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June 26, 2013

Will the Affordable Care Act Affect Doctors? Yes

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Among President Obama's broken promises, there is this gem of June 15, 2009: "No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period."

That promise helped sway the American Medical Association to back the Affordable Care Act, commonly known as Obamacare. But the AMA endorsement merely reflected a tremendous gap between its Washington lobbyists and the folks they claim to represent.

In 2011, a Jackson & Coker survey found that 70 percent of doctors disagreed with the AMA position supporting the law.

It gets worse. Last year, a Physicians Foundation survey found that as a result of the Affordable Care Act, about three of every five physicians were "less positive" about the future of American health care, and more than a third planned to restrict their Medicare or Medicaid practice.

Doctors are demoralized and feel powerless. Obamacare never addressed physicians' most pressing concerns, particularly the need for medical tort reform. It completely ignored the already difficult problems physicians face with Medicare payments, which are below market rates.

Worse, the law created the Independent Payment Advisory Board, a bureau charged with cutting Medicare payments even more.

The new law also turned the heavy flow of government red tape into a gusher. A 2012 Physicians Foundation survey found that almost four of every five respondents identified too much regulation and paperwork as a "very important" reason the medical profession is in decline.

With more than 13,000 pages of regulations thus far, and more to come, the Affordable Care Act will make running a medical practice even more stultifying. In addition to the mountain of paperwork under which they already labor, doctors will be faced with reams of new bureaucratic requirements, such as new Medicare rules governing patient referrals and reporting, new rules governing practice standards, plus tougher civil monetary penalties and criminal sanctions.

None of this will make medicine more attractive or enticing. The Nov. 9, 2010, edition of Medscape Family Medicine quotes an internist as saying: "If dealing with Medicare was a headache, dealing with the new bureaucracy will be an intracranial hemorrhage."

If you're a young doctor, finishing four years of medical school after college, plus three or more years of a residency, plus further training through a fellowship, you will start your career with an accumulated debt averaging $150,000.

Fewer doctors, meanwhile, will accept new Medicare and Medicaid patients. It's not the patients; it's the bureaucratic baggage, combined with sub-par reimbursements and inflexible price controls. Expect even more doctors to abandon private solo practice, go to work for hospitals or join big group practices. Expect even greater consolidation of health-care markets and less competition.

Real health-care reform would restore the traditional doctor-patient relationship. In such a relationship, physicians would be the key decisionmakers in the delivery of care, and patients would be the key decisionmakers in the financing of care. That can't happen unless and until patients control health-care dollars and decisions, and third-party insurance executives are directly accountable to those who pay the health-care bills. In other words, until Congress repeals and replaces Obamacare.

The president's promises were lofty and empty. The real issue is not whether you can keep your doctor; it's whether your doctor can keep you.

-Robert E. Moffit is a senior fellow with the Center for Policy Innovation at The Heritage Foundation.

First appeared in the Denver Post

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