Video: ObamaCare’s impact on doctors

posted at 11:25 am on July 5, 2010 by Ed Morrissey

An excellent video and report from my friend Robert Bluey at the Heritage Foundation demonstrates why ObamaCare was exactly the wrong medicine for what actually ails the American health-care system.  This dovetails well with my previous post on emergency-room visits and the people most likely to overutilize that delivery of care. Medicare and Medicaid systems are far more broken than the private sector in delivering care and compensating providers — so why did the Democrats expand the former instead of expanding the latter? (via Newsalert)

Because many doctors double as small businessmen, they face the reality of meeting a bottom line in addition to treating patients. Boone figured she had three options: lay off her office manager, drop patients who rely on Medicare or relocate her office.

She didn’t like her options, but didn’t have much of a choice. After months of agonizing over the decision, Boone this month moved her practice to a less expensive office in an older building. It was hardly the ideal outcome, but it allowed her to keep her staff intact and continue treating her Medicare patients.

“I feel a sense of shame; I feel failure because, on some level, I want to provide the very best for my patients and for my employees,” Boone said.

“But it’s getting to the point where the bottom line is coming up and we’re just not able to sustain what we’ve done in the past.”
Boone isn’t alone. Doctors across America are facing the same types of tough choices. An American Medical Association survey of more than 1,000 physicians earlier this year found 68 percent would limit the number of Medicare patients they take if the reimbursement problem wasn’t resolved.

The answer to the question I posed above is rather simple. Democrats didn’t want to fix the real problems of compensation and access, many of which originate with the government, but be seen to fix problems they defined in terms of hypothetical access. Expanding Medicaid means that Democrats can claim to have covered more people. But does that help when providers are dumping Medicaid? Does that cut costs within the system when Medicaid patients are the most likely to overutilize emergency rooms, thanks to the perverse economic outcomes Medicaid creates when clinic providers won’t see them thanks to low reimbursement rates?


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There is an option to make this problem work: outreach to the muslim world.

Start importing muslim doctors from such places as Somalia, Bangladesh and Mali so that the muslim world can feel good about their contribution to modern medicine. Sure you might have to undergo surgery by some guy who really hates infidels but everything will be fine. See you on the other side :-)

Bishop on July 5, 2010 at 11:31 AM

I’m sorry Ed… your plan has only facts and doesn’t contain unicorns and rainbows…

Skywise on July 5, 2010 at 11:32 AM

There is only so much we can do “for free”. And there are few things better in life than having some person who doesn’t pay a dime in taxes shout at you “I’m paying your effin’ salary,” when you cannot give them more and more of something the shouldn’t have to begin with.

clnurnberg on July 5, 2010 at 11:32 AM

“We’re heading in the right direction” – clueless

Electrongod on July 5, 2010 at 11:35 AM

It’s not as if this sort of information was not out there before the arm twisting and games.

It’s because it’s NOT about controlling costs or “helping the pooooooor.”

IT IS and ALWAYS WAS about CONTROL!

JamesLee on July 5, 2010 at 11:35 AM

Our former family doctor, an excellent physician, foresaw what was coming here, so he and another physician joined an outfit called MD-VIP, which essentially charges patients a flat fee of $1500 a year just to be a patient under their care! They did this primarily to stay in practice or risk losing patients due to the upcoming healthcare disaster as well as because of the ridiculously high malpractice insurance rates they had to pay yearly.

As this Obamacare thing starts to become a nightmare reality, expect to see more doctors doing what our former doctor did here, just to survive.

pilamaye on July 5, 2010 at 11:36 AM

Clearly she is a shill for big pharma. She doesn’t want to give up all the perks she gets from the drug companies.

Keep voting democrat!

Inanemergencydial on July 5, 2010 at 11:37 AM

Costa Rica is looking better and better every day.

GrannyDee on July 5, 2010 at 11:37 AM

So how long until they make it illegal for doctors to refuse to see medicade/medicare patients and/or to change professions.

chemman on July 5, 2010 at 11:38 AM

I’m sure there’s a “boot on the throat” or an “a$$ to kick” that will fix this right up.

