By Alex Merto, NY Times, to illustrate this article below.

By Paul Goldfinger, MD, FACC.    (I wrote this piece in 2014 but it could have been written yesterday.)

Since 2014, the damage being done to quality care is becoming much more clear.  By now most of you have gotten a taste of what the ACA has wrought. Yet there has been no discernible public outcry, but just speak privately to nurses, doctors and patients.

I do realize that as long as patients have insurance, they will put up with almost anything.

When someone I know was recently (2018)  in a horrible car crash and wound up at Jersey Shore hospital with serious injuries, he was tended to by a “trauma team” but no physician saw him until the next day;  and mistakes were made.

Here is the 2014 post:

In our Blogfinger series about the Affordable Care Act, I said that practice guidelines without flexibility for physicians to make individual decisions for patients would compromise quality. But since the details of how medicine would be practiced under the ACA was not available, I predicted that once care was actually provided under the new system, we would begin to see the worrisome truth.

Now, in an opinion piece published yesterday  (2014) in the New York Times*, and written by two doctors from the Harvard Medical School faculty, we find out that “financial forces largely hidden from the public are beginning to corrupt care and undermine the bond of trust between doctors and patients. Insurers, hospital networks, and regulatory groups have put in place both rewards and punishments that can powerfully influence your doctors decisions.”

This quote (above) is from the article written by Drs. Pamela Hartzband and Jerome Groopman, both well known authors on the subject of what’s right in the care of patients.

When I was learning to become a competent practicing physician, I was taught that patients should be viewed as individuals. In fact, it is those individual differences that make the practice of medicine so fascinating and demanding. For example, consider hypertension (high blood pressure.) Between the different causes, complicating factors, various manifestations, and the myriad of drug combinations and interactions, each patient poses a unique challenge.

High blood pressure, a extremely common condition, cannot possibly be reduced to guidelines that are suitable for the group as a whole. Doctors must be able to treat each case individually, and, their professionalism must be trusted to make the right decisions. What is the point of spending about 10 years of one’s life becoming a doctor if bureaucrats turn the profession into a mindless field governed by mandatory robotic rules, financial priorities, and staffed by unsupervised non-physicians?

It is now becoming apparent that the new health plan is providing regulations and incentives that compromise the doctor-patient relationship. Physicians have a moral imperative to place the patient’s best interests first. That is one of the prime values for the practice of medicine. But to adhere to that imperative is becoming more difficult.

The cat is now out of the bag.  The public must pay heed  to what their doctors are saying about this situation.  My own doctors, almost uniformly, say to me, “You got out just in time.”  Many have become employees of large corporations.

According to Drs. Groopman and Hartzband, “The power now belongs, not to physicians, but to insurers and regulators that control payment”   In other words, the bottom line is becoming the top line.

To help patients understand what conflicts of interest may be occurring in their care, the authors say, “We propose a …..public website to reveal the hidden coercive forces that may specify treatments and limit choices through pressures on the doctor.”

The Times opinion piece concludes by saying, “Medical care is not just another marketplace commodity.  Physicians should never have an incentive to override  the best interest of their patients.”

NYTimes article    *

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