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Eyes Wide Shut

Posted Nov 11 2012 11:32am

Stanley Feld M.D.,FACP,MACE


I cannot believe the results of the Presidential election.

All of President Obama’s policies have failed so far. All have served to inhibit economic growth or make it worse.

Yet the majority of Americans voted for President Obama. Why could this occur when many of the structural ideas and ideals representative of the United States are being dismantled?

This is a great county. Americans accept the winner and move on.  They continue to speak to their neighbors who had the other guy’s sign in their front yard.

On the other hand it amazes me to see that the electorate ignores the real issues and votes for the  personality. Marshall McLuhan was correc t. The media is the message. Why the media is ignoring the facts is beyond me.   

It is disappointing because Americans are also ignoring the obvious coming unintended consequences that are going to be the result of their voting decision.

The devil is always in the details. I have presented my views of how the medical care system is going to be destroyed by Obamacare . It is only a matter of time.

The healthcare system is becoming too expensive, unsustainable, impersonal, rationed. The result will be a denial of access to medical care for many Americans. 

Obamacare’s effect will become the opposite of what President Obama intended and  promised.

I have also stated that his strategies for change have been misguided.  

President Obama’s advisors are all ivory tower professors and bureaucrats. They have no understanding of what is happening in the street at the interface between patients and physicians.

Ideologically they want to make medical care better for all. President Obama does not understand the pressures and the reality of the real practice interactions between physicians and patients or physicians and their communities.

President Obama believes that healthcare should be an entitlement and not an individual responsibility. Healthcare entitlements will never solve America’s problems with obesity and chronic diseases.

In the process of making healthcare an entitlement, President Obama is devaluing the skills of those practicing medicine.

Many physicians have quit practice because of adverse conditions. The result will be a decreasing physician workforce in an increasing covered population. This is not a good equation.

Most physicians do not accept Medicaid and many have stopped accepting Medicare.

This will shift the burden of higher cost of medical care to seniors and poor people.  

Bob Doherty is Senior Vice President of Governmental Affairs and Public Policy, American College of Physicians. His blog at The ACP Advocate Blog is reprinted below. It deserves a wide audience.

Bob Doherty has dealt with the socioeconomic concerns of Internists and Internal Medicine Sub Specialists for at least 30 years both at the American Society for Internal Medicine and later after ASIM merged with American College of Physicians.

Bob Doherty wrote this article discussing the effects of Obamacare on the practicing physician. He presents practicing physicians’ complaints about  Obamacare.

This article should be read carefully. President Obama should pay attention to physicians’ complaints.

 “T he micro level of health reform cannot be ignored”

by  BOB DOHERTY  on November 5th, 2012in 


Much of what passes for debate on health care during this election year is focused on the macro side, on big issues like how do we cover the uninsured or restructure Medicare and Medicaid financing.  But for all of the talk about vouchers and block grants and insurance mandates, the candidates are missing the micro issues that really matter most to doctors and their patients, which is how health care policy directly affects the quality of the patient-physician encounter.

Talk to physicians around the country, as I regularly do, and these are some of the issues that have them most concerned:

1. Will anyone do anything about the oppressive burden of paperwork and red tape?
2. Will the candidates’ “macro” proposals for reforming healthcare and entitlements result in more or less paperwork and red tape?
3. I already don’t have enough time to spend with patients but now I am expected to counsel them on preventive care, lifestyle choices, and the effectiveness of different treatments?   How is this possible?
4. Electronic health records, great concept, but they don’t really streamline the process as advertised, if anything, they just make things more difficult, and besides, they still don’t communicate with other systems.
5. Everyone wants to measure me, but the measures don’t agree with other, they measure the wrong things and they are difficult to report on.   And who is measuring the value and effectiveness of the measures themselves?
6. Okay, I am supposed to practice cost conscious care, but who is going to stop a lawyer from suing me if I don’t give a patient the test they asked for?
7. Why is my cognitive care paid so little while procedures and drugs are paid exorbitant rates?
8. Payers and government keep imposing more penalties, for not e-prescribing, for not converting to ICD-10, for not meaningfully using my electronic health record, for not complying with their pay for performance schemes.  By the time they get done fining me for noncompliance, I will have had to shut my office. Then who will take care of my patients?
9. And who has the time to keep track of all of these mandates, incentives, rules, and penalties?  I would have to hire a full-time person keep on top of everything. Who is going to pay for that?
10. So I am supposed to transform my practice?  Well, we all want to do our part, but who is going to pay for that?  Besides, my patients seem to think my practice is just fine as it is

Now, I don’t really expect Obama and Romney to come out with plans to address these micro health policies.  But it is reasonable to hold their macro proposals to a standard of whether they will make all of these aggravations and intrusions better or worse.  And at some point, policymakers–no matter their political leanings and plans to reform healthcare at the macro level, need to pay attention to what is happening at the micro patient-doctor encounter level.  After all, the boldest of big ideas won’t make healthcare better if it makes it harder for physicians to give their patients the care they need.

Physician advocacy organizations also need to pay attention to the micro issues.  ACP prides itself on taking on the big issues like controlling health care costs and allocating health care resources rationally.   But the College puts at least as much effort into the micro issues, from objecting to the latest EHR mandates to offering alternatives to ICD 10 coding to advocating for higher payments.

The goal must be to fashion public policies that improve care at the macro level — universal access to coverage, spending health care dollars more wisely, and improving healthcare delivery systems — while also removing barriers at the micro level that intrude on the patient-doctor relationship.  Both are equally important.

Bob Doherty is Senior Vice President of Governmental Affairs and Public Policy, American College of Physicians and blogs at The ACP Advocate Blog.”


Bob Doherty has been an advocate of Obamacare in the past. He has highlighted the idealist principles of Obamacare. I am happy that he is starting to realize the unintended consequences that will occur as a result of  Obamacare.

Healthcare is only one area of life that President Obama is affecting adversely. I believe the majority of the population will start realizing soon that re-electing President Obama was a mistake.

Hopefully it does not become an irreversible disaster.

  The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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