Health care without active physician participation is no health care at all.

After the debate has ended and the lobbyists have moved on to their next clients, health care will be left the way it started, a physician and a patient sitting in a room trying as best as they can to prolong health and forestall sickness. Fortunately the many victories and losses claimed by both ends of the political spectrum will not change this shared pursuit.

So then why has reform that promises to get millions more in a discourse with their doctors been so polarizing? Making sure more Americans have health insurance can only be a major victory, right? Too bad the medical establishment is not celebrating. In fact, the mood in those exams rooms is downright morose.
In tens of thousands of exam rooms all over the country physicians are struggling to make sense of the 2,000-plus pages of the reform bill. A recently released poll of more than 2,000 physicians, conducted by Athenahealth and Sermo, is alarming. The poll, part of a broader Physician Sentiment Index, indicates that 79% of physicians are less optimistic about medicine since the passage of health care reform. Fifty-three percent indicate they will consider opting out of insurance plans with passage of the bill. Worst of all, 66% indicate that they will consider opting out of all government-run programs. The same reform bill that will provide “care for all” may drive away more physician caregivers than attract previously uninsured patients. What a predicament that would be.

Many may find the data from the poll puzzling. How could physicians be so pessimistic about a bill that clearly has so many positives? For one, the bill addresses none of the issues most consistently ranked by physicians as the most critical for lowering costs and improving access. Tort reform, streamlining billing and payment, and fixing the flawed government formula for calculating physician reimbursement are given little, if any, serious attention.

What physicians knew then and certainly know now is that instead of fixing these issues, the government will be forced to take the path of least resistance to save money (that is to say the path with the least special interest resistance). That means reducing physician reimbursement, just as the country is counting on even more physicians to be available.

Physicians knew the health care bill had a “gotcha” buried deep inside. The only way it could be called “budget-neutral” was to implement significant reductions in physician payments. So just as we are hoping more physicians become available to treat the influx of 31 million more patients, the government is implementing a massive reduction in physician reimbursement (a 21% reduction in physician reimbursement went into effect April 1 after several years of no adjustments for inflation, meaning physician reimbursement has been declining for several years already).

In a moment of complete legislative hypocrisy, the proponents were touting one health care bill that included cost estimates that assumed a massive reduction in payments while another bill moved its way through Congress that would reverse those cuts (the bill reversing the cuts was ultimately defeated, meaning the cuts did go into effect). At some point, basic supply and demand will kick in, and there will be insufficient physician resources for treating patients.

But what of the much-touted American Medical Association’s support for the bill? The AMA, which counts less than 10% of its $300 million dollars in revenue from physician membership dues (the rest comes from a government sanctioned monopoly whereby the AMA sells the billing codes upon which the entire health care system relies) had little choice but to endorse the bill, lest the government retract its exclusive license on billing codes. Again physicians know what the public does not: Less than 15% of practicing physicians are AMA members, so any AMA support is more a reflection of the AMA’s financial interests than what physicians in this country truly want. This is a situation that proved opportunistic to proponents of the bill but could prove painful for America’s health care system.

Indeed this might be a pyrrhic victory. Health care without active physician participation is no health care at all. Many physicians are investing in electronic health records and billing technologies that alleviate some of the huge administrative brunt that threatens the independent medical office and enables them to fare better in the uneven fight with insurers. These technologies do hold great promise in ensuring these projections remain just that, projections, and not reality.

But still, as the Athenahealth-Sermo poll shows, many physicians are ultimately faced with the choice of opting out of government insurance programs or going out of business. A significant number of physicians are realizing they cannot stay in business–let alone remain independent–if they continue to accept artificially low government reimbursement rates.

Many states are recognizing this impending crisis, and rather than addressing the causes of medical inflation are resorting to an “easy,” short-sighted fix: Make participation in state and federal insurance programs a condition of medical licensure. Far from a theoretical proposition, Massachusetts’ health care system is so over budget that the state legislature is considering a bill that would mandate physician participation, in effect making physicians state employees.

Can anyone say socialized medicine?

http://www.forbes.com/2010/04/28/health-care-reform-physicians-opinions-contributors-daniel-palestrant_2.html

The White House sought to downplay differences on Sunday between the two versions of healthcare legislation passed in Congress as Democrats prepared to meld them into one, while a top Republican saw “great unrest” and perhaps more party-switchers among Democrats.

