While the specifics of President Obamaâ€™s health care plan are still being hashed out, doctors are already getting nervous. The fear? The burdens of the new system will be inordinately placed on doctors. Dr. Scott Gottlieb has a good look at the concerns in todayâ€™s Wall Street Journal.
The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it’s open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors’ incomes will decline by as much as 15% to 20% depending on their specialty.
Primary care practices (the frontline of our health care system) already run on tight margins thanks to the costly nature of opening and maintaining a medical practice. Take money out of primary care and you risk lowering quality of care.
Doctors will consolidate into larger practices to spread overhead costs, and they’ll cram more patients into tight schedules to make up in volume what’s lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association.
Additionally, as Gottlieb notes, the best doctors could decide to go cash only or close their practices to any one carrying government insurance. If theyâ€™re good doctors, people will pay the premium. This would mean only the rich and those with generous employers will have access to the nationâ€™s best physicians. The government could react by banning private pay and forcing doctors to take the government plan, but are we willing to strip away that kind of personal choice while deincentivizing a career in medicine?
As Iâ€™ve said before, the goal of health care reform should be to provide better care to more people. Obviously that requires a certain level of affordability and not every sector of the current system can come out a winner. But we need to think very carefully about where we make cuts. If decreasing payments to doctors decreases quality of care, have we made progress or are we just shuffling around the problems? As far as Iâ€™m concerned, we should pay close attention to what doctors have to say about any new plan.