The ACP Advocate Blog
by Bob Doherty
Monday, June 27, 2011
Hey, Doc, do you remember the “good old days”? (circa 2008)
Woody Allen’s “Midnight in Paris” is a modern day parable of people looking back to another time as being better than their own. Some physicians seem to think 2008 was that better time, before Barack Obama was elected president and his health reform initiative became law.
You know, in 2008, physicians weren’t facing huge Medicare cuts. Medical liability awards were capped across the country. Everyone had health insurance. Government regulation was non-existent. Physicians could order any test they wanted without second-guessing by insurance companies. Young medical students were beating down the doors to become primary care physicians, and patients had no problem getting same day appointments with their internist.
You don’t remember it this way? Of course not, because it wasn’t so. But given some of the over-heated rhetoric from some physicians who are critical of the Affordable Care Act, you’d think that everything that is bad about medicine today is a consequence of “ObamaCare”--even though most of the law hasn’t even taken effect!
In 2008, before Obama got elected, before the Affordable Care Act became law, physicians faced double-digit Medicare SGR cuts and skyrocketing med mal premiums. In 2008, 46 million people didn’t have health insurance and there was a projected shortage of over 40,000 primary care physicians. In 2008, the U.S. scored poorly compared to other countries in two measures of access to doctors, having to wait more than 6 weeks to get an appointment and getting same day appointments. In 2008, more than nine out of ten primary care doctors reported an increase in time spent on non-clinical paperwork over the prior three years.
How then can anyone fairly pin these things on the ACA, which wasn’t enacted until March 2010, and won’t become fully effective until 2014?
A fairer yardstick would be whether the ACA makes these things better, worse or makes no difference
By this yardstick, the ACA didn’t solve the medical liability problem nor eliminate the SGR cuts, but neither did previous administrations and Congresses.
By this yardstick, the ACA will invest billions of dollars in dozens of programs to increase the numbers of primary care physicians and improve payments for their services, even though it doesn’t solve a workforce shortage that pre-dates it.
By this yardstick, 34 million people who today are uninsured at least will have health insurance, and with it, improved access and better outcomes, although wait times for appointments initially may go up as a result.
By this yardstick, the ACA didn’t end paperwork the paperwork burden on clinicians, but it will require insurance companies to streamline and simplify authorizations, transactions, and eligibility verification and to spend more money on patient care and less on administration, even as some of its other programs may add to red tape.
Perspective is important. The U.S. health care system had big problems before the ACA and, it will have some big problems after it. The ACA makes some big things much better (getting people covered), makes a stab at improving other things (training more primary care doctors, reducing insurance red tape), may make some things worse (longer appointment waits because more people will be covered), has some things that need to be changed (like getting rid of regulations that could add more red tape), and doesn’t fix some things that need fixing (SGR and medical liability reform). But this doesn’t fit in with the critics’ narrative that everything that is wrong with American health care is the ACA’s fault, including all the things that physicians and patients didn’t like before it.
Unless, of course, you buy into the fantasy that 2008 was the golden age for American medicine, until the ACA came along to destroy it.
Today’s question: Do you think it is fair to pin on the ACA the problems that existed before it?
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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