Mirror of Justice

A blog dedicated to the development of Catholic legal theory.
Affiliated with the Program on Church, State & Society at Notre Dame Law School.

Thursday, April 29, 2010

Health Care Reform: The Perspective of Physicians

Earlier this month, I completed a five-part series about the recently-enacted health care legislation, concluding that it was unlikely to succeed and that the cause of greater access to health care might be set-back rather than advanced by this irresponsible legislation.  I argued that we must maintain our attention on the matter of health care and diligently continue the search for genuine reform, because the Democrat-party-line enactment was not prudent, was not economically viable, and was not politically sustainable.  (The full series can be found here.)

A commentary today by Daniel Palestrant in Forbes reports on a recent survey of physicians which found that 79 percent were more pessimistic about the future of health care after enactment of the Democratic health care legislation.  Moreover, two-thirds of physicians were considering opting-out of government-funded health care programs, which of course would make the approach pushed through by the Democrats a non-starter:

The same reform bill that will provide "care for all" may drive away more physician caregivers than attract previously uninsured patients. What a predicament that would be.

Many may find the data from the poll puzzling. How could physicians be so pessimistic about a bill that clearly has so many positives? For one, the bill addresses none of the issues most consistently ranked by physicians as the most critical for lowering costs and improving access. Tort reform, streamlining billing and payment, and fixing the flawed government formula for calculating physician reimbursement are given little, if any, serious attention.

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Health care without active physician participation is no health care at all.

Greg Sisk


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You write: "Moreover, two-thirds of physicians were considering opting-out of government-funded health care programs ...." We'll see how long that 'consideration' lasts when they realize 'opting-out' means turning away from a $440 billion Medicare spigot (not to mention turning away from the Medicaid spigot). See: http://www.kff.org/medicare/upload/7731.pdf I know, I know, doctors complain about reimbursement rates; yet the doctors I know all seem to be doing OK, and all take Medicare. I heard the General Counsel for a large hospital group say, about health care reform: How come nobody is talking about physician greed as a part of the problem?

Posted by: DFoley | Apr 30, 2010 7:35:50 AM

Your experience is different than mine and what is generally reported. I know of physicians, including those who are relatively young in their 50s), who are giving up on medical practice and changing careers, retiring early, or moving to a fee-only basis, in part because of the increasing government presence which brings inadequate reimbursement rates and malpractice insurance coverage. The health care reform legislation will make this worse, at least if the promised cuts in Medicare come through, and the legislation conspicuously does nothing to address the trial-lawyer tilted malpractice system. Nor is this merely a matter of anecdote. There is a huge shortage in primary care physicians (the American Academy of Family Physicians outlines a 40,000 primary care physician shortage: http://www.usatoday.com/news/health/2009-08-17-doctor-gp-shortage_N.htm). An exodus of tens of thousands of physicians and a dearth of new physicians in family care doesn't support the conclusion that doctors are doing fine. Knowing the income of primary care physicians, in the light of the considerable investments of time and debt in their education and compared to other professionals, I think dismissing this as "physician greed" is off the mark.

Posted by: Greg Sisk | Apr 30, 2010 10:40:28 AM

I'm not clear what you believe I've dismissed as physician greed, so am not sure what mark you believe I missed. There are a lot of issues.
1. 2/3 considering opting out of Medicare. We'll see if a portion approaching 2/3 actually does opt out. I highly doubt it would ever approach such a figure.
2. Medicare and Medicaid pump a lot of money, collectively, into physicians' pockets. Is it enough? Is it fair? Do all share like they should (family docs)? Reasonable minds probably all over the map.
3. There is a shortage of family doctors. OK.
4. Physician greed is one of the issues that should be addressed when considering the question of providing quality care at affordable prices (to society).
Simply noting #4 does not deny the existence of #3, or cast doubts about what folks believe about #1 or #2.

Posted by: DFoley | Apr 30, 2010 12:53:56 PM