I blog about free markets in medical care and transparent pricing.
I have copied below a post from Dr. Kris Held, an ophthalmologist in the San Antonio area. She writes well and does so in a way that communicates the frustration of so many practicing medicine in this day and age. This piece should also give people a better idea about how price rationing and hassle maximization will result in shortages of healthcare. Kudos, Kris.
I am a physician and surgeon home today recovering from my third operation for breast cancer. I am blessed to live in the United States where we enjoy the earliest detection and highest survival rate for breast cancer in the world…at least for now. Tragically, government has taken over the practice of medicine in the U.S. via the unwanted and corruptly passed, without-having-been-read, paradoxically-named Patient Protection and Affordable Care Act (ACA). The US Preventive Task Force born of the ACA has already trumped our established guidelines for breast cancer screening to save money over lives- not a single breast cancer specialist was on the committee. Committee members picked and chose which studies they would include and which they would disregard- in the same fashion that this self-serving political ruling class picks winners and losers and now picks who lives and who dies. I am thankful for my physicians, surgeons, and their teams who carried me through this ordeal to a cure and good physical result. I was able to select my doctors, my treatment, and I only missed two weeks of work last year and 2 days this year. You see, as a physician and small business owner, my patients and my employees need me to be at work. There is no room in the business model for the doctor to be out. My overhead is tremendous, and when I am out the lost income is nothing compared to the uncovered operating expenses. I love my patients, my employees and the privilege of practicing medicine, but sadly I fear that at some point it is just too risky, if not stupid, to continue in this oppressive, punitive, stifling environment.
Government first got its claws on medicine when it froze wages on workers allowing employers to instead offer health insurance as a benefit to attract employees. Health insurance as an employee benefit has evolved into a government mandate, now called a tax. Then in 1965, the federal government’s grip on medicine was tightened to a chokehold with implementation of Medicare and Medicaid, massive entitlement programs that have bloated to beyond what experts fathomed to the point that they are fiscally unsustainable and will soon throw our economy into fiscal ruin. Rather than reforming these broken, bankrupting components of healthcare, the federal government has expanded them and seeks to place everyone on them. There is no understanding the irrationality of the process other than to accept that this is nothing about the health of the American patient but is all about keeping power and money in the hands of the political ruling class, whose intent is to fundamentally change our country to accepting the socialized medicine of a dictatorial state in complete disregard for the Constitution.
As an eye surgeon, most of my patients are seniors on Medicare. Cataract surgery is a minor miracle for patients who are able to continue enjoying the highest quality of life with restored vision. Having performed nearly 10,000 cataract operations over the past twenty-some years, I have become a highly skilled surgeon able to achieve successful outcomes in even the most difficult cases. With technological advances and an experienced surgeon, the operation can be performed quickly. Trust me, there are surgeons who take much longer and achieve poorer outcomes. Government, because it has no concept of how to practice medicine, judges quality of care based on time taken and pays physicians based on a convoluted communist based system of relative value units. So, ironically, as the surgeon and technology gets better, our pay gets lowered. Medicare now pays $629.91 for cataract surgery including 3 months post op care, and United Healthcare pays $526.08. Most believe the goal of this administration is to ultimately have a single-payer system (socialized medicine) to be administered by United Healthcare, the largest provider in the US and worldwide. Because of its world market, it will be able to undercut all other carriers long enough to remain the sole survivor.
While physician fees have plummeted (because we are motivated to care for our patients first as opposed to fighting for pay), payments to hospitals and pharma have skyrocketed. There is a convoluted billing game that goes on between government, hospitals (represented by the-American Hospital Association lobbyists), big insurance, and big pharma. These interest groups all colluded behind closed doors with big federal government to cut deals in the ACA. Physicians were excluded, demonized, denigrated, and lied about-especially by President Obama who famously said doctors are immediately paid “30,40, or $50,000 to cut off a foot”, when in reality a below knee amputation fee to physician is around $700 including 3 months post op care. He further accused surgeons of taking out tonsils for cash instead of prescribing antibiotics, which is not only a lie, but in reality the surgeon’s fee is around $200 while the cost of antibiotics may exceed that. The final blow was when Obama declared “we will let doctors know, and your mom know, that you know what, maybe it’s better to take the painkiller instead of having the surgery.” Government is now arrogantly practicing medicine without a license, and sadly this government puts the collective good ahead of the individual patient and family.
While I am now paid $500 for performing intricate, vision saving but potentially blinding eye surgery, the government will further reduce my pay if my patients don’t achieve a perfect outcome. So, if I operate on patients with coexistent disease, like macular degeneration, who will be greatly benefited but will not achieve 20/20, I will be penalized. Surgeons will stop operating on complex patients. My fee will be reduced further if I do not implement meaningful use electronic medical record reporting, quality reporting and data collecting, and I will not be paid at all if I do not adopt the absurd ICD10 codes by October 2014. Further, any HIPAA violation subjects me to a $1.5 million dollar fine, and a dictation error can land me in jail, as exemplified by Dr. Natale this past year. Government is doing random unauthorized audits on physicians looking for fraud; the physician is presumed guilty until proven innocent, and bounty hunters are offered a percent of what they can dig up. The government is seeking to link the license to practice medicine with forced-taking of government insurance and forcing doctors to spend thousands of dollars and hours on “Maintenance of Certification” and “Maintenance of Licensure” scams that ultimately line the pockets of our specialty societies, which like the AMA have become nothing more than partners in crime with the feds. All this, while patient expectation and sense of entitlement escalate…patients are unhappy, if not angry, if they have to come out of pocket a dime and if they don’t get 20/20 vision without glasses. Doctors are then subject to lawsuit. No tort reform was enacted in the ACA, because the trial lawyers’ desires exceeded the doctors’ need for protection. So, is the risk of jail, lawsuit, audit, $1.5 million dollar HIPAA fine, patient and government harassment, oppression, and demonization and MOC and MOL demands worth the $500, when I can’t even cover my expenses? Is your eyeball worth more than your Iphone? At some point it becomes too risky and flat out stupid to continue to operate in this environment.
When the doctor in me wants to throw in the towel, the patient in me says “stay in the ring”. I would not be here if my surgeons had quit. What we must do as physicians is refuse to play this game any longer. We must stand against government for the sake of our patients, profession, and future of our country. When Government says grab your ankles, physicians must say NO! Government can’t do this without us. Are we complicit, compliant pawns doing government bidding, or are we men and women of the mind serving the sick, honoring the tradition and advancing the field? The only way not to lose is not to play. Physicians must refuse to participate in this destructive, abusive, wasteful system. We must practice our trade outside the stranglehold of government. We have actual workable plans founded on the sacred doctor–patient relationship that will drastically cut costs and vastly improve quality of care. Will we stand? Will our patients stand with us?