By Dr. Marc Siegel
Thursday, October 27, 2016
When President Obama gave an impassioned defense of
Obamacare last week in advance of this November’s open enrollment period, he
bragged about the uninsured rate being the lowest in American history.
But though he acknowledged problems such as
affordability, which are driving huge annual premium increases on the Obamacare
exchanges, he didn’t say one word about a key unhappy group: doctors.
For good reason. The latest Great American Physician
Survey surveyed more than 1,000 doctors and found that “because of continuing
economic and regulatory pressures, 72%” “found the profession more stressful
and less lucrative than in previous years, and a strong majority said they are
concerned about the direction that health care is headed.”
I am among that 72%, and as Democrats urge repairs to the
law and Republicans use the bad news to again make the case for repealing and
replacing it, it’s critical that America understands the sources of physicians’
simmering discontent.
Doctors like me look at health insurance very differently
than Obama does. To us, insurance often presents a cumbersome roadblock to
actual health care.
When a patient comes to me smiling with their new
Obamacare coverage, it is difficult for me to smile back. That’s because I
immediately envision a test or a referral that may not be covered by their plan
or an essential service they will have to reluctantly pay for out of pocket
because of their deductible.
No one bothered to ask doctors our opinion before passing
Obamacare back in 2010. We knew it would flood the system with low-paying
insurance. We were already overwhelmed with transitioning to time-consuming,
mandatory electronic health records, due to a law passed in 2009.
Obamacare added insult to injury by expanding Medicaid
(which close to 30% of doctors don’t accept, because the reimbursement rates
are too low), and introducing a highly restricted, high-deductible type of
insurance that utilizes a narrow network of doctors.
I have the option of not accepting Obamacare plans
myself, but have always seen my role as a physician as accepting all comers —
though this is becoming more and more difficult.
So, no doctors are surprised when premiums jump while
insurers (UnitedHealthcare, Blue Cross, WellCare and others) examine their
bottom lines and pull out of many states. None of us blink when millions of
smart younger patients with few medical problems pay the tax penalty rather
than jump into the health coverage pool. Doctors know that young, healthy
patients don’t want to see us unless they require a work or school physical.
We doctors are also not surprised by Hillary Clinton’s
plan to essentially double down on Obamacare by offering a public option if she
wins.
On the front lines, expanding Medicare to younger
patients or adding a public option to the state exchanges translates to doctors
having more patients with highly regulated insurance that doesn’t pay us very
well. Sweetening the pie with efficiency and quality reward incentives is
shortsighted, too.
What if the patient doesn’t do well and has to go to the
hospital? Should doctors lose payments because a patient dies despite our best
effort to save him? Increasing subsidies or giving every family $5,000 to play
ball with Obamacare, as Clinton proposes, also increases the tax burden without
ensuring quality or access.
The solution is more choice, not less. Introducing more
competition by making insurance portable across state lines while expanding
tax-deductible health savings accounts would help drive down costs. If my
patient pays more out of pocket, she will come to see me only when she really
needs to.
If the first three sick visits a year are covered by
Obamacare, as Clinton proposes, my patients will use these visits up quickly,
often unnecessarily.
Don’t get me wrong: Health care is crucial to protecting
society, especially because doctors can cut down dramatically on the spread of
disease by screening, vaccinating and treating.
But if the government deems itself responsible for
providing care to the have-nots, a noble goal, it should build more clinics and
hire the doctors and nurses directly to staff them.
Expanding Obamacare would also create a disincentive for
employers to continue to pay for health coverage for their employees, the
backbone of the health care system since the Eisenhower years. Such plans still
cover more than half of those insured, pay doctors better than Obamacare
policies and offer patients more choices.
I wish that lawmakers, Presidents, presidential
candidates and insurance company CEOs could spend a day with me in my office,
seeing and experiencing the realities of health care in the medical trenches.
Then again, I no longer have the time to show them around.
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