A review of the comments posted to the ACP Advocate blog would suggest that internists (or at least those who take the time to read and respond to my posts) are a pretty disgruntled bunch.
Primary care internists express unhappiness that health care reform is not going to raise their fees by enough to achieve parity with other specialties. Many also resent the encroachment of nurse-practitioners. As one of commenter wrote, "Far from having a rejuvenated PCP workforce, we will end up with an angry, bitter, fed up and revolting specialty workforce, with manifestations such as disinclination to take call, cherry picking referrals, early retirements and other such actions that will make a PCPs life far more difficult." Even when the news is positive, such as my blog about a Medicare proposed rule to yield a 6 percent increase in total allowed Medicare charges to general internists, the reaction was, well, less than enthusiastic - "tossing primary care a bone" is how one comment described it.
Subspecialists aren't a happy lot, either. Cardiologists are livid that their total Medicare allowed charges would be cut by 10% under the same CMS proposed rule. Endocrinologists are upset about a proposal to eliminate higher Medicare fees for consultations and to redistribute the savings to other evaluation and management codes.
Single payer advocates are mad that the College hasn't endorsed a Canadian-style health care system. Conservatives take issue with just about anything that smacks more government involvement in health care. Some of our members want ACP to enthusiastically embrace a public plan option, while others want us to vigorously oppose it.
Even ideas championed by ACP itself, like paying internists for the work involved in care coordination through a qualified Patient-Centered Medical Home, are viewed with skepticism by some ACP members, especially those in smaller practices, and outright hostility by some.
I bring this up not because I have a problem with internists' expressing their views, even when sharply critical of proposed health care reforms and the ACP itself. The blogosphere is not a place for thin-skinned people.
But as we debate what is wrong with the health care reform prescriptions coming from Washington, I hope we don't lose sight of the consequences if health care reform fails.
Does anyone really believe that doctors and patients will be better off if health reform falters and we continue the status quo? If the ranks of the uninsured are allowed to grow? If insurance companies are allowed to continue to turn down or charge exorbitant rates to people with pre-existing conditions? If small businesses can't hire people and pay decent wages or even keep their doors open because of the rising costs of health plan premiums? If the Medicare trust fund is allowed to go broke? If health care reform dies, and along with it, our best chance to begin to restructure workforce and payment policies to support primary care?
I believe that the U.S. health care system is a train wreck in waiting, and that 2009 may be our best and perhaps only chance to put it on a safer track. We have within our grasp the chance to enact legislation to provide affordable coverage to most Americans, to make the cost affordable and sustainable for families and businesses, and to begin to rebuild the primary care physician workforce. Yes, I understand why so many internists are unhappy with the way things are, and distrustful of the changes being proposed to make things better. I also respectfully suggest that there will be far more reasons for internists to be discontented if health care reform is allowed to fail.
Today's question: Do you think internists and patients will be better off if the effort to reform health care collapses?