The ACP Advocate Blog
by Bob Doherty
Tuesday, May 26, 2009
Are physicians truly on board with health care reform?
The Portland (Oregon) Register-Guard reports that physicians "are as eager as their patients" to reform health care, with surveys revealing "that overwhelming numbers of physicians resent the current crazy patchwork health care system, which fixes their reimbursements, regulates and too often denies patient care, and piles physicians with paperwork so unending and from so many directions that the average doctor has little time left over to challenge the status quo." The authors write, approvingly, that the American College of Physicians is "the medical organization perhaps most vocal in support of universal health care coverage."
Most of the physicians I know are hugely dissatisfied with status quo. ACP has channeled such frustrations into a powerful call for a better health care system that provides all Americans with access to affordable coverage and to a primary care physician.
Still, I wonder if physicians will be on board with health care reform when Congress begins producing the details of legislation. My sense is that most physicians urgently want health care reform and believe strongly that all Americans should have affordable health coverage. But they worry that instead of improving "the current crazy patchwork health system, which fixes their reimbursements, regulates and too often denies patient care," health care reform will be more of the same, or worse.
Physicians' hearts and minds are still very much in play, and it would be a huge mistake for President Obama and Congress to take them for granted. Democratic and Republican pollsters alike tell us that physicians' views on health care reform could be decisive in determining if the public will be behind the effort, because voters are much less likely to support health care reform if told that it will result in the "government" taking decisions away from their own doctors.
There are two specific questions that I think could make or break health care reform with physicians:
1. Will health reform pay them fairly for their services? No, physicians don't care only care about money, but they do expect to be paid a fair rate. They will be much less likely to support health care reform if it fails to put an end to the annual cycle of Medicare payment cuts caused by the Sustainable Growth Rate (SGR) formula. Primary care physicians may turn away from health care reform if it offers only a token increase in payments, instead of re-structuring payments to make primary care a competitive career option. Other specialists may balk if increased pay for primary care comes solely out of their pockets. Physicians of all stripes are less likely to support a bill that includes a "public plan" option if the public plan would pay them based on these same flawed Medicare payment rates, and drive other payers to do the same.
2. Will health care reform reduce the administrative burdens and paperwork requirements that drive physicians mad? Physicians will wildly embrace health care reform that streamlines billings and reduces the hassles associated with health plan interactions and second-guessing of clinical decisions. But health care reform that adds more pre-authorization requirements, second-guessing and paperwork, all in the name of controlling costs, will drive doctors away in droves.
If President Obama and Congress want the support of physicians, they will produce health care reform that pays physicians fairly for their services, restructures payments to support primary care doctors, reduces hassles and second-guessing, and yes, provides all Americans with access to affordable health coverage. I think they will also be more likely to have the support of the general public, which pollsters say will be taking their cues from doctors as they make up their own minds.
Today's question: What could make doctors turn for or against health care reform?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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