ObamaCare Is Killing Private Practice Physicians

First ObamaCare had death panels.  Then massive public outrage forced Democrats to abandon the death panels.  Then Obama brought back his death panels by sneaking them in via backdoor regulation in secrecy.  Then the public exploded in anger again.  And now the death panels are gone again.  At least until the next time these dishonest rodents go behind our backs to impose vile policies the people have already loudly rejected.

Then there’s the case of all the waivers.  As of now, 222 businesses have been given waivers from ObamaCare provisions because otherwise they would have to dump their employee health coverage altogether.  Including quite a few unions that pushed for ObamaCare, by the way.

Doctors are still getting shoved into nasty little death panels, however.  Because ObamaCare is murdering them:

12.21.10 | Sandy C. Pipes | MedCitizen
Private practice doctors: Another Obamacare casualty?

While making the case for his health reform package, President Obama argued that his proposal would make life easier for small-business owners.

Unfortunately, Obamacare threatens to undermine a group of small-business owners that is perhaps more important than any other to his reform effort — doctors in private practice.

The number of privately owned medical practices has declined sharply in the past five years. In 2005, at least two-thirds of practices were in private hands. That figure has dropped to less than half today — and is expected to sink below 40 percent by next year.

Many doctors, specifically those who have just completed a resident specialty, are now choosing not to enter private practice in the first place. Instead, they’re heading to salaried positions at large hospitals. Last year, 49 percent of first-year specialists chose hospital employment.

Obamacare will only exacerbate these trends. Some of the law’s dictates will make it more expensive to operate small practices — even though the rules are supposed to reduce medical costs.

Take the new law’s health IT initiative, which pushes doctors to set up extensive electronic health records in hopes of better coordinating care among providers. More information, the law’s boosters argue, means less waste and lower costs.

But many private practices can’t afford to drop five or six figures on expensive health IT systems that may not even save them money.

Boosters of health IT acknowledge that large organizations are more likely to enjoy its benefits. But shoving patients into ever-larger medical groups may not actually bring down costs.

The reason, as representatives of the American Medical Association recently warned, is that big hospital networks have greater market power. They can use that power to keep prices high, and there’s little that insurers — and even less that consumers — can do about it.

Paying more for treatment doesn’t necessarily guarantee better access or quality. Without an ownership stake in their practices, salaried doctors have an incentive to work the hours for which they’re paid — and no more. Fewer hours for doctors means fewer appointments for patients.

History demonstrates that these incentives matter. In the 1990s, several large hospitals bought up practices and put doctors on flat salaries. As Dr. Bill Jessee, CEO of the Medical Group Management Association, observed, doctors suddenly “weren’t working as hard as they were before their practice was acquired.”

Proponents of Obamacare have conveniently ignored these lessons. President Obama’s top health care aide Nancy-Ann DeParle, for instance, wrote in the August issue of the Journal of Internal Medicine that the new law is “likely to lead to the vertical organization of providers and accelerate physician employment by hospitals.” These organizations are called Accountable Care Organizations, or ACOs.

Such vertical integration may prove costly. Already, hospitals lose money on a substantial chunk of the people they see. In New York, for example, hospitals take a loss on more than 70 percent of patients.

That’s mostly because of the stingy reimbursement rates paid by government health programs like Medicare and Medicaid. In 2008, the average Medicare reimbursement in New York represented a 4.7 percent underpayment. Medicaid’s reimbursements were even worse — as little as 64 percent of a hospital’s actual treatment cost. Those with private insurance are forced to pay more for care to make up the difference.

Hospitals’ Medicaid losses are compounded by the fact that the program’s beneficiaries use far more medical services than other patients. On average, the privately insured visit the doctor three and a half times a year. Medicaid patients make an average of seven visits.

Yet Obamacare will add 18 million new individuals to the program’s rolls by the end of the decade — and thus stretch our healthcare infrastructure even thinner.

Primary care physicians are already in short supply. The Center for Workforce Studies predicts that by 2020 there will be a shortage of 45,000 family doctors and 46,000 surgeons. Unfortunately, Obamacare provides no funding to significantly increase their numbers.

Emergency rooms will have to pick up the slack. The new law could result in as many as 41 million additional trips to the emergency room each year.

The health reform law was sold as a way to fill in the cracks in America’s fractured healthcare system. Instead, it has only made them wider.

