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Home » Headline, Medicine & the Law, News Briefs

How the Healthcare Reform Bill May Affect the Docs

Submitted by on 08/03/2009 – 5:40 PM 41 Comments

By Alan Lyndon

President Obama’s efforts for massive healthcare reform endured a predictable setback in July.  With so many moving parts, Obama’s chances of fast-tracking reform before the August recess were small.   For physicians, the meat of the bill is being buried in the press coverage and appeals to voters.

In late July, the president went live on primetime for the fourth time in his six months in office – this time in an attempt for one last push to the public and to Congress to pass healthcare legislation prior to a self-imposed August 7 deadline.

“As we rescue this economy from a full-blown crisis, we must rebuild it stronger than before,” said President Obama. “And health insurance reform is central to that effort.”

According to the Kaiser Family Foundation, a nonpartisan health policy group, spending on health care totals about $2.5 trillion, 17.5 percent of our gross domestic product, which is a measure of the value of all goods and services produced in the United States. That’s up from 13.8 percent of GDP in 2000 and 5.2 percent in 1960, when health spending totaled just $27.5 billion – barely 1 percent of today’s level.

Health care has been “one of the few engines of job growth during the recession,” said Drew Altman, president of the Kaiser Foundation.  Employment in the huge health care sector has grown by about 427,000 jobs – nearly 3 percent – since the recession began in December 2007, according to the most recent U.S. Bureau of Labor Statistics figures.

In his July address, President Obama slightly altered his emphasis from an all-encompassing overhaul of the healthcare system to a push for “health insurance reform.”  Of the four major components of the healthcare system – physicians, patients, hospitals and insurance companies – Obama began to redirect his message by placing the spotlight on the insurance companies.

“I realize that with all the charges and criticisms being thrown around in Washington, many Americans may be wondering, ‘What’s in this for me?’” Obama asked.

The more important question, for our purposes, is how will America’s Affordable Health Choices Act (H.R. 3200) affect physicians and their practices?  To paraphrase the president, “What’s in it for you, the doctors?”

The bill is over 1,000 pages long and contains many proposals with few details.  Thomas Miller, resident fellow of the American Enterprise Institute and former senior health economist for the Joint Economic Committee, suggested that such a complicated bill would be more difficult to pass through Congress.  “The most dangerous parts of the bill are the embedded regulations to come,” said Miller in reference to the lack of detail and ability to change the bill after passage.

The full text of the bill can be read here.

Following are the major proposals included the H.R. 3200 that will most directly affect physicians and hospitals:

PROMOTING ACCOUNTABLE CARE ORGANIZATIONS

An “accountable care organization” is an organized group of physicians who are rewarded for providing high quality care at low cost over a sustained period of time. Section 1301 directs the Secretary to establish a comprehensive ACO pilot program and authorizes the continued expansion of the program where it proves successful in improving quality and keeping costs under control.

PROMOTING PAYMENT BUNDLING

Hospital and physician incentives can be restructured by paying a lump sum for an episode of care (“bundling” payments), rather than paying separately for each service provided. Section 1152 directs the Secretary to establish pilot programs to test the effectiveness of payment bundling across the nation in a wide array of formats so we can learn the best way to bundle payments to encourage efficiency and ensure quality.

REDUCING HOSPITAL READMISSIONS

Section 1151 uses new financial incentives to encourage hospitals and post-acute providers to undertake reforms needed to reduce preventable readmissions, which will improve care for beneficiaries and rein in unnecessary health care spending.

REWARDING HIGH-QUALITY AND EFFICIENT CARE

Section 1162 provides for increased payments to Medicare Advantage plans that demonstrate high quality of care and outcomes and plans that significantly improve quality. Section 1123 increases Medicare rates by 5% in the areas of the country that provide the most efficient care.

PROMOTING THE “MEDICAL HOME” MODEL

Section 1302 directs the Secretary to establish a pilot program to reward physicians and nurse practitioners who make their offices a “medical home” for patients by being fully available to patients and by ensuring that patient care is coordinated and comprehensive. The Secretary is authorized to expand the medical home concept if it proves effective in improving quality of care and holding down costs.

PROMOTING “SHARED DECISIONMAKING”

There is evidence that providing patients with more information about the risk and benefits of treatment options can help keep health care costs down and ensures that patients are fully involved in the care they receive. Section 1235 directs the Secretary to establish a demonstration program to evaluate the benefits of having doctors spend more time consulting with their patients about various treatment options.

PROMOTING PRIMARY CARE

Primary care providers can provide lower cost and higher quality care for many ailments. Section 1303 increases payment rates for primary care physicians by 5% and provides an additional 5% payment increase for primary care physicians in health shortage areas. Section 1121 provides for preferential updates for payment rates for primary care services in Medicare. Section 2212 expands scholarships and section 2211 creates a new loan repayment program to train more primary care physicians. Section 2201 builds on current expansions to the National Health Service Corps to get more physicians to health shortage areas, and this expansion in the Corps could eliminate 40% of the current estimated deficit in primary care providers. Sections 1501 and 1502 encourage more training of primary care medical residents and advance training in the outpatient setting, where most primary care is delivered.

DISCLOSING FINANCIAL RELATIONSHIPS

Section 1451 reflects MedPAC (Medicare Payment Advisory Commission) recommendations that all manufacturers of drugs and devices should report their financial relationships with health entities, including physicians, pharmacies, hospitals, and other organizations. MedPAC has concluded that such relationships can create conflicts, which lead to increased spending and suboptimal patient care.

UPDATED PAYMENT RATES

MedPAC has identified areas of overpayment to skilled nursing facilities, inpatient rehabilitation facilities, and home health care providers. Sections 1101, 1102, and 1154 adopt these payment changes to ensure we are spending taxpayer dollars appropriately. Sections 1103, 1131 and 1155 embrace the President’s recommendation to adjust payments so that providers are encouraged to increased productivity in how they deliver health care.

