Blog | Thursday, August 9, 2012

Who speaks for doctors about health care reform?


My partner showed me an interesting piece from the Wall Street Journal. In it, Daniel Henninger (a journalist without a twitter account!) argues that doctors have largely been left out of the health care reform debate. His own paper, he complains, has failed to take doctors into account, relying instead on the opinions of CEOs:

"A Wall Street Journal story the day after the Supreme Court ruling examined in detail its impact across the "health sector." The words "doctor," "physician" and "nurse" appeared nowhere in this report. The piece, however, did cite the view of one CEO who runs a chain of hospitals, explaining how they'd deal with the law's expected $155 billion in compensation cuts. "We will make it up in volume," he said."

I have no doubt that he is an experienced journalist and that he properly researched his piece by interviewing a diverse group of physicians. Right?

I appreciate someone speaking up for doctors. We aren't particularly organized and don't have an agreed-upon interest group (a minority of doctors belong to the AMA). But who is this Fox News contributor to tell doctors how we should feel about health care reform?

There is no general agreement among doctors about what Obamacare means for us and our patients. There is broad frustration (I believe) about many of the so-called reforms that began before Obamacare was a twinkle in Barak's eye. Insurers, both private and public, have mandated confusing system of incentives and penalties. And here is where Henninger happens to get it right--sort of:

"We're all pressed for thinking time these days, but the one group we should make sure has time to focus on what's in front of them is doctors treating patients. Instead, they'll also be doing mandated data dumps for far-off panels of experts."

I make the attempt to collect and enter data for at least three completely different "incentive" programs. This sucks away money and more important takes time away from my patients. These systems are superficially designed to improve patient care, to ensure that I am following the most up-to-date guidelines for patient care. But what they really are designed to do is make money. My primary responsibility is to my patients, not to insurance companies, and if I lose money by setting aside paperwork, I can at least sleep better at night. I agree that these data-collection programs as designed are onerous. But Henninger's next assertions are unfounded, inflammatory, ridiculous, and counterfactual:

"This isn't just a fight over insurance companies. It's about the people at the center of health care--doctors. Affordable Care Act will damage that most crucial of all life relationships, that between an ill person and his physician. Barack Obama's assertion that we all can keep our doctors is false. You could line up practicing physicians from here to Boston to explain to Mr. Romney why that is so."

There is nothing stated or implied in the Affordable Care Act that would prevent someone from keeping the doctor they had before implementation. The insurance companies have been forcing the paperwork on us for years. And the people at the center of health care aren't doctors, but those we serve. If ACA helps us to serve more people and serve them better, it will be a success.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.