Yesterday, the Wall Street Journal's editorial page launched an extraordinarily deceptive attack on "Obamacare" for waging a "war" on specialists to benefit primary care.
Let's start with the WSJ's dismissive attitude about primary care. "Compared to bread-and-butter primary care doctors, specialists cost more to train and make more use of expensive procedures and technology - and therefore cost the government more money. Even so, the quiet war Democrats are waging on specialists is astonishing," says the WSJ. Yet, as ACP has documented, these same "bread and butter" primary care physicians save taxpayers a lot of "bread" by improving outcomes for diseases like cancer and diabetes and preventing avoidable hospital admissions. You would think that a newspaper that likes to think of itself as a champion of fiscal responsibility would support the importance of primary care in saving taxpayers' money, instead of dismissing them as being less valuable than other specialists.
And what's with the WSJ's implication that general internists, pediatricians, and family physicians aren't specialists in their own right? In a recent policy paper ACP describes, the highly specialized skills required to be a primary care physician: "The IOM defines primary care as 'the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.' Primary care physicians provide not only the first contact for a person with an undiagnosed health concern but also continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis . . . General internists are specially trained to solve puzzling diagnostic problems and can handle severe chronic illnesses and situations where several different illnesses may strike at the same time. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, and mental health."
Now, what about the Obama administration's alleged "war" on other specialists? The WSJ mixes up, confuses, connects, and distorts several different policy initiatives: provisions in pending health reform bills, supported by President Obama, to improve the accuracy and appropriateness of physician payments; and a completely unrelated regulatory initiative (which began long before the current administration came into office) to update Medicare's relative value units. The health reform bills being considered by Congress provide a relatively modest Medicare payment increase (5% in the House bill, 10% in the Senate Finance version) for designated services by primary care physicians. In the Senate version only, one half of this increase would be funded through 0.5% offsets to other physicians. Otherwise, the proposed primary care increases are funded with additional federal dollars at no cost to other physicians. The bills also would pilot test new payment models to increase payments to primary care physicians and other medical specialists alike for working together to achieve better outcomes, and create an expert panel to identify potentially mis-valued services under the Medicare fee schedule. Yet instead of applauding these efforts to improve the accuracy and value of Medicare payments so that tax payers are getting more value for the money they spend on Medicare, the WSJ condemns them. Go figure.
Finally, the editorial directs most of its ire at a proposed rule that would increase Medicare practice payments for primary care physicians and some other specialties, but lower them for cardiologists and oncologists. The origins of this proposal go back to 2006, when over 70 specialties urged Medicare to conduct an updated survey of physician practice expenses. Medicare subsequently contracted with the AMA to conduct a new survey, and in June of this year, it asked for comments on a proposal to use the new survey to update how much it pays physicians for their overhead costs. In ACP's comments to CMS , the College urged the agency to address, in an open and transparent manner, the concerns from cardiology and oncology about the application of the survey to their specialties, as it also expressed support for updating the practice expense payments for all specialties. But the essential point that the WSJ misses is that this whole regulatory process is part of Medicare's statutory responsibility to update physician payments on an annual basis, is independent of the health reform legislation being debated by Congress, and its origins pre-date the current administration. Sure, there can be legitimate differences of opinion on whether Medicare should proceed with the proposal as announced in June, but to label it as Obama launching a war on specialists, to benefit primary care, is absurd.
The WSJ may not like the fact that there is a broad and civil consensus within medicine, primary care and other specialties alike, on the need for more primary care physicians, including reforming physician payments to support primary care. It's true that no specialty wants to take a pay cut to increase pay to another, but medicine has, for the most part, been able to engage in a respectful discussion of such issues without making this a "primary care versus [other] specialists" issue. I hope that physicians will not allow the WSJ's to turn this civil discussion into a civil war.
Today's question: What is your opinion of the WSJ editorial?