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The Risks and Perils of Obamacare
Paid for by the above named doctors, Dr. Farid Naffah,
Warren, Ohio 44484
Many of those who cheered in March 2010, when the Affordable Care
Act was signed into law, continue to be
bamboozled by its promise. As details of the plan have emerged, however,
a large number of people have changed their minds, realizing that what was pledged is an administrative and fiscal
disaster, bringing higher health care costs, a severe physician shortage, and
the rationing of medical services. In brief, a recipe for mediocrity. If
all you know about Obamacare is that it will provide insurance to 32 million
Americans who don’t have it; that patients with pre-existing conditions may not
be excluded from coverage; that certain screening procedures are offered
without co-payments, and that children may remain on their parents’ plan until
the age of twenty-six, you would have no reason to fear or oppose it.
Sadly, that is exactly where the Obama White House wants you to be: in sheer
ignorance of the innumerable provisions that make up the2,700 pages of the law.
A law that directs you to providers you may not choose or even like, that
forces you to pay more for the services you receive and that decides what level
of care is suitable for you. Most disturbingly, it is a law that subjugates your doctors’ judgment-and their
livelihood-to bureaucratic authority. Those whom you have come to regard as the
guardians of your health will have other motives than to preserve or improve it. If the Affordable Care Act is not
socialized medicine it will of necessity lead to it, by the exercise
of regulatory mechanisms and fiscal pressure. Medicine will
no longer be a liberal profession, but a government job, where your physician’s
desire to excel in the delivery of care will
cede its place to the fulfillment of government imposed
requirements, the adherence to imperious rules and the fear of retribution. In a first phase, Obamacare
eliminates private physicians and consolidates the practice
of medicine around hospital institutions. President Obama
once promised “If you like your doctor, you can keep him.” What he omitted
to mention is that, sooner or later, your doctor will go out of business. The
Affordable Care Act prohibits physicians from owning hospitals and
implements measures to cripple and bankrupt their practices. Drastic cuts in
reimbursement and a slew of new regulations have already led to the closing
of many free-standing facilities or their acquisition by neighboring
hospitals. Regulations have escalated to the point that full compliance has
become virtually impossible. Physicians’ offices are raided on a massive scale
and systematically audited to recover monies allegedly
paid in wrongful billing. Impropriety is quickly adjudicated and called
fraud to justify the huge fines which are then imposed. The intimidation and
the resulting financial strain often lead physicians to close their practices.
Auditors entreated with that task are compensated with a generous portion of
the fines they collect, leaving little doubt as to their incentives. This
is absurd in any free society but many physicians capitulate, in fear of
retaliation. Those who contest the ruling do so at their own expense and, when
victorious, can only hope to recover the fines they paid. That state of
affairs, buttressed by media sensationalism and its unrelenting attack on the
medical profession, unfortunately lends credence to the notion that physicians
are somehow responsible for Medicare’s fiscal insolvency, a ridiculous notion,
but one that furthers the Obama administration’s agenda to strip them
of practice ownership and make them employees. Many have already resigned
themselves to the new fiscal reality and hasten to avert the inevitable
collapse. As they quietly surrender their practices for a hospital job, often in
bitterness and depression, they put a pragmatic face on their decision. They
soon find themselves trapped into roles they never wanted or felt prepared to
assume. They become demoralized, sometimes rancorous, as they enter
a world ruled by bureaucrats who, generally, don’t have a fraction of
their education, their training or their experience. Yet, a hospital CEO
typically earns north of a million dollars, sometimes several million. Other administrators are also
generously remunerated but an internist can only hope for a$150,000
annual salary. Medical education and
training is an arduous and lengthy process, requiring anywhere between
seven and thirteen years after college, and its cost is exorbitant. Few
students faced with the prospect of a career under Obamacare will sacrifice
their youth to study medicine, while incurring a greater than $200,000 debt.
First year earnings are often higher for MBA and law school graduates than for primary care physicians, with
four or five fewer years committed to the study of their discipline, and
their quality of life is certainly more appealing. They don’t work evenings,
weekends or holidays, and rarely, if ever, do they have to face a lawsuit.
