Worried

I really, really don't like to post about political topics. Mostly because it is inflammatory, but also because, to me, it is extremely personal. However, based on recent media coverage, and President Obama's recent remarks to the AMA, I feel that I cannot keep silent on this subject. In his recent speech to the AMA, he downplayed the importance of tort reform in decreasing rising medical costs (such as unnecessary, expensive tests, ordered primarily to CYA and keep the lawyers at bay). More disturbing, however, was the notion that, in a "public option" (aka Government-run plan) he would base physician rating and reimbursement based on their personal health outcomes.

So, wait a minute, what's wrong with that? You ask. I mean, it is the doctor's *job* to make you *better,* right? It doesn't seem so horrible...you have a cold, you visit your physician, s/he diagnoses you with a viral infection, you get better, life goes on. But, what about this? As a physician, your patient population is obese. Despite your multiple attempts and counseling and lifestyle change recommendations, your patients continue along their unhealthy lifestyle, becoming even more obese. Guess what? You get a pay cut. Your patient that has smoked a pack a day for 50 years, and laughs in your face at your attempts to counsel smoking cessation develops COPD. Sorry, that is coming out of your hide. You did such a *bad* job of taking care of this patient! Your diabetic patient doesn't fill their medicine for a month, and then comes in to the hospital in frank DKA. *Your* fault for a negative outcome. Then, to add more fun, your ability to order laboratory/imaging tests will be limited (in the interest of keeping costs low), but if you miss out on a diagnosis? Your *fault,* and here come the lawyers for their piece of your livelihood. Where is the personal responsibility?

Who wants to put up with years of rigorous training, difficult study, and mountains of student loan debt only to be stymied in patient *care* at every turn? Surely not our best and brightest. I am worried about the future of our profession. A "public option" (not "free," by the way, more like $62,000 taxpayer dollars per person) for all intents and purposes will likely undercut any private competition (not to mention the tax burdens that will be levied to discourage competition). This will leave us, both patients and physicians, with only one choice. Government Medicine. Just like Government Motors. I don't want to become a government employee. I don't want my health care options to be limited to government employees. I don't even like to spend a day at the DMV!

I do believe that some reform, obviously, is needed, but I think it needs to be more geared to catastrophic coverage. I think we need to go back to fee-for-service health care, even schedule fees on a pro-rated percentage based on income to make health care visits affordable for all. Get rid of insurance for preventative care, labs, and office visits. Competition will then drive the costs down naturally. We, as physicians, can stop shuffling through piles of insurance paperwork and prior auths and get back to doing that which we were trained to do. Something that we love to do....take care of patients! Personally, I feel that "free" = "of little value." I believe we need to give people back a financial stake in their health care, and, perhaps, when they are financially vested in staying healthy, then they will value their health, and their health care providers, once again. Until then, I jump through a few more hoops to get my patients the care they need, and I worry about the future of our profession, and our nation.