HEALTHCARE ASSOCIATED INFECTIONS

Section 1461 requires that hospitals and ambulatory surgical centers report public health information on healthcare associated infections to the Centers for Disease Control and Prevention. Section 1751 expands to Medicaid the current Medicare policy of denying payment for certain healthcare associated infections.

MORE AND BETTER HEALTH CARE DATA

The transition to a more efficient, higher-quality health care system begins with getting more data about the clinical effectiveness of medical procedures. Section 1401 invests $2.9 billion in comparative effectiveness research. Sections 1124, and 1441, 1443, 1444 and 1145 expand physician and hospital reporting of quality measures. Section 2531 creates a registry to track the use of medical devices. Section 1442 directs the Secretary to develop improved measures of health care quality. Section 2402 creates the Assistant Secretary for Health Information to provide for ongoing monitoring and reporting on critical population health data.

DEVELOPING NEW INNOVATIVE PRACTICES TO IMPROVE QUALITY

Measurement of quality is only useful if there are levers for change. Section 2401 creates the Center for Quality Improvement at the Agency for Healthcare Quality and Research in order to identify existing best practices, develop new best practices, and disseminate successful models around the country.

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41 Comments »

  • DR. ROBERT D. ALLISON says:

    In my belief, the natioanl health care issue will only be resolved if:

    1) Compleat transparancy is exercised in terms of how the “matched medicare” payroll deductions [employee and employer] are utilized.
    What happens to those matched funds? How much of the fund pays for medical residency training programs at designated teaching hospitals as a “pass through” accounting item?

    2) The medical profession must utilize less expensive non-invasive, outpatient procedures for evaluating cerebral and peripheral circulation in nursing home patients. The present discriminating regulations reqire Ultrasound technology and do not permit other non-invasive procedures that have been utilized and funded by CMS for many years. Ultrasound technology has not been fully proven and is not cost effective. I would welcome an opportuity to discuss this issue with someone who would be interested in learning about a non-invasive system that precedes Ultrasound and is cost effective!

    3) The general statement that health care will be for “everyone” will never happen as long as the attitude and policy of CMS continues to refused financial responsibility for early managements of chronic vascular conditions. This attitude by TriCenturian and other offices that denies coverage for procedures considered to be “screening’ is archaic. Chronic vascular conditions are not mysteries. Early recognition and mangement saves money and improves quality of life.
    The contract with TriCenturion and CMS should be cancelled. That contract has been and is a costly mistake for providers. TriCentruian’s decisions have denied providers of deserved millions of dollars at the expense of needed care for designated patients. TriCenturian staff are not stupid, they are ill-informed and practice medicine from remote offices. the government saves money at the expense of patients!!

    4) More to home – the Denison office that processes Medicare claims should ONLY process claims from TEXAS!! The Medicare regions served by Denison, Texas includes Oklahoma, New Mexico, Colorado as well as Texas. Parts of Arkansas, Louisianna and Arizona may also be included. This is a major diservice to Texas Providers and promotes a severe delay in patient health care for Texas. Let those other States take care of their own. The CMS office, as currently configured is not the “golden standard” for health care despite the tributes paid to CMS by political sources.

    5) What percentage of uninsured hopital emergency room patient care is computed in the total national “welfare” cost? This uninsured emergency patient population cost is a financial disaster!

  • Paul Handel says:

    What isn’t in the bill will affect physicians to a greater degree. There is no SGR fix, no liability reform and no reasonable way to fund it. Where are the fundamental public health initiatives to reduce obesity, tobacco usage and preventable injuries and death? Granted these result in long term savings but what the heck, shouldn’t we be concerned with generations and not just a budget or election cycle?

  • Steven L. Hirsh, MD says:

    There will never be true health care reform unless and until there is tort reform with NATIONAL caps on non-economic malpractice awards and a significant decrease in malpractice insurance premiums.

    There will never be significant savings in health care costs until ownership and usage of imaging equipment is FORBIDDEN to all except those who are certified to operate it and interpret the studies –NO F***** loopholes.

  • R. Dave MD says:

    Many Americans are stunned by what our President and Congress wants to deliver
    for health care for our country. The lack of physician voices, and reticence to
    contact our Representatives results in our silence as tacit approval.

    Obama and Pelosi recently called doctors “greedy”. This is a new tactic imposed
    to silence dissenting voices. Health-policy Adviser at the Office of Management
    and Budget, Dr. Ezikel Emanuel, has claimed that we take the Hippocratic Oath
    too seriously, “as an imperative to do everything for the patient regardless of
    the cost or effects on others” (JAMA, June 18, 2008). As our patient’s
    advocate, we are on higher moral grounds than anyone sitting in Washington. Many
    of us have given sacrifices and trained for many years to be able to practice
    our craft. It is time that we speak up for our patients and stop living in a
    vacuum. We should not underestimate our position in the society and impact of
    our opinion on all Americans.

    From R. Dave MD

  • Archimedes says:

    Overhauling the healthcare issue is relatively easy. Eliminate mandated employer health insurance. This would allow a uniform pricing in policies. Indiviuals will be able to shop more effectively for healthcare and develop the policies that they desiore. Think of shopping for a car and which amentities that the buyer desires. The patient can modifiy their policy according to the needs. Most are already paying partial premiums at work anyway. The free market will drive down costs. Next eliminate third party payment. The patient should pay the doctor directly and submit an invoice to their insurer. The patient can then decide if they are getting the quality of care for the cost. If they are disastified they can switch doctors. If they do not like the remitance from the insurance then they pick new policies or insurers. Both will be adequately drive by free market. The financial burden may actually change behavior which would improve health.