This is just another example of how Marxist Democrats imposed their utter contempt for the free market system.  Doctors who don’t have their own practices have far less incentive to work hard when they receive the same salary whether they work hard or not.  And at the same time, the Medicaid patients go to the hospital twice as often as people who have insurance because it doesn’t COST them anything to do so.  Contempt like that is only possible for freeloaders who don’t have a stake in anything and don’t have to worry about their premiums going up like the people who pay into the system to keep the whole thing running.

This is why I keep saying that Democrats are either genuinely evil or totally stupid.  And either way they are moral idiots.

This is hardly the only article, and hardly the only issues that explain why ObamaCare is so vile.  I’ve got plenty of articles which detail plenty of reasons why ObamaCare is murder for the doctors whom our entire medical system depends upon:

Medical Pros Needed To Staff ObamaCare Getting Canned Because Of ObamaCare

Medical Doctor Points Out That Doctors Will Be Fined Or Jailed If They Put Patients First Under ObamaCare

ObamaCare Driving Essential Primary Care Physicans Out Of Medicine

Doctor Cassell: ‘If You Voted For Obama, Seek Urologic Care Elsewhere’

ObamaCare Factoid: Access To Health Care Doesn’t Mean Squat When Hospitals, Doctors And Pharmacists Bail

38 States Now Working To Preempt ObamaCare Disaster

Mayo Clinic Realizes ObamaCare A Total Disaster, Stops Accepting Medicare

Harvard Medical School Dean Flunks Democrat Health Bill

Why Won’t Obama Invite The Doctors Who Will Resign If His Health Agenda Passes?

Wall St. Journal Bursts The Obama Bubble: ObamaCare Is All About Rationing

And yes, that IS just for starters.

ObamaCare pledges to push something like 30 million more people into the health care system even as it forces the doctors who ARE the health care system to leave medicine.

How does that NOT sound like a total disaster in the making?

Medical Pros Needed To Staff ObamaCare Getting Canned Because Of ObamaCare

As if ObamaCare wasn’t terrible enough…

Side Effects: Obamacare Accelerates Hospital Job Losses
Posted November 15th, 2010 at 4:00pm

Repeatedly, reports have shown that Obamacare will increase job loss.  But what happens when those who are laid off are the workers meant to enable the health care law’s expanded access of care: namely, hospital employees?

According to one hospital, layoffs of workers have already begun as a result of the new law. Leaders of Memorial Hospital in South Bend, Indiana, said that although “the economy sparked this problem…the Obama Health Care Reform Act gave the hospital a one-two punch. While more people may soon get more health coverage, Obama’s plan cuts reimbursement dollars for hospitals at a time administrators say they could use them most.”

Obamacare includes $575 billion in cuts to Medicare to pay for a Medicaid expansion and a new entitlement program, which will provide generous subsidies for middle-class Americans to buy insurance. The cuts include slashes to hospitals’ reimbursement rates.

Of course, cutting reimbursement rates is bound to have an effect on hospital operations.  Centers for Medicare and Medicaid Services Chief Actuary Richard Foster reports:

“[P]ayment update reductions will create a strong incentive for providers to maximize efficiency, [but] it is doubtful that many will be able to improve their own productivity to the degree achieved by the economy at large.”

“[P]roviders for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and, absent legislative intervention, might end their participation in the program (possibly jeopardizing access to care for beneficiaries). Simulations by the Office of the Actuary suggest that roughly 15 percent of Part A providers would become unprofitable within the 10-year projection period as a result of the productivity adjustments.”

Health providers dropping Medicare patients is the worst case scenario, especially in light of the flood of baby boomers set to retire and join Medicare.  For now, many hospitals are preparing for revenue cuts as best they can. For Memorial Hospital, this means reducing the work force. “We expect that reality to get worse moving forward,”the health facility said.

Obamacare is projected to insure 34 million more Americans by 2019. But by 2015, the nation will face a physician shortage of 63,000 doctors across all specialties, up from 39,600 before the law passed. The last thing the U.S. health care system needs is “reform” that encourages a reduction in its work force.

You Democrats ought to be ashamed of yourselves.  Just ashamed.

This godawful law is going to throw millions more people into the health system even as it forces tens of thousands of doctors to leave the system.  And what do you think is going to happen???

Your evil president and your evil party are going to be responsible for not just deaths, but outright murders by medical neglect.

Democrats ‘Fix’ ObamaCare Numbers By Leaving Out TRILLIONS In Additional Spending

This is Bernie Madoff Accounting. And the same fate that befell Madoff’s investors will one day befall the American people. The Democrats only count the costs they want to count, and simply pretend the rest don’t exist, or assure us that they somehow shouldn’t be counted.  Positive numbers from unrealistic expectations show up on one side of the ledger, while negative numbers representing massive government and personal spending are ignored.