RBMN on July 5, 2010 at 11:38 AM

Obama’s health care plan will destroy White Castle a family owned private business that’s been around for almost 100 years.

The depression couldn’t kill it. World War 2 couldn’t kill it. Communism couldn’t kill it, the energy crisis couldn’t kill it and they survived the Carter years.

But the health care “reform” law will kill it.

What more do you need to know?

Skywise on July 5, 2010 at 11:42 AM

For some reason, I’m picturing white coated doctors standing outside a bank with “not economically viable” signs a la Falling Down.

ElectricPhase on July 5, 2010 at 11:43 AM

Hey Docs, don’t biatch to me, talk to AMA.

Caper29 on July 5, 2010 at 11:44 AM

ObamaCare wasn’t designed to succeed. It was designed to fail. That way the Democrats could move on to ‘single-payer’. Which is what they wanted in the first place.

GarandFan on July 5, 2010 at 11:44 AM

The white jack means that down deep she supports Obama on this issue. /

CWforFreedom on July 5, 2010 at 11:45 AM

Our former family doctor, an excellent physician, foresaw what was coming here, so he and another physician joined an outfit called MD-VIP, which essentially charges patients a flat fee of $1500 a year just to be a patient under their care!

Good for them, but this would be illegal in the future. Every doctor would do it.

Marcus on July 5, 2010 at 11:46 AM

Hopefully people will wise up and realize healthcare coverage and actuall healthcare are two totally different things when the government enters the picture.

tommyboy on July 5, 2010 at 11:47 AM

Screw every one of these doctors.

The AMA was pushing this every step of the way.

tetriskid on July 5, 2010 at 11:50 AM

Cuban medical system coming to a storefront clinic near your home. You won’t have to walk as far for medical treatment.

Skandia Recluse on July 5, 2010 at 11:51 AM

So how long until they make it illegal for doctors to refuse to see medicade/medicare patients and/or to change professions.
chemman on July 5, 2010 at 11:38 AM

Soon enough, I can only imagine the shape of that particular legislation which will of course be authored by the likes of Fruitbat Waxman.

Bishop on July 5, 2010 at 11:53 AM

Screw every one of these doctors.

The AMA was pushing this every step of the way.

tetriskid on July 5, 2010 at 11:50 AM

The AMA only represents about 20% of all doctors…

The other 80% aren’t members nor are they big fans.

Tim Zank on July 5, 2010 at 11:57 AM

Yeah.. but I bet she got rich cutting off peoples feet unnecessarily. POWER TO THE PEOPLE!!!

lm10001 on July 5, 2010 at 11:57 AM

Bottom line is that cannot make a service provided by a person into a “right” for others to have. That is what we call slavery, no matter what kind of pretty words one wants to apply to it.

It’s still slavery.

ButterflyDragon on July 5, 2010 at 11:58 AM

Screw every one of these doctors.

The AMA was pushing this every step of the way.

tetriskid on July 5, 2010 at 11:50 AM

Only because of the doc fix.

ButterflyDragon on July 5, 2010 at 12:00 PM

Screw every one of these doctors.

The AMA was pushing this every step of the way.

tetriskid on July 5, 2010 at 11:50 AM

Only because of the doc fix.

ButterflyDragon on July 5, 2010 at 12:00 PM

The AMA was long ago taken over by leftists. They do not represent the majority of physicians. This has been posted MANY times in the past here. The AMA leadership is interested in their leftist agenda and political access, “doc fix” not so much.

Aviator on July 5, 2010 at 12:04 PM

Our former internist also joined MD-VIP and now charges $1500 per year per patient just for the privilege of being seen in her practice. She says she did this because of the cost of overhead…she says it amounts to more than $900,000 per year and the paltry reimbursements from Medicare/MedicAid (and eventually ObamaCare) can’t cover her costs, let alone make a good living after all it took to become an MD.