  • Rob Dahmes, MD says:

    Tort reform is not included in this bill AND no one can answer my question regarding physicians being required to participate in a national health corps or losing their license.

  • Delfin J Beltran MD says:

    This article refers to the Kaiser Institute as non-partisan. They, unfortunately are non-partisan in the sense that they have found the answer to medical care management and they desire not to consider any other format. I practiced in the Palo Alto, Menlo Park, Redwood City area for 25 years. Our group of cardio-vascular physicians had multiple interfaces with the Kaiser Group through patients referred because they could not or would not managed the difficult ‘outlier’ problems. This included retirees who had been told that they were just old and had to live with their circulatory insufficiency to resident moon-lighters who were told not to make a diagnosis on the charts because diagnosis requites intervention and that costs money. It should be noted that Mr. Kennedy’s concepts of universal healthcare are derived from the financial success of the Kaiser Group, in particular compared to the massive failure of the Blue Cross Blue Shield California group, At one time our hospital had not received any BS-BC payments for services completed for one year. Any thought that the government will do any better is sheer folly. Capture of control of the ‘Health Industry’ has been a political goal of the Progressive movement since Edwin Witte wrote FDR’s Old Age Subsistance and Universal Healthcare Bill in 1935.

  • Gary Kiefer MD says:

    On about page 640 of the House bill is a section that defines “Primary Care Physician” as an MD, DO, NURSE PRACTIONER, or supervised PA trained in primary care.”With apologies to NPs and PAs, they are NOT Physicians, but the current Administration would LOVE to make them interchangeable with Physicians, to dilute what little political clout we have. I guess I wasted 4 years in medical school, and 3 years residency!

  • Concerned provider says:

    I am concerned about this bill. I currently practice physical therapy and have my own practice. The amount of time I spend dealing with insurance companies unpaid claims is ridiculous. Also with the current Medicare B cap system some patients are never able to reach maximum functional potential and as a result may end up injuring themselves again and costing the government more money. The current system biggest problems are the insurance companies ripping off the patients, not paying providers appropriately, and the Medicare B cap. The insurance companies annually increase their premiums every year and pay us providers less and less every year. I believe if the government created an insurance program that offered lower premiums for the patients, less complicated billing procedures, and reasonable reimbursement to providers the other insurance companies would fall in line. The reason is providers and patients would have incentive to participate with the new program and as a result would drop all the current insurance companies that pay us 20 – 30 % of what we bill. Also I believe the government should pay for uninsured emergency visits, since this a problem at hospitals. We all went to school and spent a $100,000 plus in education along with sleepless nights and unbelievable stress why should we be penalized for our hard work. We all strive the best for our patients, so I hope they stop attacking the providers and start by dealing with the insurance companies.

  • Dallas PA-C says:

    I appreciate the apologies to NP/ PA’s. I am one, military trained and practicing since 1992, now in a Rural Health Clinic. I have trained Family Practice Residents in clinical Medicine, and most of my supervising Physicians in the military had less clinical experience than I did. I stayed in Primary care/ Family practice to care for the whole body and family. I am disgusted to see the American Academy of Physician Assistants endorsement of this Healthcare Reform, just because it includes Mid-level providers. I was trained as a Primary Care Manager in a Socialized Medicine System- the military. It doesn’t work. I refuse to endorse such a reform, I do agree that a “Health Care home” is needed, but the move to specialize has left a hole in Primary Care, that will have to be filled by someone. I have read and studied Healthcare policy and reform. Without Insurance reform, tort reform and tax reform first (fairtax.org), there will be no true health care reform.

  • BLD says:

    You all need to read Sectio 261 because I think it could have an impact on malpractice. You might not be so quick to support Obama and his minions. It is around page 145, and here is what it says:

    SEC. 261. CONSTRUCTION REGARDING STANDARD OF CARE.

    (a) IN GENERAL.—The development, recognition, or implementation of any guideline
    or other standard under a provision described in subsection (b) shall not be construed to
    establish the standard of care or duty of care owed by health care providers to their
    patients in any medical malpractice action or claim (as defined in section 431(7) of the
    Health Care Quality Improvement Act of 1986 (42 U.S.C. 11151(7)).

    So, it appears you will be in a catch-22: face potential malpractice by following govt. guidelines on what is the “best” treatment and is approved for payment, even if it is not consistent with the standard of care in the medical community, or treat a patient according to the standard of care in the medical community and not get paid or even get penalized for overtreating because the treatment was not approved by the govt. How can any doctor actually support this bill?

  • Dismayed D.O. says:

    Going from military to civilian practice several years ago has opened my eyes to a whole host of perplexing issues. My biggest pet peeve has to do with 3rd party payers and “my overhead at about 62%”; most of which is directly related to doing the work of the insurance companies on behalf of the patient. Also the daily expectations of patients that I should know what is or is not covered by THEIR insurance plan. The silly game of “Pre-authorizations/PA’s” for medications is another splinter under my fingernail..”the pharmacy said I could get this if you just called my insurance company”, which translates into at least 30 minutes on the phone and 15 pages of paperwork for me. No other business I am aware of has to deal with this CRAP. My analogy is if your pipes burst in your house, you call the plumber; he fixes your leak and hands you a bill. He could care less if you have homeowners insurance or not, much less who it is with or what it may or may not cover. You would also never expect your plumber to have to get on the phone and hagle with your homeowners insurance representative as to whether he can install PVC#6 or PVC#8. You would never expect his office to have to hire a host of billing staff to file your claim for you either. Hell, I should have been a Plumber……………

  • BLD says:

    Dismayed DO #8 – Have you read this bill? I have and can tell you that with all of the bureaucracy being created, you are going to be going through the same, if not worse. The only difference is instead of an insurance company, you will be dealing with the govt. Did you know that the govt. is going to do studies to decide what is the most effective care and you could not get paid for not following that? I think you might even get fined or have to face a board to explain why you didn’t? I think you might even face losing your license. READ THE BILL. I think the Section I cited should be enough to make you afraid. Maybe you have been subject to malpractice yet, but when you are placed in the position of deciding whether to get paid by following govt. guidelines for the most effective treatment versus following the standard of care established by the medical community, what are you going to do? Follow the govt. and leave yourself open to malpractice or do what is right and face not getting paid or even “getting in trouble” with the govt.?

