Obamacare Is Bad Medicine

The current health-care bills do nothing to help doctors, and much to hurt them.

By Soumi Eachempati
Monday, December 07, 2009

As a full-time practicing surgeon, I unequivocally can say that the American health-care system is among the world’s finest. For elective and emergency care, American hospitals boast the most modern equipment, the best training facilities for physicians, and the most fertile ground for the development of new products and technologies.

However, this system has several flaws that harm physicians’ ability to treat patients effectively. The bills currently before Congress do nothing to address these issues — and in fact place additional burdens on doctors.

One problem is that over the last two decades, decreased reimbursement has forced doctors to take on extra patients — and thus spend less time managing each patient. For example, for a complex hemorrhoid removal, a general surgeon received $390 from Medicare in 2008, compared with $574 in 1997 — and in general, Medicaid pays about one-third what Medicare does.

Growing overhead is another major issue for practicing physicians. Physician overhead consists of administrative taxes, office space, support staff, and malpractice insurance. Of these, the latter is the most onerous. When I started as a surgeon, I paid about $60,000 a year. I currently pay $130,000, even though I never have lost a lawsuit and generally am named in litigation only as a consultant. (By Medicare standards, I would have to take out 174 gall bladders just to pay my malpractice insurance; since most surgeons average between 200 and 300 operations a year, most barely would cover overhead if Medicare were their sole carrier.)

The price of defending against a suit is monumental, both financially and emotionally. The defendant must be prepared for multiple days away from his practice for briefings, depositions, chart reviews, and testimony. I probably lose tens of thousands of dollars in revenue defending each suit, even when I am involved only peripherally. Many physicians are devastated after being sued by patients whom they tried their best to treat. For some physicians, the damage to subsequent doctor-patient relationships and the pressure to practice defensive medicine are incalculable.

The health-care bills currently before Congress ignore these problems. At least 20 physician organizations, including the American College of Surgeons, have come out in opposition, largely due to reimbursement issues, lack of tort reform, and failure to correct Medicare’s perverse Sustainable Growth Rate formula.

One reform that has been the subject of much discussion, meanwhile, is the “public option.” But since only private carriers yield any profit for physicians, doctors feel that increased government intervention in health care will force them to be even more indentured to Medicaid and Medicare — two bureaucratic, low-paying systems that perpetually appear to be on the verge of collapse.

I urge you to review the Athena Health report, which summarizes most of the major carriers’ payment patterns. Unsurprisingly, Medicaid fares the worst of any national carrier. My state’s Medicaid program takes the longest amount of time — 160 days — while denying 34 percent of all claims. I can attest that the reasons for New York State’s payment denials are largely bogus: I use similar codes and documentation for all my patients, yet continually see more reimbursement issues with governmental payers. As physicians become more frustrated with governmental payers and drop them, access for the poor will decrease.

Another problem with the public option is that as government-run insurance expands and unfairly “competes” with market-rate insurance plans, it will drive down reimbursements for all plans.

While forcing doctors to rely more on government insurance, the new health bills would cut Medicare payments by $500 billion over the next ten years to fund increased spending. Some physicians will drop Medicare as a result, denying seniors access to health care. I honestly am shocked that seniors are not up in arms that the AARP supports Obamacare. Seniors certainly will be outraged if this legislation passes, and they cannot find doctors in their communities.

As for longer-term consequences, the best and the brightest no longer will choose medicine as a career, and more and more doctors will leave the field. According to the Association of American Medical Colleges (AAMC), the average educational debt of indebted graduates of the class of 2008 is $154,607, and the average debt of graduating medical students increased in 2008 by 11 percent over the previous year. About four-fifths of graduates have debt of at least $100,000 before they undergo three to nine years of specialty training at wages in the $45,000-per-year range — while in their early thirties working 80 hours per week. Reports estimate that up to 20 percent of physicians in practice are contemplating leaving medicine.

These trends already have started. Take, for example, my field, general surgery, a specialty that provides a great deal of the trauma and emergency surgery that communities need: There were 7.1 general surgeons per 100,000 people in 1994. Today there are 5.0 per 100,000, and the differences are even more exaggerated in rural areas.

In summary, the health bills being considered by Congress would expand government intervention in health care and create an even more monopolistic system of price fixing, while ignoring quality improvement and tort reform. As a society, we have to make choices. Do we want our doctors to be well-qualified practitioners using their experience and judgment to help as many patients as they can? Or do we want detached, disenfranchised doctors looking to their next career while practicing medicine with the mentality of postal workers?