this is before the reform plan creates dozens of new, bloated federal bureaucracies, each of which will be incessantly promulgating ever-more new and invasive regulations, most of which will reduce the time and attention we need to be expending on our patients.
Currently most of our fights are with private insurance companies. The one leverage we have with a private company is that if it gets too stingy, word gets out, and they start losing customers. But in a system where insurance companies cannot deny coverage for preexisting conditions and if someone gets sick (so essentially for all comers), cost containment will become paramount, and utilization management is likely to become extreme. And as to losing customers to a competitor? If a patient needs “excessive” care, a company would likely welcome that person leaving for a competitor.
That of course assumes that patients will be able to find or afford private insurance at all. Under the current Senate reform system, the requirement of covering all comers regardless of health status will force insurers to drive up premiums. With the “reconciliation fix”-created government board ‘regulating’ (read preventing) premium increases, insurers will either have to push utilization management to draconian levels or else drop out of the health insurance business altogether.
Imagine if most or all of the insurance companies throw in the towel. What’s left? Under this plan, not much. But I have said from the beginning: the Democratic plan with a public option is a back door to a single payer system, and the Democratic plan without a public option is a Trojan Horse for a single payer system. The first funnels people into the single payer; the second creates a system predetermined to fail, so that a single payer system can be brought in when “the free market system has failed” as “the only thing we haven’t tried”. Of course this disregards the fact that the free market has not been in control of the health care system for almost 70 years.
The problem with a single payer system in regards to patient care is that it can deny services and reduce payments with impunity. Where are patients and physicians to go, when all the private competitors have been driven out of the market? And I am assuming that medical care outside the single payer will be made illegal like it has been in Canada.
The sad commentary here is that past surveys of physicians have found a surprisingly high acceptance level of a single payer system among physicians. What these surveys don’t tell (since they don’t ask) is that this high approval rate is based upon the idea in many physicians’ minds, as well as that of their practice managers, that it would be easier to deal with one payer and its requirements than the current system of dealing with dozens of payers each with their own quirky payment requirements. I suspect most of these physicians have not thought through the concept that dealing with a dozen 800 pound gorillas one at a time will result in success much more often than having to deal all of the time with one 800,000 pound behemoth that cares only for its own interests.
The Senate reform plan will take a lot of the profits out of the health care system, just as one of President Obama’s health care advisers, Tom Daschle, wanted. Unfortunately it is these profits that fund the vast majority of the medical research not just for America but for the entire world. The limitation on the growth of medical innovation is seen by these misguided fools as a cost containment measure. But how much cost containment have you achieved if you have delayed or scuttled finding the cure for diabetes or an effective treatment for Alzheimer’s disease, to name only two simple examples? And how many patients must needlessly suffer and die on this altar of faux cost containment? The very prospect of this makes me both sick and angry when I contemplate it.
Finally, there is one more reason why I have opposed this plan and continue to oppose it. And it is a very selfish reason. Whatever health care reform plan we institute today will be the system that will be taking care of me when it becomes my turn to be not the doctor but the patient. I look at this plan that passed today and realize that I do not want this to be the system I have to depend on when my turn comes to play that role. So how can I want it for any of my patients, or the patients of my colleagues, or any of my fellow citizens? The simple answer is, as a moral and ethical physician, I cannot. As a moral and ethical citizen and person, I cannot.
Alea iacta est. The die is cast. But it can be cast again. There is precedent for the repeal of a health care reform package. The Medicare Catastrophic Coverage Act of 1988 was repealed 18 months after its passage under pressure from an unhappy electorate. I understand that Glenn Beck this last week compared the fight against the passage of this bill to the battle of Normandy. I believe he is wrong on that point. The battle we have just fought was the battle of Dunkirk. We have suffered a setback in the battle with totalitarianism, but we have not lost the war. Our Normandy, and our victory for liberty, lies ahead in our future.
I have been closing my posts in various places with a variation of the quote from Cato the Elder. He said at the end of all his speeches Carthago delenda est – Carthage must be destroyed. I had initially altered this to call for the destruction of one of President Bush’s mistakes, the Medicare Part D program. But I now have a much more important target: ObamaCare delenda est!!!!
Today starts the beginning of the fight to make that come true. But not for physicians. For patients. Which means for every American.
Moe Lane
Steve Maley
Daniel Horowitz
Jake Walker
Victoria Coates