It should therefore come as no surprise that, according to a recent survey,
nine out of ten physicians currently dissuade their children from pursuing a
career in medicine. The desirability of a medical career is nowhere better
reflected than in the plummeting number of applications to medical school
during the last generation. The quality of medical education will undoubtedly
decline and the AAMC (Association of American Medical Colleges) predicts that
by the year 2025, there will be a physician shortage of 160,000. What that
means is that nearly one of five people will have insurance coverage but
no access to health care. The reality is probably even bleaker, as
disillusioned physicians, by then all employees, will have cut their hours,
become less efficient and less productive, lost their desire for excellence and
taken early retirement. When health care is not accessible, many will
have to go without it, suffer or die. When physicians cannot be found in their
offices and a growing population who demands care cannot be served, emergency
rooms will be flooded, crowding out the critically ill, and lines will format
their doors. Those who were around in the late1970s will remember with
bitter nostalgia the long lines that formed at gas stations during the Carter years. What happens when a
physician’s practice is acquired by a hospital is that the cost
of healthcare soars. So much so that you will quickly long for the days when a mammogram and a screening
colonoscopy entailed a small co-payment. Hospitals are compensated by Medicare
and private insurers at rates far higher then the modest payments made to private physicians. For example, a
routine visit which runs seventy dollars at your private doctor’s office will
cost over $120.00 when that office becomes part of the hospital outpatient department. An echocardiogram, which costs
$373.00 in a cardiologist’s office may bring in $1,600.00 when that office
enjoys the hospital outpatient designation. A colonoscopy, reimbursed at a flat
facility fee of $350 in an ambulatory center, easily reaches three times
that amount when charges are itemized under the hospital label. In today’s
economic reality, most patients with private insurance have large deductibles,
ranging from $2,000 to $5,000 dollars. The increased cost burden incurred by
hospital billing becomes the patient’s responsibility until the deductible is
met and, even after that, co-payments
remain considerably higher. Insurance premiums will therefore continue
to rise, to accommodate the higher charges, and will set the stage for
rationing. There just isn’t enough money to
go around. Yet even so, Obamacare will continue forcing physicians out
of their practices, by pressuring them to join accountable care organizations
(ACO), and that will effectively dismantle the patient-physician relationship.
The ACO is a new government-imposed structure, a group of physicians,
in charge of delivering care to a certain population of patients. Its stated
goal is to improve quality, by the fulfillment of preset criteria, and cut
cost, by coordinating care amongst physicians and eliminating waste. ACO’s indeed
have a financial incentive in cutting cost as they retain a
portion of the savings they realize. Accordingly, physicians will find
themselves in the uncomfortable position of denying care in the name of
fiscal responsibility. Their obligation to their patients may be compromised by
their loyalty to the group and the pressure
to save may overtake the commitment to
heal. Inferior care will rear its ugly head and frown upon
unwilling partners in this new pact of negotiable morality. We will thus have established a new
standard, one that the government will hail as thoughtful and well
proportioned, that hospital administrators will label as coordinated and aptly
delivered, and that regulators and accreditation agencies will honor as
compliant. Regardless, the rest of us will recognize the new standard for what it really is: medical
mediocrity. Contrary to what its name suggests, the Patient Protection
and Affordable HealthCare Act neither protects patients nor is affordable. It
only protects a new mammoth bureaucracy created to enforce the law by pilfering
precious healthcare dollars. Innumerable agencies
and boards will rise to administer those changes, i.e. provide
insurance coverage to residents of each state, including illegal immigrants,
and no fewer than16, 500 new IRS agents will be hired to monitor abidance by
the law. Hundreds of billions of taxpayer dollars will be seized from
the Medicare fund and squandered to support the new bureaucracy, seriously
imperiling the treatment of seniors. And if that were not enough, the law
imposes scores of new taxes and tariffs on individuals and businesses, most of
which will hit the middle class.
Furthermore, patients are far from protected. In fact, their rights
are trampled upon as new paradigms are applied to the management
of their health and they are forced to pay for services they
find morally reprehensible. Supporters of the bill, including our
congressional representatives, were dangerously misinformed about its contents
and its devastating effects. The president and his allies preached that
universal coverage was a moral issue but were careful to avoid discussion
regarding the methods they would use to achieve it and the bleak future those
methods portend on the quality of care, not to mention the economy. They wanted
you to believe that just because the idea was good, the bill was sound. We
would like to remind those fervent believers that support of the Arab Spring also
seemed honorable and lofty but its execution proved foolish and calamitous.