We, however, see this as a way to reduce the size of the practice (essentially a self-select filter) that allows her to continue to make a very good living on the backs of wealthy and/or desperate people.

My husband described all this to our excellent dentist who said that this MD-VIP thing has been brought to the attention of our state legislature, and that there are efforts afoot to look into opposing this practice in some way. It kind of flies in the face of the idea of letting private businesses do what they want, but it all gets confusing when you add ObamaCare to the mix.

We think its going to be like eating a crap sandwich: no matter how you try to take a bite, its going to be unpleasant.

LEBA on July 5, 2010 at 12:04 PM

ObamaCare wasn’t designed to succeed. It was designed to fail. That way the Democrats could move on to ’single-payer’. Which is what they wanted in the first place.

GarandFan on July 5, 2010 at 11:44 AM

Actually ObamaCare is succeeding. It was designed to re-shuffle the medical industry by causing companies to reduce their overhead and cost. Just like in this story, she had to move to a cheaper building. Next will be lower wages and less advanced, used medical equipment since the new tax on these devices makes it cost prohibitive for new equipment. Insurance companies will have to merge while others fold.
Single payer was too big of a change if done overnight. But with ObamaCare, erosion of the industry is slow and the public awareness of a this will increase. Only Big Government will be able to fix this problem the Big Government created. But by that time, no one will remember.

Electrongod on July 5, 2010 at 12:05 PM

She’s clearly just another toe wrangler trying to prevent the advent of a truly just society.

trubble on July 5, 2010 at 12:05 PM

It’s time to Joe-the-Plumberize Dr. Boone. That’ll teach her mouth off.

The Reasonable Man on July 5, 2010 at 12:09 PM

<blockquote

Screw every one of these doctors.

The AMA was pushing this every step of the way.

The majority of doctors will have nothing to do with the AMA

I am not a racist on July 5, 2010 at 12:11 PM

ARE WE BETTER OFF NOW THAN 19 MONTHS AGO?

NOPE.

VOTE ACCORDINGLY.

reliapundit on July 5, 2010 at 12:13 PM

Electrongod on July 5, 2010 at 12:05 PM

I agree. The sad fact is that undoing this legislation will be impossible. Yea, we can fight the good fight, but hang it up, folks. The liberals are going to get what they wished for, watch the country tank and realize they were wrong. Those who are strong enough to survive are going to have to push up through the ashes and try to salvage the country about 40 years from now. I am going to drink a beer on my back porch, shoot some squirrels and salute times gone by.

catlady on July 5, 2010 at 12:13 PM

LEBA on July 5, 2010 at 12:04 PM

If you want to “make a very good living” you do not go into medicine. Over the length of a career someone with a MBA from a top flight school will make more than a physician with a lot less sacrifice.
Medicare and Medicare, in general, COST a physician money. In the past the revenue from other payers (i.e. insurance companies) allowed the physician to see the money losing patients. Once Obamacare is in place there will be a much lower percentage (eventually zero) other payers.
No business can continue to exist if their expenses exceed their revenue – economics 101.

Aviator on July 5, 2010 at 12:15 PM

Oh, and as has been said many many times here before – most docs HATE the AMA, and feel betrayed by it. So don’t go blaming them. They are seeing years and years of hard work go down the drain….

catlady on July 5, 2010 at 12:15 PM

Simple; when someone else pays the bill the demand is unlimited. Wish I could get some affordable 5-star hotel insurance!

I am not a racist on July 5, 2010 at 12:15 PM

Aviator on July 5, 2010 at 12:15 PM

Very true statement.

catlady on July 5, 2010 at 12:16 PM

Can’t wait to see what kind of service docs will give when they are “required” to, ala involuntary servitude. God help members of Congress when they go in for treatment under that scenario.

catlady on July 5, 2010 at 12:18 PM

Can’t wait to see what kind of service docs will give when they are “required” to, ala involuntary servitude. God help members of Congress when they go in for treatment under that scenario.

catlady on July 5, 2010 at 12:18 PM

They have no intention of receiving the same care as the proles.