This article will demonstrate the REAL cost of ObamaCare.  And what we will find is that the monster it creates will sneeze chunks bigger than the $940 billion that the CBO score pitches.

It’s not like the CBO isn’t aware that it is being played like a fiddle.  They can only analyze legislation as it is presented – and this legislation is being presented by partisan Democrat ideologues.  The CBO has pointed out that the Democrats have a pattern of double-counting the same dollars.  But they can’t do anything about it: if the Democrats tell them to double-count, they dutifully double-count.  Paul Ryan points out that Medicare cuts are double counted, Social Security taxes get double counted, increased CLASS Act premiums get double counted, to the tune of hundreds of billions of dollars.  Other sources of revenue – such as the not-to-be-implemented “Cadillac Tax” which would itself count for 25% of deficit reduction in the CBO score – will likely NEVER see the light of day. The CBO numbers become a shell game.

You can understand why the Democrats would want to run away from details of the CBO score. If the facts get in the way of their theory, so much the worse for the facts.

Then there’s the likelihood that ObamaCare will destroy as many as 700,000 jobs.  What’s THAT going to cost America?  Would THAT be “deficit neutral”?  And how much will it cost Americans as increased government taxes on private health insurance companies, pharmaceutical companies, and medical device and supply companies, pass the burden of those taxes onto us? Will THAT be “deficit neutral” for American families?

But let’s stay out of the budgetary weeds, and remain on what is clear and straightforward.

Let us first begin with the “Doctor fix,” which is a $208 billion spending measure to restore the reimbursement rates for doctors who treat Medicare patients.  If it isn’t passed, the current rate – which already leaves hospitals and many doctors losing money to treat Medicare patients – would be slashed by an additional 21 percent.  It simply has to be fixed, or doctors and hospitals will quit treating Medicare patients.

But if the Democrats strip that part out of their health care bill, they can claim that 21 percent reduction in doctors’ reimbursements as “savings.”  Even if they intend to fix the reimbursement rate, such that those “saving” never materialize.  And that little bit of fiscal circular reasoning allows them to claim that their bill is “deficit neutral.”

Medicare fix would push health care into the red
Rollback of Medicare cuts to doctors, if added to health care bill, push it into the red
On Friday March 19, 2010, 6:33 pm EDT

WASHINGTON (AP) — Congressional budget scorekeepers say a Medicare fix that Democrats included in earlier versions of their health care bill would push it into the red.

The Congressional Budget Office said Friday that rolling back a programmed cut in Medicare fees to doctors would cost $208 billion over 10 years. If added back to the health care overhaul bill, it would wipe out all the deficit reduction, leaving the legislation $59 billion in the red.

The so-called doc fix was part of the original House bill. Because of its high cost, Democrats decided to pursue it separately. Republicans say the cost should not be ignored. Congress has usually waived the cuts to doctors year by year.

What this basically means is that $940 billion number in the CBO report that the Democrats are cheering over is entirely subjective.  It would have been a lot higher if they had included the stuff they should have included.  And they didn’t include these things simply because it would have made their number look bad.  It’s Alice in Wonderland accounting.

So let’s look at the truth: Democrats are claiming that their “$940 billion bill” would reduce the ten-year deficit by $138 billion.  But in reality, the doctor fix which SHOULD be in the bill would INCREASE THE DEFICIT by $59 billion.  That’s a swing of 197 billion dollars, which is one hell of a swing indeed.

But that certainly isn’t the only budget shenanigan that Democrats have used to monkey the numbers to appear to look like what they want:

For a variety of reasons, this tally doesn’t remotely reflect the bill’s real ten-year costs.  First, it includes 2010 as the initial year.  As most people are well aware, 2010 has now been underway for some time.  Therefore, the CBO would normally count 2011 as the first year of its analysis, just as it counted 2010 as the first year when analyzing the initial House health bill in the middle of 2009.  But under strict instructions from Democratic leaders, and over strong objections from Republicans, the CBO dutifully scored 2010 as the first year of the latest version of Obamacare.  If the clock were started in 2011, the first full year that the bill could possibly be in effect, the CBO says that the bill’s ten-year costs would be $1.2 trillion.

