Pres. Obama says he embraces the name “Obamacare”
By Paul Goldfinger, MD, FACC
On Sunday, the Asbury Park Press began a series on Obamacare. The first two installments were mostly about health insurance. But there were some comments in the piece that went to an aspect that I have been writing about on Blogfinger, namely, “Will Obamacare improve the quality of healthcare in America?” Of course we have already seen some beneficial changes that have to do with insurance issues, such as the pre-existing illness rules and the ability of everyone to have health insurance.
But, as a physician, I want to know how the day-to- day practice of medicine will be implemented considering the certainty of thousands of new regulations that mandate how doctors will do their jobs. I am skeptical because so little practical information has been released that explains to patients and healthcare workers, including doctors, as to how the everyday machinery of care will work. And I am worried that physicians will not be in charge of medial practice policy decisions.
In addition, these quality concerns tie into money, because quality costs money, so we physicians must also pay attention to financial considerations. The advocates of the Affordable Care Act (aka “Obamacare”) say that it will improve quality while lowering cost. Do you believe that?
Here is an example of a financial matter that relates to quality: In the first APP article the following claim is made: “For every $1 spent per person on smoking cessation, better nutrition and exercise, the government and insurers can expect to save $6 in long-term medical care or about $16 billion, according to Trust for America’s Health, a physician-led public health organization.”
As a prevention expert, I am hopeful that this frontier will be breached, but I am skeptical that the hoped-for financial benefits achieved with preventive medicine will occur, because we would need a small army of life-style counselors, nutrition advisors, exercise teachers and stop smoking therapists. Also who will work with the obese, who will properly monitor blood pressure control, and who will monitor lipid (blood fats) controls to achieve recommended targets? The cost of this prevention component of the ACA will be huge if it is done properly. Aside from the cost, it will take years to see any results in cost savings or life savings. And there are other issues:
Most primary doctors are not trained to achieve effective prevention results. For example, studies have shown that primary care doctors rarely achieve target goals for cholesterol therapy. The ACA says that it will depend on primary doctors to achieve the prevention benefits claimed for the new system, but there is a shortage of such physicians, and that will get worse. Physician extenders such as physician assistants (PA’s) will take charge of prevention, but they are not substitutes for doctors.
Even if we have the proper personnel and money for prevention, it will be very difficult to get the public to adhere to prevention life-styles . That sales job will take time and money.
And then we have concerns about access. Consider the three quotes below from Bloomberg News:*
“The percentage of family doctors in Massachusetts [a state with a universal healthcare plan] accepting new patients has dropped 19 percent in the past seven years [since implementing their plan] and the percentage of internists accepting new patients has fallen 21 percent over nine years, according to a July report by the Massachusetts Medical Society, an advocacy group for patients and physicians. Only about half of family doctors were accepting new patients this year. ”
“About 25 million Americans are expected to gain coverage under the health law, commonly known as Obamacare. Starting Oct. 1, as many as 7 million uninsured Americans will begin shopping for private plans through government-run exchanges, with many people eligible to have their premiums subsidized by taxpayers. On Jan. 1, Medicaid programs for low-income people will be expanded in about half the U.S. states.”
“David Longworth, chairman of the Medicine Institute at Ohio’s Cleveland Clinic, was working in Massachusetts when the state passed near universal health coverage. ‘Practices closed and patients would wait for eight to nine months to get in,’ Longworth said by telephone. ‘We overwhelmed the primary care health system.'”
I will continue monitoring the question of quality as the new plan unfolds. Stay tuned, and please comment below.
Here is the link to Bloomberg News:*