Friday, June 29, 2012

Higher Taxes with NO Doctors thank you Obama

Get your own Concierge Doctor now before they are all taken.

Doctors will not take the tsunami of new patients.  They will simply opt-out.  GOOD LUCK WITH YOUR FREE HEALTH CARE…..  

"Concierge Medicine" is a term applied to a special kind of primary care medical practice offering personalized, in-depth, convenient and high-quality healthcare services. 

So, those with money will still be taken care of.  If you like taking extra time in the emergency rooms now just wait …..                                            

Direct care physicians, as many prefer to be called - typically provide a level of care beyond that of a standard general practitioner, including such perks as easy scheduling of appointments, no waiting times, longer and more thorough examinations, coordination of all medical care and even, in some cases, house calls. Doctor-delivery services are another increasingly popular (and costly) option for patients seeking convenience. In this case, instead of the patient traveling to the doctor, the doctor comes to the patient - and he or she might even carry that iconic black bag.

Of course, all this comes at a price, but most fee-for-service boutique doctors often require a contract and charge an annual retainer fee ranging from $1,500 to upwards of $20,000 per family, and doctor delivery services aren't cheap either. Yet despite that, it seems that a growing number of people are considering those medical bills money well spent. Guess they agree with the old adage "health is wealth."

Since the new law’s ability to deliver care to tens of millions of additional patients rests on its ability to cut costs, both Medicare and Obamacare reimbursement to doctors will be low.

A basic tenet of Obamacare is to force doctors to take untenable cuts in pay, all the while absorbing overbearing new regulations and mandates with little or no personal recourse. Proponents of the Obamacare law know that they can suffer concessions made in Washington, D.C. as long as the doctors delivering the majority of medical care in towns all across this land are made to heel to the new law’s demands in the end.

Some on the political left have conjured up schemes to tie physician state licensure to participation in Medicare and Obamacare. Others have taken solace in the notion that the regional ACOs themselves will be able to quash any doctor rebellions by simply using their control of the purse strings to withhold or limit how much local money each doctor will be paid for his services.

Unbeknownst to most people in or out of the healthcare arena, however, are the legal options available to physicians to either never enroll in Medicare or to voluntarily withdraw their participation in the government’s plan. The legal nuances of the doctor-Medicare relationship may shed light on options available to physicians to skirt inclusion in Obamacare if the law’s enforcers decide to use a heavy hand in mandating their participation.

Universal health care means that the government decides health care allocation and its costs. At first, it reduces how much it pays doctors, hospitals and nurses. As doctors drop out, the government then rations how much care people get. This ranges from requiring verification before surgery to minimum wait times to simply reducing the number of beds to limit supply. More government officials are selected to review the books, make sure all money is spent correctly and find more cuts - but it is never a manager's salary or secretaries, only the doctors or nurses or even cleaning staff whose wages, benefits and even jobs are cut. All of this reduces quality of care in the name of saving money.

Although the American Medical Association (AMA) signed on to support Obamacare, the majority ofAmerica’s physicians did not. In fact, about 85% of practicing community doctors in America are not AMA members and do not support the ‘Affordable Care Act’.

Contrary to common lore, most physician are not rich. By increasing the number of low-paying ‘Obamacare card-carrying’ patients they will be asked to see, and failing to address the long-term Medicare (‘SGR’) payment formula for physicians, many quality docs will be forced to restrict, rather than expand, their services (or close shop altogether). The recent Congressional two-month extension to the ‘Doc Fix’ problem is unacceptable.

The medical field demands that the best and the brightest students make a huge personal sacrifice of time and expense. Most medical students finish their residency training at the age of about 30 or older; their undergraduate and graduate school debt ranges from $250 thousand to $600 thousand or more. Coming ‘out’ to the work force a decade later than most in their age group, and working 80-100 hour work weeks is stressful business for doctors. Medicine is a fascinating and wonderful profession, but the undertaking demands the highest caliber individual. There are two ways to insure that American doctors remain the best in the world: sustain competitive, free-market incentives, or go completely ‘socialist’ by paying for the entire process of medical education and training as is done in many European countries. Obamacare does neither, and thus leaves physicians dangling in a precarious position as education costs continue to climb and reimbursements continue to fall.

Every President, every congressman, and every person who has every worked in or around the White House, the Pentagon, Capitol Hill, or any other elevated branch of government receives the very best the American medical system has to offer. This basic assumption of quality, and the implicit policy of safety under a physician’s care, will always be there for those with power or means; under Obamacare, the powerful will continue to be well cared for. But for the rest of America, this assumption will likely not hold.

In 1993, the Centers for Medicare and Medicaid Services, then known commonly as ‘Medicare’, cut the reimbursement for my specialty of anesthesiology by roughly 70%.

Many other specialties have received large cuts in reimbursement since. Anesthesiology as a specialty was able to survive in teaching institutions, community hospitals and surgical centers because of higher reimbursements received by private health insurers.

Under Obamacare, there will be an expansion of what are called ‘physician extenders’. Many patients may not consider the care of non-physicians to be an acceptable replacement to their doctor. As more and more companies drop their private health insurance plans, and society moves toward a nationalized, single-payer health care system, doctors will no longer be able to afford to meet expenses, pay off educational loans, and be incentivized to endure the challenging and demanding years of study and training to become board-certified.

