Tuesday, April 20, 2010

My Two Cents on Healthcare

I have had multiple patients ask me what my "take" on our current health care issue is and how I think it will affect the practice of medicine and my office.  So many patient's have asked me this question, that I figure I would just blog my thoughts here for all to read. 

Interestingly, I got spamed an e-mail today from Lori Heim, MD, president of the American Academy of Family Physicians, stating how wonderful this new "Obamacare" is and what a great "step forward this is for healthcare."  Let me give you my impressions on how "wonderful" this really is.

In order to understand Healthcare reform as it stands today, it is important that we look at three specific issues.  First, lets take a look at history, at some societies that have taken paths similar to ours.  Muselini, Stalin, Mao and others have shown that there are five steps in leading a society to socialism.  Those steps are 1) to take over the financial institutions, 2) take over major industry, 3) take over healthcare, 4) take over gun control and 5) control immigration.  Our great but sleeping country has allowed the first three of those steps to occur in the last year.

The banks were bought by Obama's Czars under the guise of "bail out money," car manufacturing, the largest private industry in our country, is now under the thumb and major ownership of our government by the same method. Now healthcare is under the control of the Obama Administration.  In this healthcare plan, Obama has succeeded in creating 159 new buerocratic agencies to oversee your doctor in rendering healthcare to you.  And to top this off, this new plan that Nancy Pelosi was so sure you and I would love will only raise our income tax by 9.7% by 2012.  That's right a 10% tax hike for a buerocraticly driven healthcare system.  Healthcare is not the goal, socialism is the goal, and healthcare control is just one of five steps in that direction.  Watch the news for control of guns and immigration as the next steps.

Second, Obama told us that this health care plan would pay for itself.  That's because the cost of this $940 billion (yes, that billion with a "b") plan at the time it was voted on was offset by the fact that the Medicare paycut, that would cost $930 billion to fix, had already taken place.  The Obama Administration used the money from the pay cut to balance the new healthcare plan.  The media just sucked this right up and never said a word about it. 

Interestingly, they tried to throw the physicians a bone by saying, "Hey, well will give you a 10% raise for seeing medicare patients."  That won't help because they have already cut reimbursement to physicians by 21.5%.  This cut is occuring because Bill Clinton, in his wisdom at the end of his presidency, decided to balance the budget by cutting reimbursement by 5% every year starting in 2002 for 10 years.  Medicare currently only reimburses physicians payment rates equivalent to the 1986 economy.  (You look around and see if there are any other industries functioning that haven't had a pay raise in 30+ years) We as physicians have never had a pay raise since.  Congress has "deferred" this pay cut each year but never fixed it. Congress missed deferring it this year on April 1st because of Obama's push to "fix healthcare instead."

As of Monday, congress again retroactivly deferred this cut until May 30th, however, patient's seen from April 1st to April 18th will be paid at the cut rate.  Medicare will "try to ensure that these are corrected" but have you ever tried to get Medicare to correct a payment error?  Good luck! You're more likely to get the IRS to waive your taxes this year.

Third, the balance of the pay cut will continue to rise each year.  As of September 1st, this pay cut will increase to 26.5%. 

Let me explain to you what this means.  If the 21.5%  pay cut occurs May 30th, I will have to lay off three of my employees and drop my personal health insurance and insurance for my remaining staff just to keep my doors open.  As an employer, the 10% personal income tax my employees pay starting in 2012 is matched by the business they work for, that means that my employer taxes go up by 10% per employee.  Commercial health care sets their rates on the Medicare reimbursement, so with in 6 months of the pay cut ALL insurance will cut their rates too.  A 21.5% pay cut to physcian's offices and a 10% increase  per employee payroll tax will put me out of business.  Good thing I have kept my shovels around, I may be digging diches soon.

Unless this is fixed, 2012 will see thousands of physician offices closing their doors.  There are already not enough primary care physicians and the need will drastically increase to cover the additional 30 million people "Obamacare" claims it will cover.  This means healthcare shortages will occur beyond what this country has ever seen.  You thought wait times to get in to see your doctor were bad, wait until 2012.

Our wonderful Republican party has done nothing but vote no.  In fact, Arizona's Senator Kyle, Senator McCain and House Representative Franks all voted "no" on Monday's Medicare deferrment.  I have been watching their voting each week for the last year.  When questioned in a recent town hall meeting by multiple physicians as to what the Republican Party was doing to create legislation that would fix the problem, all Senator McCain could say was "we are determined to vote down Obamacare."  Great line Senator McCain! That's all you've been doing for the last year.

So, as a physican with 40% of my practice Medicare based, healthcare reform is "wonderful." It fills my mind "full of wonder" as to what type of work I will be doing in 2012, and wondering where my patient's will find care.

I suggest two things to you.  First, pray, and pray sincerely.  The only way out of this fiasco is by the hand of divine intervention.  Second,  watch closely for and vote for congressional leadership that understands these issues.   That's what I'll be doing.

1 comment:

Bill Schroader said...

Love your thoughts on this issue. Sadly, the voices of our medical professionals seem to have been muted by our objective media. Doctors have been demonized by those who are behind these reforms and are made out to be part of the problem. People who gravitate to government entitlement programs lack the insight to realize that it's government intervention who has in large part, been a huge part of the problem of medical costs.

These lawyers, now politicians, are remiss to consider such cost saving measures as torte reform which would certainly aid in the bottom line of an office such as yours who has to include as part of their overhead, the cost of malpractice insurance. How many of *us* in our given professions have to actually buy insurance to protect ourselves from ambulance chasing lawyers who seek to profit from the suffering of others.

Also lacking in this mindset of "socking it" to the doctors is a lack of appreciation for what sacrifices have been made to rise to the position of MD. 4 years of college is suitable to launch you into a respectable career. Another 2 years would earn you an MBA which can earn you a pretty penny. I've never seen a lawyer or businessman ever have to, as part of their induction into their career, have to work for free through an internship program to earn their bona fieds.

This entire premise behind health care reform was flawed from the get go. We always warn, "Beware the law of unintended consequences." Boy, this has never been more true!

How do we persuade aspiring young students to pursue a career as a physician in this day and age? So far as our unintended consequences go, the shortages, in my estimation will be staggering. #1, we'll over saturate an already stressed health care system by adding even more to the rolls. #2, as you so eloquently illustrated, Dr.'s like yourself will be forced out of your practice, and #3, we'll see a shortage of medical students as the career choice grows ever more unappealing.