  • Bruce PA-C says:

    I think we will all (PAs and NPs) see our salaries go down due to the glut of mid level practitioners in general along with RNs and other “ancillary staff”…rad techs, respiratory therapists, physical therapists, etc. since reimbursement to hospitals and MDs will drop they can’t afford to pay us as much. Also they will force us to take a financial hit before they will accept one. You will also see a HUGE movment to use “techs” which essentially are non-licensed people hired off the streets with little or no medical experience to do work at a pittance of a salary. This is essentially what people mean when they say the quality of health care will go down….and they are right, since more of it will be provided for by people with no actual licenses or medical experience. This is already occurring a lot in nursing homes where care is provided for by “techs” who are overseen by one RN. You also WON’T see any of the benefits reform could have taken such as ordering meds from foreign countries more cheaply. The government and pharmaceuticals are in bed together and have a choke hold on any threat to that arrangement ever occurring. I’m usually not an alarmist but the overall debt of this administration along with the taking over of nearly every aspect of society, including now health care (roughly 1/5 the economy) scares me.

  • Prospective Med Student Kate says:

    As a prospective medical student, I am frankly extremely confused as to what my future as a physician could turn out to be. I’ve read a large number of articles but nothing truly lays out what this “reform” will look like. Everything from the white house says that this reform will increase coverage and insurance options. However, there is very little about how this will affect physicians. If anyone has some objective information on this topic I would greatly appreciate it. Will the payment system be the same? Will the government’s “public option” be billed the same way as any other insurance company? Is there anything about a minimum that insurance companies must pay providers for specific services?

  • Kathy, FNP says:

    Let’s not put all the blame on the lawyers and pharmaceutical companies for this health care disaster. I’ve worked with more than a few greedy doctors in my lifetime, so don’t think the majority of them actually care about their patient’s health and welfare. From what I’ve witnessed, the majority of them care far more about their pocket book.

    Obama hit the nail on the head when he commented that doctors were greedy, because the MAJORITY of them are! If the state medical boards witnessed what I have, there would be far fewer doctors. What’s really sad, is that physicians won’t report the unethical ones, even though they know they’re harming patients!

    It’s almost laughable that physicians are so adament about NP’s needing their “supervision.” From what I’ve witnessed, nurses need to supervise DOCTORS and protect patients from them.

  • 2/26/2010
    One would say that people who have the abilty to read these Laws, Government Officials failter, as when The United Nurses ORG. step in over a issue found and it set back this Bill for Law,

    2/26/2010
    Wow, It was stated that Health care is not a moral issue,hmmmm
    Please allow me to share a little story with you. As I watched my mom die from cancer, and Health care Insurance Companies dumped on her as if she was no more than a dog dieing on the side of the road, i dropped from and out of this system for over 30 years, and now because of system failure, the IT, has come into my life. As I watch Government Officials fight over this Health care Dollar, it reminds me of a bright sunny day in Tennessee while on a friends farm and a little bug flew in to the ground, and the chickens went plum off, boy oh boy the scawking and the feathers went shy high, so I reached down and I took this scared little Health Care Bug from Government Officials, and I have it safely in my hands. As I searched for a way to help, I asked God to help me build a Reform that is of a moral building block for the better good of man kind and to rebuild the National Security of the United states Of America. And you would never guess what God has allowed me to see. This little blog statement you will find true,
    first;
    I wish to give a great big thank you to all my new friends on the Internet for posting FASC Concepts in and for Pay It Forward.
    This building block for a honest Health Care Reform has been a great experience and for any one who did not take part, you have truly missed out on what makes Americans Great. This diversity created by Government Officials has failed and now the eyes of 173 million American People watch as now, for the first time Government Officials sit down together as it should be. The out come is yet to be seen. But they know that a anomaly has been created and it is because of the restructuring of The Constitution, The Bill Of Rights, and The Declaration Of Independence, “has been used in it original created forum” as a factor of a peoples right to undo the amendments of Laws that protected Health Care Companies against the People, over a dollar.
    And I wish to say i write what is needed in order that some how I can undo all the wrong I have done in hopes that the slate will be wiped clean….
    Just because our children do not understand I wish to share this again,
    “For days I worked the word diversity in my mind and it came to me that because of this it is not Americas weakness it is our greatest strength. And this is how I will show you.
    Constitution-
    Bill Of Rights -
    The Declaration of Independence-
    United under one forum, builds what is called the Trinity of the Protection Of Laws. This is because these Laws were built by people of faith who gave thanks to God for this wisdom. One would have to see and admire the simplicity of the three as one and at the same time they maintain their independence.”