Those naive enough to trust the unfailing wisdom of government surely
remember that sub-prime lending allowed many to achieve the American dream
but led to the largest financial crisis in recent history. Misplaced
generosity ushered the way to collective insolvency. Not only did the
beneficiaries pay dearly but society went down with them. The plan was
ill-conceived, its prosecution bungled. Similarly, not only will the health
care law fail to bring good medicine to the newly insured, it will deprive
everyone else of the quality care they have so far enjoyed. “If what Romney and
Ryan say about Medicare is true, how come our plan is endorsed by the
AMA (American Medical Association), the ‘national’ American Hospital
Association and, most importantly, the AARP (Association of American
Retired Persons)”, challenged Vice-President Biden in a recent campaign speech in Fort Myers, to an innocent and cheering group
of supporters. Were they to infer that those organizations, perhaps
by virtue of their names, are somehow the defenders of our rights, the
guarantors of our morality? AARP is in the business of selling insurance and
expects large profits from Obamacare’s
onslaught on Medicare Advantage plans. Hospitals, the big winners in the
Health Care Act, will see their coffers swell as doctors become their employees
and patients pay more for services. Even catholic hospitals have
embraced the law, while the Catholic Church issuing the federal government over
it. As to the American Medical Association, far from
representing physicians, with fewer than 17%holding membership, it survives on government
funds. Mr. Vice-President, we are not stupid. In her address at the
Democratic National Convention, Health and Human Services Secretary Sibelius
declared that, for Democrats, Obamacare was a “badge of honor”. But if it is so
wonderful, why have so many companies and organizations been
exempted from it? Secretory Sibelius’ words betray her true
sentiments, for the passage of the Affordable Care Act was purely a
political victory, achieved solely by one party, without a single vote on the
other side of the aisle. Such a political
victory was hardly a way to bring the country together. It is fiscally
catastrophic, the ruin of Medicare as we know it and, what is worse, the
harbinger of the most dreaded consequence in a country where healthcare has
been the envy of the world: medical
mediocrity. Last year, Ohioans voted by a two-third majority to opt out
of Obamacare. Today, that majority would be even greater. By 2015, when the law
is fully implemented, ACOs have burgeoned
around the country, to which patients are assigned without their
knowledge, the IPAB(Independent Payment Advisory Board) is rendering decisions
on the care to which you are entitled, and doctors are totally demoralized, few
if any, will want the law upheld. The law must be repealed. Unfortunately, that
will be impossible if President
Obama is elected to a second term.
DR. AMINE ABDUL-AALDR. MARISHA AGANADR. HOWARD AMESDR. BAHAA
AWADALLADR. AMY AWAIDADR. RONY AWAIDADR. JEAN CAIRNSDR. FERNANDO G. CHAVESDR.
CHRISTOPHER C.CHUIRAZZIDR. MICHAEL T. CILETTIDR. LAWRENCE D’AMICODR. ERNEST
DEPASQUALEDR. DAVID J. DUNCHDR. PAUL D. GATEWOODDR. SHARON GEORGEDR. PAUL N.
GOULDDR. STEPHEN E. HELMSDR. ROBERT G. HELWIGDR. WILLIAM J. HELWIGDR. LORI
HEMROCKDR. RONALD N. KHOURYDR. JAMES H. KONDOLIOSDR. DESAI G. KRISHNARAODR. KAPIL
KWATRADR. RICHARD J. LOGESDR. MAZEN MAHJOUBDR. HEBA MIKHAILDR. PAUL
MUSSELMANDR. FADI NADDOURDR. FARID NAFFAHDR. ROBERT NAPLES, SR.DR. PATRICK
PATCHENDR. JAMES E. PORTDR. JOSEPH POTOCKIDR. MORRIS PULLIAMDR. ROBERT
REDLICHDR. RAMONA SHETHDR. SANJAY SHETHDR. JEFFREY B. SUTTONDR. JOHN D.VANCEDR.
FRANK VERESDR. ZACHARY VERES
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