By Bob Unruh
The headlines have been appearing sporadically for months.
“Why is it so hard to find a doctor?” the Boston Globe asked in October. PBS reported six months earlier, “Access to doctors shrinks for some Medicare patients.” And the New York Daily News suggested only two weeks ago it was “Obamacare vs. American doctors.”
But with death panels, millions of policy cancellations, the disastrous failure of the website, Democrats backtracking and other issues, the looming doctor “shortages” Obamacare is causing haven’t received much attention.
They soon will, because not only are doctors going to face huge cuts in their reimbursements for patients under the federally funded Medicare and Medicaid health systems, experts are warning physicians won’t be offering ordinary services to new patients, because the federal bureaucracy is taking control of all rates and payments under Obamacare.
Rep. John Fleming, R-La., said six weeks ago that “half of the primary care doctors [in Massachusetts] are not accepting new patients.”
The comment came in a debate about how much access Americans will have to insurance and physicians under Obamacare.
The online Politifact said Fleming was right on with his assessment.
The 2013 edition of the Massachusetts Medical Society’s “Patient Access to Care” survey – which was based on 1,137 phone interviews with Massachusetts physicians – found that 51 percent of family medicine practitioners in the state were accepting new patients. As Fleming indicated, almost half are not.
The argument has focused on Medicare and Medicaid, which have had strictly regulated reimbursement rates. But with Obamacare kicking in now, the reimbursement rates also are going to be set for many routine services from all physicians.
No problem, said one Democrat.
Just a month ago, a candidate for office in Virginia said that doctors should be forced to accept patients under the Medicare and Medicaid programs.
According to a blogger’s comment on the issue, Kathleen Murphy was blasted for wanting “to make physicians slaves of the state.”
“The Obamacare law and regulations are causing millions of people to lose their health insurance, drop many doctors and hospitals. The HHS internal forecast is 93 million Americans would lose their health insurance due to the Obamacare law and rules about adequacy of insurance,” the report said.
Dr. G. Keith Smith, who founded a surgery center in Oklahoma, said it’s really a stretch to think that the government in any way could solve the problem it is making.
Smith, a board certified anesthesiologist since 1990, cited the Murphy comments in a commentary at the website for the Association of American Physicians and Surgeons.
He suggested the entire premise of Obamacare is built on the idea that health care is a “right” that an individual can demand from society.
So take this scenario, he suggests:
“About two weeks after I quit accepting Medicare, an angry cardiac surgeon, inconvenienced by my departure from the group of available cardiac anesthesiologists, told me that he was going to see to it that I was forced to do these anesthetics, so as not to disrupt his schedule. I guess he thought he had a ‘right’ to my services. I told the surgeon I’d be happy to visit with the family before their loved one’s elective surgery and inform them that I want no part of this, but someone is making me do it. Perhaps they would prefer to wait for an anesthesiologist who was doing the work willingly. The surgeon got it.
“Now imagine angry mobs of folks waving their Obamacare ‘insurance’ cards, demanding their free healthcare outside a closed and vacant doctor’s office. The government cannot change human nature. If government points its guns at the doctors to make them participate, the ‘healthcare’ that is delivered under these conditions will be different from what the mobs expected …. You don’t want to trust your life to someone who has a gun pointed at him.”
It was health insurance industry analyst Merrill Matthews in a commentary in Forbes today who noted that the issue is coming to a head because of the rollout of Obamacare along with the expected 24 percent cut in Medicaid reimbursements coming Jan. 1.
That issue has reared its head repeatedly, and each time Congress has stepped in to fix it by spending more money, he said.
But that can’t continue forever, he said.
The cut comes from the 1997 legislation that established a “sustainable growth rate” for Medicare spending. If Medicare spending grows faster than a predetermined amount, reimbursements for doctors are supposed to be cut the next year.
Previously Congress has waived the requirement and raised the spending.
The result is clear, he said.
“As I pointed out last week, the Centers for Medicare and Medicare Services recently released a document showing that 9,500 doctors who had previously accepted Medicaid patients refused to do so in 2012. In an effort to gain – some might say ‘buy’ – physician support for Obamacare, drafters required Medicaid programs to pay doctors the same rate as Medicare for 2013 and 2014 – and that’s all states, not just the ones expanding Medicare. … Together both programs cover more than 100 million Americans, and the government expects about nine million more people to join Medicaid next year.”
Matthews, of the Institute for Policy Innovation in Dallas, said, “It’s yet another unforeseen consequence of Obamacare, which Democrats thought would be so popular that it would ensure Democratic control of Congress and the White House for years to come.”
Michael Fitzgerald in the Boston Globe said of the issue: “It’s hard to get a doctor. Entire practices are booked. … It takes an average of 39 days for new patients to get an appointment with a family physician and 50 days to see an internist.”
He said the wait could get longer.
“The Association of American Medical Colleges projects that nationwide, 13,700 more doctors of all types were needed than were available in 2010, and the gap will hit 130,600 by 2025, with about half of the shortfall in primary care.”
Fitzgerald said Obamacare’s impact in his state isn’t significant, because the state has its own universal access.
“Only 4 percent of Massachusetts residents remain uninsured,” he said, “and MassHealth and related programs mean far more people can go to doctors. Sort of.”
He pointed out that many doctors are accepting fewer and fewer insurance policies.
In the New York Daily News, Dr. Marc Siegel wrote that the “fundamental flaw” of Obamacare was that it “never considered us.”
“President Obama’s promise that you would get to keep your doctor was propaganda to me from the first time I heard it. Health care doesn’t work this way. How can you keep me as a doctor unless I decide to keep you as my patient? Don’t I have the fundamental right to choose? What happens if your health insurance plan pays me too little and overly restricts the prescriptions I write or the tests I try to order for your benefit?”
In his commentary just days ago, he warned: “And even if you can somehow manage to keep both your doctor and your hospital, you may not be able to keep your expensive lifesaving treatment. Even as medicine itself is moving in a personalized direction of robotic surgeries and cancer vaccines and predisease genetic manipulations, Obamacare is moored in the one-size-fits-all disease model.”
“Those of us who can escape the Obamacare noose will,” he said.