    On page 100 at our site is the early stages of what is called A Prime Directive for Health Care, so please drop on by and see 173 million peoples views in and for Health Care. And it should be known that this information on page 100 is true and documented in Law and History.
    Henry Massingale
    FASC Concepts in and for Pay It Forward

  • Robert L. FNP says:

    I find it amusing that some docs have an issue when the term “Primary Care Provider” is used instead of “Physician”. As an NP it never was my intent to replace a doctor. I was trained in primary care and feel that within that realm of medicine I function very well. The fact is that most docs do not go into the area of Family Med/primary care due to various reasons (pay, patient load, etc…). NP’s ( and PA’s) have stepped into that gap and provided quality primary care with good rates of patient satisfaction. There are many studies that document this. In the future I think we will continue to see the movement of NP’s and PA’s performing primary care and physicians going into specialties. I just wish we could do away with the bickering that goes on between the AMA and Nursing Organizations. We are all after the same thing, providing care to improve the quality of a patient’s life. Also, I despise the term “mid-level”. What the heck am I “mid-level” to? It is a very degrading term.

  • Larry Lembach says:

    I’ll bet you Doctors regret voting for Obama.
    He wasn’t talking to you all when he said “yes we can!”
    It,s meant “yes they can.” Obma alway gets what he wants no matter what!
    When he finish being president this Country
    will be I worst shape than Ever!
    Never make a lawyer president ,there views
    are narrow and far.

  • Concerned MD says:

    Medical doctors’ fees and the procedures they performed account for only less than 20% of the current health care budget. Unfortunately, the bill is presented to an ignorant public with the goal of making them believe that doctors are “greedy” and make too much money. They did, thirty or forty years ago (paradoxically when health care was not as expensive) but that is no longer the case. In the fight for political survival, republicans and democrats both will squeeze physicians further to show off that they succeeded in “reducing” costs at the expense of already overworked and overstressed care providers.

    Either bill will also quadruple the amount of paperwork burden which is already consuming more that 50% of the time any doctor in average can allocate to the care of each single patient. Unfortunately, neither bill will take on any of the big fish, aka, the corrupt phamaceutical and insurance industries, a number of large health care related corporate entities or the worse of all monsters, trial attorneys which have driven providers constantly to practice defensive medicine, such as ordering a myriad of expensive tests with feeble real justification other than to protect the doctor from highly unlikely events should any of these happen. What a joke!!! what an insult to the American people. Shame on you both Republicans and Democrats!

    A caring and concern MD.

  • Future Med-Student says:

    i’m in undergrad school now and i have heard so many things about what this bill will do for medical school students. i am a pro-life person and according to the things i have heard i may not be able to graduate med school and become a doctor unless i am trained and am willing to preform abortions. i have not yet found conformation of this online and am wondering if anyone has heard this or has proof of this or the contrary. i would hope that the first amendment would allow me to keep my religious beliefs that prevent me from taking the life of an unborn child. anyone have any views on this issue?

  • FutureformerAnesthesiologist says:

    The same tactic used to win the election again. Gain support from the many, who have less and take from those who have more. He got support of primary care docs, ie the AMA and pitted them against the relatively few who chose long difficult residencies, high stress, odd hour, high liability exposure medical careers (Surgeons, Anesthesiologists etc). We’re going to fix this all by giving primary care folks more income and “save money” by paying less to the “greedy” specialists, who drive up costs, and, by the way, taxing the crap out of their income they have. Well, as someone who spent many extra years of training and now sweats through long complicated surgeries on the sick elderly for about $80/hour, I’m soon done. Yes, the rate of “reimbursement” for Medicare is about $20 per unit (15 minutes of time). Anesthesiologists got royally screwed when they calculated the relative value scale, and even the Government admits it. Most specialties collect 80-90% of insurance rates for Medicare patients, we get about 33%. My income has stagnated or gone down in the last 15 years while the cost of living here has skyrocketed. I can no longer affort my mortgage payment, in addition to college tuition. I pulled my other kids from private schools (thank God we have good public schools here) and we essentially quit the country club. We can’t afford a vacation this year. So someone please tell me why I’m still staying up all night taking care of laboring patients, busting my ass to keep old sick people alive while they have their hips replaced? My family and I no longer can enjoy any of the benefits I thought I secured while spending my 20′s studying and working while all my friends played. When I am forced to sell this house (the value of which just got crushed), I’m done in Medicine. Yeah, you’ll have insurance, you just won’t have the quality people you have now taking care of you. Have your primary care doctor or Michael Jackson’s doctor push your Propofol. I’ll be working on a dive boat in the Caribbean.

  • Neve says:

    Im a Canadian and I love Obama!! Healthcare for all!! Now americans are on par with us:)

  • Dr bob says:

    Neve,
    You and all of canada can have him. This country was made great by limiting government. Plain and simple, this will destroy they quality of our health system and criple our economy. Then I suspect we’ll be on par. Maybe if we’re lucky we can be as stong as France one day.

    Sad for our country,

    F Robert Glatz

  • Dr.A says:

    Health reform… for whom? Definitely not for us. The problem at hand is that Obama and this great government have the need to make us the medical doctors responsible for the fiasco of the desperate need of public health. Uhmm, is very simple. Allow me to explain, The USA our beloved country is the only country in the world in which make the medical student pay outrageous cost for education, never the less we have to go through extremely expensive and difficult medical boards. By the way, is a government exam and not a medical school exam. Which means the government pocket billions of dollars per year from the medical boards on its own. In other countries medicine is free, they even pay medical students to engage in such a demanding career and they only have to take 1 medical board. We are the recently grad medical doctors in debt thanks to the government for at least $250,000 and counting, and that is before getting into residency. Obama, the people, and other medical personnel as RN,PA and whoever decide to think of us as greedy should understand something. Medical school is not free as in other countries who therefore can offer free health care provided by their government. Our government make us pay for Medical school,malpractice insurance and the USMLEs which keep on rising in cost. Who benefits from all of that? The government. Who is the greedy now? If Obama wants health reform, then he should start offering free medical schools, and minimize the amount of boards to at least 1 instead of 3 that we take and maybe he could start a reform. You want a reform this is what I propose:

