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
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 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
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
In the process of making
healthcare an entitlement, President Obama is devaluing the skills of those
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.
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
Doherty wrote this article discussing the effects of Obamacare on the practicing
physician. He presents practicing physicians’ complaints about Obamacare.
article should be read carefully. President Obama should pay attention to
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.
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
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.
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.”