When President Obama gave an impassioned defense of Obamacare last week in advance of this November’s open enrollment period, he bragged about the uninsured rate being the lowest in American history.
But though he acknowledged problems such as affordability, which are driving huge annual premium increases on the Obamacare exchanges, he didn’t say one word about a key unhappy group: doctors.
For good reason. The latest Great American Physician Survey surveyed more than 1,000 doctors and found that “because of continuing economic and regulatory pressures, 72%” “found the profession more stressful and less lucrative than in previous years, and a strong majority said they are concerned about the direction that health care is headed.”
I am among that 72%, and as Democrats urge repairs to the law and Republicans use the bad news to again make the case for repealing and replacing it, it’s critical that America understands the sources of physicians’ simmering discontent.
Doctors like me look at health insurance very differently than Obama does. To us, insurance often presents a cumbersome roadblock to actual health care.
When a patient comes to me smiling with their new Obamacare coverage, it is difficult for me to smile back. That’s because I immediately envision a test or a referral that may not be covered by their plan or an essential service they will have to reluctantly pay for out of pocket because of their deductible.
No one bothered to ask doctors our opinion before passing Obamacare back in 2010. We knew it would flood the system with low-paying insurance. We were already overwhelmed with transitioning to time-consuming, mandatory electronic health records, due to a law passed in 2009.
Obamacare added insult to injury by expanding Medicaid (which close to 30% of doctors don’t accept, because the reimbursement rates are too low), and introducing a highly restricted, high-deductible type of insurance that utilizes a narrow network of doctors.
I have the option of not accepting Obamacare plans myself, but have always seen my role as a physician as accepting all comers — though this is becoming more and more difficult.
So, no doctors are surprised when premiums jump while insurers (UnitedHealthcare, Blue Cross, WellCare and others) examine their bottom lines and pull out of many states. None of us blink when millions of smart younger patients with few medical problems pay the tax penalty rather than jump into the health coverage pool. Doctors know that young, healthy patients don’t want to see us unless they require a work or school physical.
We doctors are also not surprised by Hillary Clinton’s plan to essentially double down on Obamacare by offering a public option if she wins.
On the front lines, expanding Medicare to younger patients or adding a public option to the state exchanges translates to doctors having more patients with highly regulated insurance that doesn’t pay us very well. Sweetening the pie with efficiency and quality reward incentives is shortsighted, too.
What if the patient doesn’t do well and has to go to the hospital? Should doctors lose payments because a patient dies despite our best effort to save him? Increasing subsidies or giving every family $5,000 to play ball with Obamacare, as Clinton proposes, also increases the tax burden without ensuring quality or access.
The solution is more choice, not less. Introducing more competition by making insurance portable across state lines while expanding tax-deductible health savings accounts would help drive down costs. If my patient pays more out of pocket, she will come to see me only when she really needs to.
If the first three sick visits a year are covered by Obamacare, as Clinton proposes, my patients will use these visits up quickly, often unnecessarily.
Don’t get me wrong: Health care is crucial to protecting society, especially because doctors can cut down dramatically on the spread of disease by screening, vaccinating and treating.
But if the government deems itself responsible for providing care to the have-nots, a noble goal, it should build more clinics and hire the doctors and nurses directly to staff them.
Expanding Obamacare would also create a disincentive for employers to continue to pay for health coverage for their employees, the backbone of the health care system since the Eisenhower years. Such plans still cover more than half of those insured, pay doctors better than Obamacare policies and offer patients more choices.
I wish that lawmakers, Presidents, presidential candidates and insurance company CEOs could spend a day with me in my office, seeing and experiencing the realities of health care in the medical trenches. Then again, I no longer have the time to show them around.
Siegel is an internist practicing in Manhattan.