    1. STOP providing medicare to those who contribute to the high rising cost of health care. The everyday parasite of society who will even injure themselves to obtain vicodin and sale it down the street or waiting to sue us.
    2. STOP taking away 20% of the MD paying salary per cost that began in july ’09. So, you can claim later on that you r increasing 5% of our salary.
    3. STOP taking away the service that the Diabetic needs for their Glaucoma and their Podiatrist.
    4. Free Medical School and pay our loans including boards….
    5. eliminate malpractice suit, therefore no need for malpractice insurance and that on its own will lower your cost.
    6. Make the real patient pay for their medical expenses and you the government should pay the patient back for their medical expenses. Helping us deal with real patients instead of malingering. Lets see how the people deal with the unpaid claims that we deal on daily bases and still think that we r greedy.
    7. Increase the bar exam and multiply it x 3 bar exams before finishing Law school. In case you still need to compensate. ( just kidding) Just helping you feel a bit of what we go though.
    8.Stop making contract with other countries to bring residents, but I guess that would be difficult because those countries also pay the government to reserve positions in our hospital making our american students to pursue their medical career abroad.
    9.Stop making deals with the insurance companies and the pharmaceutical companies
    10. Start making new legislations protecting us the americans against Fire Arms, Tobacco products, Fast food restaurant. Prevention, the key to help compensate the monetary deficit and save life.

    I am pretty sure that we are in a desperate need of government reform… I wonder why the need to focus on us became so appealing to them. Fix this actual problems and then you can even consider a new health reform for every one.

    Dr. A

  • Ron says:

    Please would all the Docs get over their hippocratic oathes and speak out against this attack on their families and livelyhood by our so called government as you have on this forum. As consumers of your skills and abilities we need your voice now more than ever. God bless.

  • Stephanie says:

    To the Future/Former Anesthesiologist – You are a “BIG ******”
    You must live well beyond your means. You are the reason our country is in this situation! You are greedy. I’m so sorry you don’t belong to country club or could not take a vacation. Perhaps, you should spend time at home with the family? You said you had to take your other kids out of private school? Gee’s, How many do you have? What a wonderful parent you must be? Then you said you take care of “SICK OLD PEOPLE”? God forbid! What do you suggest? Kill them off? I’d never want someone like you to care for anyone.

    I believe YOU should not have the opportunity to make money off of anyone. Now, my doctors on the other hand deserve to make a lot of money. They care! I hope you are done. You ARE NOT quality.

    I have a good job, my house will be paid off in 5 years. I’m 47. I have compassion and lots of love in my life. I feel sorry for you. You are a very, very bitter person!

    To the FUTURE MED STUDENT!! STOP!!! LEARN HOW TO SPELL FIRST. NOT THAT I’M ANY BETTER BUT I’M NOT A FUTURE MED STUDENT.

    OBAMA HAS DO WHAT HE’S GOTTA DO! YOU ARE ALL IDIOTS!

  • chris freeman says:

    Stephanie, just see what happens to patient care when you stop attracting the top minds and work ethics into medicine with lower reimbursements. In 30 years you will see the effects of this bill. You are obviously not in medicine as you have no idea what doctors deal with on a daily basis and the work that goes into becoming a successful physician…careful what you wish for.

  • Dr. KP says:

    Speak up doctors! This bill affects us all and it will not be pretty. Our situation before this was already grim what with malpractice, decreasing reimbursements, and insurance companies ripping off patients. What has become of our country that we allowed a government that we elected to represent us, push through a bill that 46% of the country didn’t want? Not one republican voted yes, and 34 democrats voted NO, but yet somehow it is now a law. How did something like this happen? Why didn’t we just elect Obama as a dictator? The only way we are going to fix our health care problems are to address tort reform, limit malpractice payouts –> this will help fix the “defensive medicine” practices, and go after the insurance companies that are continually increasing premiums, but decreasing reimbursements.

    If the democrats wanted help constructing a healthcare reform bill they should have put together a committee of seniors with a chronic illness or on a poly-pharmacy regimen, families of children diagnosed with cancer and in which the parents lost their jobs and coverage because they spent too much time at the hospital with them, diabetic patients, family practioners, emergency room doctors, medical students with $200,000 plus debt of school loans, nurses and other ancillary technicians, and even a few lawyers. If a group like that could not come up with ways to address: quality and standard of care, coverage standards, paperwork, reimbursement percentages, areas of waste, areas of neglect, the humanity factor, reducing defensive tactics, and decreasing lawsuits —- then our country is in real trouble. These are the people that deal with, work in or benefit from the system day in and day out. This group of people is qualified to construct a bill that would concern 1/5 of our country’s economy and the entire country’s health and well being. How can you say you know what is best for a patient if you know nothing about how to treat them, or know nothing about what it is like to be one? I think the major failing on this administrations part is that they were so busy trying to be the era of change and reform, they missed the target completely. They will in fact be hurting the very people they claimed to be helping, but they are just too short sighted to see it. Our future generations will reap the havoc of this unfortunate legislation if we do not speak up now.

    Doctors, speak up and be heard. Don’t let this liberal president with his grandious ideas and narrow forethought sink our country into even further economic crisis.

  • Brennan Strickland says:

    Nursing Student

    To all the doctors out there,what is America’s other option for reforming healthcare? And I mean in it all aspects, not just in way that it helps doctors. I’ve read through all of the comments and I understand your concern, but this isn’t just about you guys, it’s for the patients. I know that people cheat doctors all the time with lawsuits, but if a time comes when my mother or nieces are sick and we can’t afford the treatment, there will be hell to raise and I would expect that from anyone else. I apologize, but I won’t give a damn about anything or anyone else if one of my family members is on a hospital bed dying and I can’t do anything about it. I know this makes me seem like a Obama bandwagoner or some uneducated person, but thats just me speaking the truth if something like that ever happened.