Aviator on July 5, 2010 at 12:20 PM

The answer is quite simple. Make getting sick or hurt illegal.

jukin on July 5, 2010 at 12:24 PM

Good stuff, Ed. Reposted at uncoverage.net

GoldenEagle4444 on July 5, 2010 at 12:25 PM

so why did the Democrats expand the former instead of expanding the latter?

ObamaCare wasn’t designed to succeed. It was designed to fail. That way the Democrats could move on to ’single-payer’. Which is what they wanted in the first place.

GarandFan on July 5, 2010 at 11:44 AM

I’m afraid you’re right.

cartooner on July 5, 2010 at 12:25 PM

From the writings of Leonard Peikoff in 1962 from Ayn Rand’s signature publication from which she posited her philosophy The Objectivist.

In a free society, a man cannot force his terms on others; those who dissent are free to deal elsewhere. A patient who disapproves of a doctor’s methods of treatment can seek out another doctor; a doctor who considers a patient’s demands irrational is not compelled to give in to them. And, in the long run, it is the best and ablest doctors—those who achieve the cures and demonstrate their value—that rise to the top and set the example for the rest of the profession.
“But when the government sets the terms, they are enforced by the police power of the State. The standards of the government become the laws of the country, and no others are legally permitted. Should any doctor object to the decrees of the officials who staff the State Health Board—should he attempt to act on his own best judgment and make an unauthorized use of the drugs, the hospital beds, the operating rooms being paid for by the State—he becomes thereby a criminal, and he is legally subject to retribution: to loss of license, or fine, or jail-sentence. There is no one to whom he can turn: the government is his sole employer. He either submits—or he leaves medicine—or he escapes from the country
.”

The above article was of course expounding on her seminal work from this bit in 1957 from Atlas Shrugged:

“I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward.
“I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything—except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards—never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind—yet what is it that they expect to depend on, when they lie on an operating table under my hands?

“Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn’t.”

In Atlas the end results of Obamanable Governmental intereference did not end prettily, nor will it for us!

Archimedes on July 5, 2010 at 12:26 PM

Doctors will stop taking insurance, all insurance, and demand cash on the barrel. In addition will come a non-malpractice waiver and any treatments will require the patient sign off on them while fully accepting all risks for any treatment or procedure.

Medical costs will drop, medical tests will subside, patients will be faced with their pocketbook and start looking to get catastrophic coverage from a neutral insurer, lawsuits will go down as breaking a non-suit contract is a breech of contract that gets its own suit immediately, patients will be faced with their own sign-offs on what happens to them so they THINK about their health and don’t expect others to take care of them.

Net effect will be more doctor time with patients, lower staff for doctor’s offices, lowered record keeping for doctor’s offices, patient involvement in their care by default with the patient being the prime mover of their care as they stop taking just the word of one physician and seek advice for complex problems.

The poor will benefit as doctors free up time for pro-bono work and can even get some outreach hours to poor patients in, and provide not only care but payment plans for those that can pay back over a period of time. The destitute will see an uptick in charitable giving as funds drain out of the medical insurance system and back into the hands of patients.

By squeezing so hard to break the system, the system will morph to re-route around the external damage inflicted upon it. That will be the end of the comfy, high cost, care-free system we currently have… and put the power of treatment back into the hands of patients, first, and get rid of the middlemen of insurance companies and governments. That is called disintermediation and it works just fine when let go to run its course.

ajacksonian on July 5, 2010 at 12:28 PM

As mentioned above several times Obamacare is NOT supposed to work out for the good of the people. It was designed from the start to bankrupt the American heathcare model and put us on a single payer road. Why do people continue to whine about the individual misery that exists for pros and patients alike. No one in the Demoratic Congress cares one whit about your complaint because like weight loss diets everyone complains in the begining. The only difference is that we will not lose weight but our access to health care. Contrary to the comment above that we are stuck with piece of excrement we can do something this November. Make your Rep/Sen agree to repeal Obamacare or else! Make them sign a pledge that if the opportunity comes up that they MUST vote to repeal Obamacare.

inspectorudy on July 5, 2010 at 12:37 PM

So how long until they make it illegal for doctors to refuse to see medicade/medicare patients ?

