The Nation's Pulse

Obama and the Doctors

Obamacare will not improve their morale -- nor increase their already dwindling ranks.

By 3.22.10

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One of Barack Obama's favorite stage props lately is a doctor in a lab coat trying to make us believe that physicians support Obamacare. In keeping with every other Democrat claim about health care "reform," the truth is something rather different.

A September, 2009 poll of physicians by Investor's Business Daily found that two-thirds of respondents "opposed the government's attempts at taking over the health care system." The left dismissed the poll as a product of a conservative publication and self-selection bias (i.e., that the most anti-Obamacare doctors would be the most likely to respond.)

However, a subsequent poll by physician job search company the Medicus Firm found that "nearly one-third of physicians responding to the survey indicated that they will want to leave medical practice after health reform is implemented." Fully 63% of respondents said they "support reform but would prefer a different, more incremental approach" and 27% said they "would recommend medicine as a career now, but not if health reform passes." (Remarkably, 36% would not recommend medicine as a career whether or not the Democrats' "reform" passes.)

As the Medicus Firm notes, "It's probably not likely that nearly half of the nation's physicians will suddenly quit practicing at once. However, even if a much smaller percentage such as ten, 15, or 20 percent are pushed out of practice over several years at a time when the field needs to expand by over 20 percent, this would be severely detrimental to the quality of the health care system. Based on the survey results, health reform could, over time, prove to be counterproductive, in that it could decrease patients' access to medical care while the objective is to improve access. Furthermore, even if physicians are unable to act upon a desire to quit medicine, there could be an impact in quality of care due to a lack of morale in physicians who do continue to treat patients despite feeling significantly stressed."

Just as Barack Obama likes to use the occasional health insurance horror story to demonize an industry with which the vast majority of Americans are satisfied, I also was looking for at least one bit of anecdotal evidence -- a more personal touch than a poll -- from a physician I know regarding Obamacare. (If only President Obama would look at his own cousin, Dr. Milton R. Wolf, who is vehemently against Obama's plans…)

So I sent the poll results to a surgeon in the employ of a large "managed care" company -- a surgeon who operated on me some years ago and who has in my political discussions with him been consistently liberal on issues regarding health care specifically and economics in general.

Given his previous positions, his view of the Obama/Pelosi/Reid "reforms" and the intensity of his reaction to it (he's a rather mild-mannered guy) is somewhat surprising and most instructive:

If I were in private practice, I'd be totally pissed at Obamacare. Being with this company, and thus being a little more insulated from the finance part of a practice, I'm only partly pissed. As far as I know, Obama's plan gives absolutely nothing to doctors regarding malpractice reform, and yet asks them to take substantial cuts in reimbursement. And he partly blames doctors for the rising cost of medicine (he says we order too many tests and do too many operations). Every doctor knows that 1/4 to 1/3 of the tests we do are probably unnecessary; we just want to cover our asses in case there's that a 1 in a thousand chance the patient might have that rare condition which we'll miss and then sue us. So that translates into billions of dollars, but if Obama doesn't want us to order these tests, then is he going to save us from litigation? Yeah right, he wants it both ways, make us work more cheaply, and then throw us to the plaintiff's attorneys.

I bet folks would be surprised at how many unnecessary tests and operations we do. Obama had a spokesperson who said that malpractice only accounted for 1-2% of our medical costs. What this person meant was that malpractice awards and insurance premium increases account for that. If he factored in defensive medicine, then we'd be talking about much more. There's disagreement about how much since this hasn't been studied well, and the studies that have been done are controversial. However, I don't know of any doctors who don't practice defensive medicine. Today I ordered over $1000 in tests on a patient who I knew didn't have an intestinal blockage, but her significant other was in the legal profession and I wasn't going to take any chances that I'd miss something. I'm somewhat disgusted by this, I feel like a McDonald's worker who's forced to throw away dozens of Big Macs because they're a few minutes too old, instead of giving them away. If the government is not going to protect us by reining in plaintiff attack dogs, then we have to protect ourselves somehow.

 So if I were in private practice, then I would really consider working as a consultant for a private industry if the "reforms" go through. With my company I won't see the cuts right away, but they do peg the doc salaries on the state salary averages, so as these averages go down, so will my salary.

So as far as I can tell, the current Democratic bill has absolutely nothing to offer to docs in terms of malpractice reform. I saw this interesting article by a fairly progressive think tank which says that defensive medicine comprises 4-9% of medical costs, that even if half of that were eliminated, the savings would cover the costs of insuring currently uninsured patients. If there was real malpractice reform, such as developing the "Malpractice Courts" suggested by the article, I know that I certainly would be ordering fewer than half of the tests which I have been requiring, and I'm probably not that different than the average doctor. Wow, with just malpractice reform we could fix our current health care crisis! However, the trial lawyers interest groups would never allow this, or admit to it.

Now how did I get into this rant? Thanks Ross, I thought I was an economic liberal, but maybe I'll be wearing "Capitalism" tee shirts in a couple of months.

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About the Author
Ross Kaminsky is a self-employed trader and investor and is a senior fellow of the Heartland Institute. He is the host of The Ross Kaminsky Show on Denver's NewsRadio 850 KOA on Saturday mornings from 6 AM to 9 AM. You can reach Ross by e-mail at rossputin(at)rossputin(dot)com.