The Senate passed its version of healthcare reform, President Barack Obama’s top legislative priority, on Thursday with no Republicans voting for it. The House of Representatives passed its bill on November 7 with just one Republican vote. Democratic lawmakers in early January will begin the tricky task of resolving differences between the two versions, such as whether to keep a new government-run insurance program as the House envisions, how to craft language to restrict abortion funding, and what approach to use to pay for the overhaul.

‘Not law yet’
Republicans vowed to keep battling to block it and expressed hope some Democrats may yet turn against it. “The bill is not law yet,” Senate Republican leader Mitch McConnell said on ABC’s “This Week” program, adding that there were rumors of more possible Democratic defections amid unhappiness over the healthcare proposals.

U.S. Representative Parker Griffith of Alabama switched parties on December 22 and became a Republican. “There is great unrest in the Democratic Party,” McConnell said. “The reason for that is the surveys (opinion polls) indicate the American people are overwhelmingly opposed to have the government take over all of their healthcare.” White House spokesman Robert Gibbs, on NBC’s “Meet the Press,” downplayed differences between the House and Senate bills, calling them “virtually identical” in key provisions.

“The major parts of healthcare reform that the president sought to have enacted as a candidate are now very close to happening, and he thinks the commonality between the two proposals overlaps quite a bit,” Gibbs said.

Once Democratic lawmakers craft a single, unified bill, the House and Senate would have to pass it again before Obama can sign it into law. The overhaul would forge the biggest changes in the $2.5 trillion U.S. healthcare system since the 1965 creation of the Medicare government health insurance program for the elderly and disabled. One possible sticking point in the House-Senate bill is over the so-called public option, the proposed government-run insurance plan to compete with private insurers — an idea very popular among liberal Democrats. The Senate discarded the idea in its bill, but the House included it.

‘I’m all for it’
Representative James Clyburn of South Carolina, a member of the House Democratic leadership, said on Sunday he could back a bill with no public option if it still had coverage choices and kept costs in check while making insurance firms compete.

“So if we can come up with a process by which these three things can be done, then I’m all for it,” Clyburn said on the CBS program “Face the Nation.”
“Whether or not we label it a public option or not is of no consequence. What we want to do is get good, effective results from whatever we put in place,” Clyburn added.

The measure would extend health coverage to more than 30 million uninsured, covering 94 percent of all Americans, and halt industry practices like refusing insurance to people with pre-existing medical conditions. Most Americans would be required to have insurance and some subsidies would be offered to help some pay for coverage and create state-based exchanges where the uninsured can compare and shop for plans.

There also are different approaches in the House and Senate versions to financing expanded healthcare. The House bill proposes a 5.4 percent surtax on individuals making more than $500,000 and couples earning more than $1 million a year. The Senate bill includes a 40 percent excise tax on high cost “Cadillac” insurance plans among other measures including special fees on insurers, drug companies and medical device makers and a 10 percent tax on indoor tanning services. McConnell said the Senate bill’s impact would be to raise taxes by half a trillion dollars and to raid Medicare. “We don’t think you ought to take grandma’s Medicare and start a new program for someone else,” McConnell added.

On “Fox News Sunday,” Republican Senator Richard Shelby conceded that Republicans were unlikely to be able to block a final version emerging from House-Senate talks. “I think both of them are bad bills,” Shelby said. “I hope that something happens that we don’t see either one come out of a conference, but I’m afraid we will.”

http://www.msnbc.msn.com/id/34603916/ns/politics-health_care_reform/

As the Senate sprints to pass a health-care bill by Christmas, the latest NBC News/Wall Street Journal poll finds that those believing President Obama’s health-reform plan is a good idea has sunk to its lowest level.

Just 32 percent say it’s a good idea, versus 47 percent who say it’s a bad idea.

In addition, for the first time in the survey, a plurality prefers the status quo to reform. By a 44-41 percent margin, respondents say it would be better to keep the current system than to pass Obama’s health plan.

By comparison, in September’s and October’s NBC/Journal polls, the American public preferred changing the system to the status quo, 45 to 39 percent.

The poll was conducted Dec. 11-14, and has a margin of error of plus-minus 3.1 percentage points.

http://firstread.msnbc.msn.com/archive/2009/12/16/2153563.aspx