Attorney General Eric Holder’s Justice Department has used the Antitrust Division’s civil and criminal prosecution powers to force orthopedists to accept government reimbursement rates for their services. Accepting anything other than the government rate is considered a criminal conspiracy against market pricing.”

That is how the will force doctors to accept medicare and medicaid. My doc gets paid only $19 per visit for medicaid and about $42 for medicare. Hard to pay for office space, staff and supplies with that little, let alone make a profit.

MidWestFarmer on July 5, 2010 at 1:07 PM

I had acupuncture on a cruise ship! It worked great and I had time to do it while cruising. Whats to stop good doctors from setting up a hospital ship and treating patients for cash?

Maybe get their charter from the Bahamas where my Senator Harkin lives. I’d pay I don’t go often anyway most people who go to doctors die!

dhunter on July 5, 2010 at 1:08 PM

ajacksonian on July 5, 2010 at 12:28 PM

Sounds great, but I see government intervention before we get to that place you described. I see docs being forced to take a certain percentage medicare, or being forced to operate at a certain salary level, with the penalty being loss of their license/ability to practice at all.

I see millions of ignorant slothful sheeples bleating about the long lines at drs offices and the importation of thousands of substandard foreign doctors, while the med schools here make the students sign some kind of legal document that they will HAVE to serve to the state. AND I see regulation of what we eat, drink, etc with the ruling class having exemptions, or at least having the enforcement agencies turn a blind eye if you are a Senator’s son.

Going back to my porch to have another beer and shoot more squirrels.

catlady on July 5, 2010 at 1:14 PM

Well if ones real goal is to abolish medical free enterprise which I believe it is, than Obamacare will be an overwhelming success, and if the quality of medical care goes in the sewer, who in the Democrat party cares?

docdave on July 5, 2010 at 1:25 PM

catlady on July 5, 2010 at 1:14 PM
How many squirrels do you have?
Keep a sharp eye those shootin skills may come in handy some day!
Aim small hit small!

dhunter on July 5, 2010 at 1:27 PM

A little off subjet but last week ALLA posted a poll from Rasmussen were the number that wanted to repeal Obama care had fallen to 52%.I said then not to worry because the numbers in favor of Obama care had not gone up much at all.Well today new Rasmussen poll back up to 60% that want to repeal it.

thmcbb on July 5, 2010 at 1:37 PM

Screw every one of these doctors.

The AMA was pushing this every step of the way.

tetriskid on July 5, 2010 at 11:50 AM

Only because of the doc fix.

ButterflyDragon on July 5, 2010 at 12:00 PM

The AMA was long ago taken over by leftists. They do not represent the majority of physicians. This has been posted MANY times in the past here. The AMA leadership is interested in their leftist agenda and political access, “doc fix” not so much.

Aviator on July 5, 2010 at 12:04 PM

There is also a little something called the CPT codes which I believe the AMA owns and publishes for sale to doctors, insurance companies, hospitals and which allow the entire system of billing to function. They have a monetary interest in perpetuating a byzantine system to which they own the key, completely apart from the interests of doctors.

txmomof6 on July 5, 2010 at 2:05 PM

Medical care will slowly but surely become a clinic-delivered system, just like the public health care systems currently in use in most big cities. You will likely see a mid-level (PA or NP) for most care and MDs only when your care becomes complicated. Your MD will have his/her med school paid for by your tax dollars because eventually no one will be willing to fork over $200K and spend 12 years in school to work in a job that will likely command less than $100K.