    I am being very brief with this statement and some of the things are probaly confusing and not well organzize. I do want to end with this statement, if I come off hateful, I don’t mean to because I have nothing but respect for doctors and for healthcare.I just want to know what other doctors think about a different bill and what they would want out of it. Cause the Republican “Healthcare Bill” doesn’t cut it for me. ( For the record, yes I am a democrat and one of few that would admit that the Republicans had a healthcare bill proposal)

    P.S. please point out my strength and weakness with sincerity. I am not going to learn anything with hateful rhetoric because of my ideoligcal views. lets make this about me and you and not the guys in washington.

    Brennan Strickland

  • jake s says:

    obama is an idiot. he’s ruinung healthcare for everyone. taking away money from those who through much hard work and many years off college have rightfully earned. who is he to do such a thing. iv put years of hard work to make my way to be a medical doctor and now with this new bill i now wont make more than someone with an associates degree, 2 years of college (even at a community college), compared to a masters to make it to medical school, more than 8 years.

  • Ima Fraid says:

    Jake S. is correct! Plain and simple..Obama is an idiot!

  • ditcheddreams says:

    Stephanie, why don’t you try going to medical school then and help yourself?

  • La says:

    Whatever obama’s plan is for the future, it better be worth it to have to go this extent to secure the immigrants and middle to lower class ppl votes in another election, which is the majority of the u.s anyway. The strategy might work..if there is one.

  • EJ Matchin says:

    I’m a college student about to enter my sophomore year (wanting to enter the medical field). I fully agree with R. Dave MD’s post. I find it ridiculous for Obama and Pelosi to call doctors “greedy”.

    “The lack of physician voices, and reticence to contact our Representatives results in our silence as tacit approval.

    Obama and Pelosi recently called doctors “greedy”. This is a new tactic imposed to silence dissenting voices”

    First off, doctors are very important to society, if not the most important type of contributor, providing care for any type of individual. Not to mention the work you must put in in order to become a doctor so that you are able to CORRECTLY treat and heal patients.

    Secondly, there are plenty of other fields that make the same, or even more than doctors, and they do not contribute the same amount of value to society. Ex. football quarterbacks making $16.5 mill a year, lawyers who make a hefty salary, and top business CEO’s.

    I am not trying to “downplay” these other fields as it takes just as much effort and will to become a professional athlete or successful lawyer, but in the contribution to society hierarchy, I would say that human treatment, making sure the individual is healthy, is far higher than providing entertainment to the public.( referring to any major league sports star)

    Also, I think that Obama should address the economic situation and America’s current status in the world first, as opposed to funding something that will only deter getting America back in the black as during Clinton’s presidency.

    I’m no political expert, but why not just do what FDR did? Social projects to provide jobs, instead of trying to get something that needs money to be accomplished. (UHC)

  • Tom O'Connor says:

    Dr’s are not the greedy party here. The Insurance companies have been robbing both the patients and the dr’s who practice medicine. The insurance companies are in the business for profit. Just ask their shareholders. Having our goverenment and the insurance companies in bed together makes for a disturbing outlook for our future. Just check your aging reports and your account receivables and ask yourself why there is so much money sitting there? The insurance companies are taking your money without any legal recourse to make them stop!

  • Kay Janish says:

    I have just been informed that my doctor is going to be accepting only 600 patients into a new program of preventative and health as a primary care doctor. He wants the 600 patient’s who enroll into this program to pay $1800.00 a year. This should be illegal. It is like buying into a private school. Your elite, rich people can afford this.
    What about the rest of us? I am so disappointed im my doctor that I have had for more than 20 years. His true colors are now showing. Green for Money. The Fat Cat’s get Fater. I guess I will be changing Doctors. I think this is morally and ethically wrong. Don’t doctors take some kind of oath. I guess they will have to revise it with the phase. “Only if I get paid a lot of Money.” So sad.

  • doctors wife and RN says:

    To Kay and others who think docs make too much money.

    Firstly, I would like to see you go thru medical school and the difficult residency. Not to mention the horrid hours docs have to work.

    My husband is an orthopedic surgeon. He leaves for work at 6am and gets home around 9pm monday thru friday. Every third weekend he is on call and must stay at the hospital. He is also a trauma surgeon and must stay in house to take care of pts when they are scraped off the highway.

    The weekends he is on call he works all day on friday, goes to the hosp and works all night. Is lucky to grab a few hours of sleep, get up at 6am Sat. to round on pts before 7.30am surgery cases. (that were added on while he was getting his few hours of sleep). Same thing happens on Sunday. He than goes to work on Monday with a full clinic–to see the non surgical pts he did not operate on over the weekend. He is also on call every third wed, which means work all day and work all night and go to work a full day on thurs.

    Not to mention he has to work many holidays in this same grueling fashion.

    His overhead costs are 54% of money that comes in from insurance payments. If the insurance companies even pay. Medicare pays 10 cents on the dollar, and the insurance companies pay 20-30% of the actual bill. He cannot work less, because than he cannot make enough money to pay overhead. Overhead averages about 30-40,000 per month. Everything a pt sees when they walk into his clinic is paid out of pocket by him. Building rent, all employees, heat, lights, computers, phones, EVERYTHING!! If he bills for a 1,000 surgery, he is lucky to recieve 300, take 54% of that out for overhead. The rest of the money is taxed by the state and federal govt 50%. He is lucky to keep $100 out of a 1,000 surgery.

    docs have to practice defensive medicine because of the ambulance chasing attorneys. This drives the cost of healthcare up. No mention of capping medical lawsuits. Most polititions are lawyers this is why this was not addressed in the healtcare bill.