This $260 billion ($1.2 trillion minus $940 billion) deficit created by backdating the bill to 2010 instead of starting in 2011 when they should (until Democrats instructed them to do differently) has nothing to do with the deficit created by the doctor fix.  So they compound: $260 billion plus $197 billion equals $457 billion.

So we’re talking about a real and obvious deficit of nearly half a trillion dollars.  But that’s nowhere near as bad as it will really be.

You see, even starting the CBO ten-year cycle in 2011 is nothing more than a gimmick.  That’s because the plan begins taxing in 2011, but benefits (actual spending outlays) don’t begin to be funded until 2014.  The Democrats tax for ten years, but only spend for six.  Why did they do that?  Because that is the only way they can get the illusion of a “deficit neutral” figure.  As Heritage points out:

[S]ome scrupulous tactics were used to calculate the 10-year cost projections. The key provisions in the health care bill don’t go into effect until 2014. Meanwhile Medicare cuts and tax increases would go into effect immediately. So the money raised through taxes and spending cuts in the first four years of the 10-year projection would offset the expenditures in the subsequent six years. Consequently, when the true ten year window (2014-2023) is examined, and the costs of the “Doc Fix” are taken into account, the cost rises to $2.3 trillion.

This – and the shenanigans Democrats employ with the CLASS Act – is why Heritage rightly calculates the REAL cost of ObamaCare as likely far higher than $2.5 TRILLION.

These are obvious and transparent gimmicks.  But the mainstream media is largely simply ignoring it.  They are liberal in their ideology and “gatekeepers” in their philosophy of journalism.  The result is that they don’t tell you anything that they don’t want you to know.

But even that – as utterly terrible as it is – is STILL not anywhere close to the REAL cost of this disastrous health care bill.  Consider the most sobering Democrat omission of all.  From Cato:

Another gimmick pushes much of the legislation’s costs off the federal budget and onto the private sector by requiring individuals and employers to purchase health insurance.  When the bills force somebody to pay $10,000 to the government, the Congressional Budget Office treats that as a tax.  When the government then hands that $10,000 to private insurers, the CBO counts that as government spending.  But when the bills achieve the exact same outcome by forcing somebody to pay $10,000 directly to a private insurance company, it appears nowhere in the official CBO cost estimates — neither as federal revenues nor federal spending.  That’s a sharp departure from how the CBO treated similar mandates in the Clinton health plan.  And it hides maybe 60 percent of the legislation’s total costs.  When I correct for that gimmick, it brings total costs to roughly $2.5 trillion (i.e., $1 trillion/0.4).

Here’s where things get really ugly.  TPMDC’s Brian Beutler calls “the” $2.5-trillion cost estimate a “doozy” of a “hysterical Republican whopper.”  Not only is he incorrect, he doesn’t seem to realize that Gregg and I are correcting for different budget gimmicks; it’s just a coincidence that we happened to reach the same number.

When we correct for both gimmicks, counting both on- and off-budget costs over the first 10 years of implementation, the total cost of ObamaCare reaches — I’m so sorry about this — $6.25 trillion.  That’s not a precise estimate.  It’s just far closer to the truth than President Obama and congressional Democrats want the debate to be.

For the record, it was this subsidizing of the private health insurance companies that Dennis Kucinich was talking about before he backstabbed his own principles and voted for the bill anyway.

In 1994, the universal health care plan proposed by President Clinton included a mandate requiring all individuals to purchase health insurance. The Congressional Budget Office studied the issue and concluded that the United States had never in all its history mandated that individuals purchase any good or service.  The CBO stated:

“A mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action. The government has never required people to buy any good or service as a condition of lawful residence in the United States. An individual mandate would have two features that, in combination, would make it unique. First, it would impose a duty on individuals as members of society. Second, it would require people to purchase a specific service that would be heavily regulated by the federal government.”

But it is going to start doing so now, under Obama and the Democrats in Congress.  They could care less about the Constitution, or about the consequences of radically expanding already massive government bureaucracies.

Obama is going to force you to purchase insurance, but the CBO won’t count the cost of one penny of that spending, now or ever.  If you send money to the government that the government requires you to send them, that’s a tax.  If the government spends money, that counts as spending.  But if the government forces you to send money to a private health insurance company, that isn’t counted.  It amounts to a tax that isn’t “deemed” (there’s a good word these days) a tax.

Thus the REAL ten-year cost of ObamaCare won’t be $940 billion.  It won’t even be $2.5 trillion.  It will be SIX TRILLION DOLLARS.  And counting, and counting, and counting, and counting.