Only in America can a pregnant patient expect an obstetrician to be accompanied by a board-certified anesthesiologist at any time of the day or night to place a labor epidural to ease the pain of childbirth. Only in America can a patient expect the highest degree of anesthesia experience, surgical expertise, radiological skill, and internal medicine know-how to guide them through treatments for advanced and complex disease. Only in America, today. With every year we move forward under the new health care legislation, these services, which we take for granted, will recede progressively. Once gone, finding ample numbers of trained physicians willing and able to provide this highest level of care will be increasingly difficult.

All of this brings us back to our esteemed political representatives in America, who will continue to receive the best medical care in the world, while many Americans will have to settle for something less than the best—something far less than what we have now.

Obamacare was crafted in back rooms to satisfy political goals and schemes, but not to expand the delivery ofAmerica’s best medical care to all Americans. In the absence of major changes to the Obamacare legislation, danger in terms of physician coverage for hospitals and physician availability for office visits lies ahead.

None of us would fly on an airplane without a trained and experienced pilot in the cockpit. Then why would we allow ourselves to ‘go under’ without an anesthesiologist at the head of our bed in the operating room, a cardiologist treating our heart problems, or an internal medicine specialist physician writing our prescriptions?

TheUnited States health system is not perfect and our heterogeneous population poses tough challenges, but our philosophy has always been to go the extra mile to treat our patients. {For example, theU.S. has perhaps the most advanced premature infant treatment programs in the world. Here, we do everything we can to save lives, even for the weakest, prematurely delivered babies. Obviously, in doing so, we extend great cost and also accept a greater mortality rate for this vulnerable population.
Be wary of the enemy at the gate. Health care reform is tricky business and the ‘Affordable Care Act’ does not have its act together. The Obamacare journey to the future could be a very treacherous one indeed.

Here are three potential approaches to understanding how physicians may resist Medicare and, by extension, Obamacare participation:

Physician enrollment in Medicare is voluntary. Sec.1866. [42 U.S.C. 1395cc] (a)(1) states a provider is “qualified to participate and eligible to receive payments from the government if s/he files with the Secretary” an agreement (i.e., voluntarily completes form CMS-855).

A non-enrolled physician has equal protections and due process rights under laws that prohibit the federal government from demanding a physician either serve (enroll in) Medicare or give free medical care to Medicare beneficiaries.

Some would say the US Constitution, Amendment Thirteen, protects every American from “conscription” in that:
“Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States …”

Section 1842(i)(2) does not restrict a physician to only two choices: “participating” or “non-participating.” Sec.1842. [42 U.S.C. 1395u] (i)(2) clearly states “The term … nonparticipating physician refers … to a physician who … is not a participating physician … (as defined in subsection (h)(1))” Sec. 1842(i)(2) is a conditional statement: if non-participating, then not participating.

But physicians obviously have more than two possible relationships with Medicare including “opted out,” never enrolled, voluntarily terminated, or employed by a Medicare Advantage IPA/HMO.

Section 1848(g)(4)(A) explains how a physician who is enrolled in Medicare should submit bills under Part B; it does not mandate every physician who is non-enrolled into enrollment, thus triggering mandatory claims submission. Section 1848(g)(4)(A) does not grant the federal government authority to press physicians into service (enrollment).

So what about patient reimbursement by Medicare? Can a patient pay his/her doctor and then seek reimbursement from Medicare? Most physicians will agree to bill the government, but if they don’t does this mean they must give free medical care to Medicare beneficiaries?

Healthcare attorney Andrew L. Schlafly wrote the following: “… even if the federal government attempted to assert control over payments by patients to disenrolled physicians, courts may well hold that it is unconstitutional for government to interfere with payments made by Medicare enrolled patients for services rendered by physicians who have disenrolled. We are unaware of a court case establishing or forbidding this option. Government may prefer not to test its authority over disenrolled physicians rather than risk a new precedent against its power.”

The Supreme Court decided on the Affordable Care Act’s individual mandate requiring all Americans to either participate in Obamacare or pay a penalty_TAX_.

Health insurance is an important and vital component of a free-market society. The question remains, should government mandate coverage? Obamacare mandates participation, additional fees, over a hundred new government agencies, and layers of additional bureaucracy, but fails to include rules to allow insurance entities to compete across state lines; it also lacks tort reform to lessen the costly and widely denounced practice of defensive medicine to ward off frivolous lawsuits.

It seems the question is not one of intent in criticizing the new health care law, but rather one of content. Obamacare gets it wrong at almost every turn. Instead of finding tax-credits and other incentives to help doctors care for the uninsured, it imposes paternalistic, over-bearing, and anti-competitive pressures to coerce providers of care to see more patients for less under unfavorable conditions.

Obamacare opponents are not against healthcare for all; nor are they against government-sponsored health insurance. What they find troubling is the notion that the government wants to control every minute detail of the medical care delivered between a doctor and a patient.

In the match up of Doctors vs. Obamacare, physicians have already opted-out—in due time, this reality will become more and more obvious.

The poor will not be able to find a doctor with Obama care.

Those with money will have their own doctor on call.  This is the new America higher taxes with no doctors for our health care.

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