    So, for all of you people that think that docs make too much money, you are ignorant.

    I would like to see the president and all of his buddies work one week in my husbands shoes. They could NOT do it. I would like to see all of the people that think the docs make too much money work a day in my husbands shoes. They could not.

    The president, and all branches of govt. is not included in the healthcare bill, just as they do not pay into social security taxes. If this govt run healtcare system is so wonderful, why have they chosen to opt out?

    Have you ever tried to deal with the IRS? The IRS is the largest department run by the govt, most americans are part of it. Try to call the IRS, you will be put on hold forever and treated poorly when your call is finally answered. The IRS does nothing for you but treat you like crap and take your money. Nationalized healthcare will be bigger than the IRS. Try calling and making a doc appt. good luck to you. You will most likely be on hold forever and have to wait in line for any medical needs.

    nationalized healthcare has promised to pay specialists 150,000 per year. What happens when overhead is still 30,000-40,000 per month? The docs will be forced to close down their practices because they cannot afford to keep their doors open. What will happen than? The docs if they want to practice will have to become a federal employee. Than the govt will have control over them and dictate how, when and where they will practice. You think you wait in line for a doc appt. now, wait until the govt takes control.

    The federal govt had a difficult time with the program “cash for clunkers”, and you think they can take care of your health?

    The govt is only out for itself. The sooner you realize this the better.

    What federal employee do you know that works weekends or holidays? When docs become federal employees, what will be the incentive to work those long grueling hours, weekends, and holidays? Have fun waiting in line.

    We have friends that live in Canada. the clincis close at 4.30, when they need emerg care, they bring thier sleeping bags to the ER and plan on staying there for three days. My friends have to pay for two extra private healtcare plans besides canada’s nationalized healhcare. One for medications, one for ambulance rides to the ER if need be. Canada’s plan does not consider an ambulance ride to the ER after a bad car accident necessary. The US will follow in its footsteps. We also know of a cardiac surgeon in Canada, he was put on the wait list for three years for bypass surgery. He luckily had a huge heart attack while in the US visiting friends and had emery surgery here. Not to mention, the Canadian leader came to the US to have cardiac surgery. Why if nationalized healthcare was so good?

    I have read a stat that 74% of all docs will quit when nationalized healthcare actually takes over. Have fun waiting in line.

    What will happen when you need emerg surgery, and most of the surgeons have quit or been forced out of business because they cannot afford to pay overhead? Wait in line, and hope you don’t bleed to death before a doc from overseas can take care of you. If they can, or if you can understand them!

    Once govt healtcare takes over, the docs will not be able to own MRI units or day surgery centers. Nat health care will not reimburse for these services if doc owned. Hospitals will be controlled by the fed govt. If a hospital wants to expand they have to have special permission from the feds in order to do it. Again, have fun waiting in line if the hosp is the only place surgical procedures can be performed. Even if the surgeon wants to operate, there will be limited surgical suites they can utilize. MRI’s will be a thing of the past. Good luck with the early detection soft tissue cancer diagnosis. You will get a cheap x ray that is a poor diagnostic tool to detect soft tiss. cancer.

    One thing you do not understand, people do not work for free.

    The brances of govt recieve $174,000 in income, this does not include all of the handouts they get. I find it interesting the president and his friends want to major tax hike people that make over $250,000. If you cannot see that govt and the officals are out for themselves you are blind.

    The govt officals love to pit people, classes, docs, pts all against each other. This is how they get things passed.

    Again, branches of govt DO NOT pay into social security taxes
    Again, branches of govt WILL NOT take part of nationalized healthcare
    Again, branches of govt WILL NOT see the major tax hike

    THE GOVT DOES NOT CARE ABOUT YOU, THEY JUST WANT TO FEATHER THIER OWN NEST!!

    If a person is rewarded by not working, they will not work.
    If a person is rewarded by hard work, they will work.

    Whatever behaviors are rewarded is what behaviors will be manifested.

    Doctors did not write this healtcare bill, politicians did. You, that think docs make too much need to get the facts, from hardworking healthcare providers.

    From a doctors wife who is also a registered nurse

  • KU Med Student says:

    To doctors wife and RN, AMEN SISTER!

  • Physician says:

    The bill offers incentives to hospitals and doctors for NOT ordering expensive test, but not even a paragraph of the stupid bill will protect them in case they were wrong! Let’s say that 99.9% you are convinced that is not necessary but but you will do it because ….the Gov won’t pick up your malpractice bill!

  • Sally says:

    All you angry people! I’m looking at these sites for a high school assignment and I think you should all stop fighting over the specifics. I’ve looked at the pro-con site and a few more articles, and I made sure to keep bias in mind. this is the general argument:
    “Obama’s heath care is awesome!”
    “NO IT’S NOT YOU LIARS!”
    From my limited view, my doctor’s views, and all of the comments I have read,i have decided that the plan stinks. most doctors get paid less than they actually charge, the “primary doctors” get paid more, but they’re swamped and have very poor quality work because of this. My mom went to a primary doctor when i was a baby, and the nurses were cruel, the doctor was rushed, and there was no care for the patients. One of our doctors is being threatened out of a job because of this plan, and he is amazing amazing amazing.
    On the pro-con site, all the pros were canceled out by the cons.
    Also, on doctors making to much money:
    Are you serious? Do you people know how much all that school costs? Heck, they need the money they get! And running an office is expensive as well. Doctors may charge a lot, but they don’t get all that they charge, just like in any other job. And with all the work they put in, maybe they deserve that yacht or whatever!
    I’m not saying there aren’t bad doctors, but does that mean we should punish all of them?
    The one thing I don’t understand is how this got passed if everyone hates it so much.

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