Future Predictions for Healthcare in America

According to the recent Presidential vote, we as a nation do in fact wish to nationalize healthcare.  We do believe that a larger federal government is the answer to our woes and finally, it is ok to ask for more taxes to enable this to go on.

Bottom line prediction:  Under forced labor plans, doctors will leave the Medicare and other Government programs in large numbers. Patient will have government covered healthcare but fewer physicians will be available to care for them. I stated this outcome could be anticipated following PPACA’s implementation and this recent article shows it is already happening. Following the recent Presidential election this position will be more firmly and rapidly actualized.

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I often hear the argument that other “civilized nations” such as Canada and England have socialized medical care and that it is a shame that America doesn’t follow their lead and guarantee healthcare to all people.  Unfortunately, no one is asking, “if these nations provide free care does this mean the most persons are getting good care”? If asked this question, they would see that patients are denied services every day while the system is still paying for their “care”.  I guess if we can say politically we are providing for all we don’t need to ask the next question “are the people really getting care?”   I have argued all along that insuring everyone doesn’t equate to actually providing healthcare.  Saying that a socialized healthcare system is “covering everyone” does not mean that proper healthcare is being delivered.  Perhaps we should ask ourselves, “if the nationalized healthcare model is taking care of everyone, then why is it in these socialized countries, the wealthy go outside of the country or outside of the socialized healthcare system to get their needs met”?  Take a look at the video Sick and Sicker sometime to get a glimpse of what I am referring to.

Before this vote but a couple of years into the PPACA law, we can now document that in the US there is a “silent exodus” of physicians in the workforce.  In the October 22, 2012 edition of AMA News a timely article documents that physician productivity is dropping.  Additionally, there are now less private practice physicians than ever before.  Could this be related to the fact that the nation is moving towards a single payer (Medicare/Medicaid) system which is enabling Hospitals and other large corporation entities (i.e. health insurance companies) to be the sole survivors of a bureaucratic health policy which is staging a coup against its citizens.  In this scenario, the government can claim it is providing insurance (or “healthcare”) to everyone in the country, thus matching the other modern nations of the world”.  Unfortunately this is being done by Executive Order with the congress’ endorsement and the tacit agreement of the Supreme Court. The Supreme Court exists to protect us from such organized infringement on our constitutional rights but it failed in its duty (derelict) to provide this protection.  Now by the results of the presidential vote, the tyranny of the majority will attempt to force its will on the healthcare system.

The AMA article informs us, however that despite the will of the majority to have cheaper/all-inclusive but simultaneously excellent healthcare, physicians are now starting to say “no thank you” to the mandated terms.

According to the article, physicians are frustrated by mounting regulation (the recent CMS report on 2013 fee schedule is over 1300 pages long), declining pay, loss of autonomy and uncertainty about the upcoming reforms. Doctors are cutting back the number of hours they work as well as the number of patients they see.  This is a predictable outcome of any socialized program but now there is documented proof of this reaction. Even the most noble of professions will succumb to human nature and injustice.

In Canada, it is well known that once the physicians (who are salaried) see the required quota of patients, they “leave shop” and inform the waiting line to “queue up” when they return. They return when the terms of their employment require they return (i.e. the next calendar year when their annual quota count restarts). Nice arrangement huh? We can anticipate this same attitude in America going forward.

The AMA article is based upon information provided by a study provided by the doctor-recruiting firm Merritt Hawkins and Associates. They were hired by the Physicians Foundation. The Foundation was born out of money donated by doctors. The doctors offered their winnings from settlement payments derived from class-action suits awarded to 22 state and county associations from health insurance plans (those benevolent 3rd party payers).  The foundation commissioned the firm to evaluate the market as it relates to physician productivity, hiring etc.

Mark Smith, President of Merritt Hawkins is quoted as saying “Physicians are feeling extremely overtaxed, overrun and overburdened”. Only half of doctors will continue their current practice over the next three years. Long hours and lack of personal time are the least satisfying elements of their careers.

Other data shows that there is a growing number of hospital employed physicians. Hospitals are now currently employing 20% of practicing physicians. Many others are in group practices owned by health systems.  Recently (November 8th, 2012) there was a national article quoting Humana Health Insurance as announcing that they are buying physician practices all along the Florida east coast and anticipate more such activity going forward. The article indicates the proportion of physicians in private practice is now a minority.

Now to the issue of productivity; remember PPACA promises 40 some million more health insured customers and more covered preventive services. This can only equate to far more demand. Couple that with the projection of 36% more Medicare eligible patients over the next decade and we can begin to get a glimpse of the demand side of the curve.  According to the survey from Merritt Hawkins and Associates, employed physicians are now the majority of doctors. Another 50% of the doctor workforce anticipate changing their practice to employed status. Employed physicians average 53.1 hours a week compared to 54.1 for private doctors. Despite this minor difference in hours, employed doctors see 17% less patients (18.1 vs. 21.9 per day) than the private employed doctors.  Now with the majority vote essentially guaranteeing to push mandated insurance and lower payment to providers we can expect this trend to accelerate in a major way.  Add the productivity drag of our government mandate of full electronic records for healthcare and we can expect even less doctor availability and less productive work.

The looming doctor shortage is encouraging the use of nurse practitioners, physician assistants and mid-level health professionals to maintain access for these newly promised consumers. The nurse practitioners argue they can fill this gap and not necessarily with physician supervision. The American Academy of Family Physicians finds this position untenable.  Dr. Stream, of the AAFP said a two-tiered system of primary care- physicians for some, nurse practitioners for others-is untenable. “To the people who propose that to fill this gap we should somehow alter our expectations of the kind of care people should get-that is not what we want in this country…  It’s not a viable, ethical or reasonable solution”.  Data shows that Primary Care doctors complete 21,700 hours of education (my math shows this to be equivalent to 10.43 years of 40 hour work weeks)  and training over 11 years compared to 5,350 hours of training and education for Nurse Practitioners over 5-7 years”. Physician assistants, LPN’s and RNs are less trained.

The physician exodus began to occur when Medicare began to actually (at least temporarily) enforce payment reductions based upon arbitrary formulas that came about from legislation starting in the 80’s and 90’s. Since Obama promised from one side of his mouth “ Medicare will not be touched” but then stated from the other side of his mouth, “ I will make PPACA affordable by cutting 750 (or so) billion dollars from Medicare’s budget”, the doctors have seen what is coming and are now saying “no thank you”.  Does the majority think they can force their providers to come to work just because we voted and wish it so?  This data says otherwise and this vote of confidence to “plow ahead” will accelerate the exodus of physicians from productivity and the work force.  How does that guarantee healthcare for all?

Bottom line:  Under forced labor plans, doctors will leave the Medicare and other Government programs in large numbers. Patient will have government covered healthcare but no physicians will be available to care for them. I stated this outcome could be anticipated following PPACA’s implementation and this recent article shows it is already happening. Following the recent Presidential election this position will be more firmly and rapidly actualized.

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