The minority of Americans that favors Obamacare either think that they will get out of the clinic system they are currently stuck in and get to see a “real” MD for “free” or think that the private care they receive now will just continue without change except for the cost. Both groups are delusional.

inmypajamas on July 5, 2010 at 2:12 PM

Like Mark Levin says: when you speak to democrats, you’re talking to a bunch of economic illiterates. Especially when you’re dealing with Obama. I can’t come to any other conclusion but the one that says liberals must have their brains completely miswired. You say “black”, and they swear in court you said “white”. You tell the truth, they’re compelled to lie. They just can’t seem to be able to help themselves. What they’ve done in passing this liberty-killing monstrosity; they couldn’t possibly have believed this was good for the country, in any way, shape or form. It’s just not possible for any sane, mentally healthy person to come to that conclusion. Absolutely unreal. As much as it would hurt, doctors and other business owners have no choice, at this point, in this country, but to go Galt. I’m sure the government will try enacting legislation to force them to work, and to try nationalizing their businesses, but we all know how well that would work. Somebody’s got to cry “uncle”, and it can’t be us.

Virus-X on July 5, 2010 at 2:57 PM

As much as it would hurt, doctors and other business owners have no choice, at this point, in this country, but to go Galt.

Unfortunately, this won’t work in reality. Most doctors aren’t businessmen. They want to help heal people. If confronted with a dying child whose parents can’t pay, they will try to save the child for free. That is why they will go out of business or be forced to become indentured laborers.

txmomof6 on July 5, 2010 at 3:36 PM

Yeah.. but I bet she got rich cutting off peoples feet unnecessarily. POWER TO THE PEOPLE!!!

lm10001 on July 5, 2010 at 11:57 AM

Not feet.
She’s a urologist.
Think higher north.

justltl on July 5, 2010 at 3:49 PM

So docs will not be able to afford to be in private practice.

The vast majority of docs will work as salaried employees for hospitals.

There you go, comrades. Problem solved.

justltl on July 5, 2010 at 4:10 PM

Don’t be such rubes.

ObamaCare was never meant to rescue the health system, it was meant to collapse it.

It is working exactly as planned.

Labamigo on July 5, 2010 at 4:24 PM

ObamaCare was never meant to rescue the health system, it was meant to collapse it.

It is working exactly as planned.

Labamigo on July 5, 2010 at 4:24 PM

Exactly. Democrats cares so little what went into their bill as in the long term it is specifically intended to fail. When it does, the left will collectively proclaim–in what may prove the single most cynical move in the history of American politics–that “We gave the free market a second chance, and it let us down! The only choice left to us is single payer!” And then the death and suffering can begin in earnest.

Blacklake on July 5, 2010 at 4:57 PM

Does that cut costs within the system when Medicaid patients are the most likely to overutilize emergency rooms, thanks to the perverse economic outcomes Medicaid creates when clinic providers won’t see them thanks to low reimbursement rates?

Just like with the banking crisis spawned by Fannie Mae and Freddie Mac’s involvement in the subprime mortgage lending fiasco, the federal government’s involvement in manipulating the health care system via Medicare and Medicaid will cause a European-style crisis when the system overloads.

Our problem continues to be an elitist class here in America that is convinced that all these socialistic programs have failed in other countries because they didn’t have the right people with the right credentials running them. What arrogance!

But they currently inhabit positions of great influence and power, and seem to be unstoppable. That’s why this November’s elections are so vitally important. Unseating these elitists at the federal government level will be a huge first step in reversing the destructive trend they’ve had us on for decades.

KendraWilder on July 5, 2010 at 5:47 PM

SHE STOLE MY TONSILS!

Oh wait, that was the doctor from India. Nevermind.

boomer on July 5, 2010 at 8:55 PM

The truly sad thing about this Morrissey, is we all know that if you were looking at the ‘work’ that she had done, you’d be complaining that it was unnecessary.
In any other circumstance you would decry the rip off of the American tax payer by the government.

Observation on July 5, 2010 at 9:45 PM

Well, all of the liberal/progressive twits have been raving about the quality of Cuban healthcare for decades, and now, we’ll all get to experience the joys.

Thanks Obama! ///

NavyspyII on July 6, 2010 at 7:27 AM