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A Doctor’s Oath: Government may be poised to mandate that all doctors participate in Obamacare.
National Review ^ | 02/14/2014 | Marc Seigel

Posted on 02/15/2014 10:16:02 AM PST by SeekAndFind

For me and many other doctors like me, taking care of you has never been about the money. I have always considered it an honor and a privilege to be allowed personal entrance into the private world of your mind and your body. It is very satisfying for me to be able to offer my medical knowledge and experience to help you, my patient. This is why no matter how much or how little you or your insurance company pay me to see you, I will continue to do so. I will not abandon you because the reimbursement I get for your office visit is constantly diminishing or because I will soon get a bundled or quality-of-care payment rather than a fee for the service. No matter what the insurance scheme, I will struggle to lower office overhead to compensate for continued loss of income.

But Obamacare may not allow me to continue taking care of you, no matter how altruistic I am. The real problem with Obamacare’s narrow networks on the state exchanges is not doctors like me dropping out; it is insurers deciding not to add us to their new networks in the first place. Don’t get me wrong. No doctor in his or her right mind is eager to accept the reduced fees that Obamacare offers, and there is every reason to believe that the new policies will cut our reimbursements to the bone. But the reason that I don’t participate in the individual market’s GHI, HIP, or Empire Blue Cross plans is that these insurers have decided not to include my university’s network of doctors.

The cost of keeping us connected to our patients is far too rich for Obamacare’s blood. And for those insurers, like Oxford, United, and Aetna, that do include me via my university plan, I worry that these networks won’t include the orthopedist or kidney specialist or brain surgeon I am used to referring to, further jeopardizing my patient’s quality of health care. Can you imagine searching unsuccessfully for a brain surgeon to remove a growing tumor? This is the hideous future of the state exchanges: limited care provided by limited networks of physicians. Remember the “capitated” HMOs of the 1990s? Obamacare is a reprise of this failed model. The word “capitated” should really be “decapitated.”

The individual market is just a taste of the future — the same problems are sure to surface when the Obamacare business exchanges are up and running. And as businesses drop employees’ health coverage or make them part-time, so that more individuals resort to the state exchanges, the numbers of patients who are used to seeing me but no longer can will increase dramatically.

Many of my fellow physicians are concerned that as Obamacare collapses without the good doctors to support it, the government will have no choice but to mandate that all doctors participate. There is already a precedent for this. With Medicare and Medicaid, you are either all the way in or all the way out. There is no middle ground. As a participating Medicare provider, I cannot refuse to see a Medicare patient, though I can certainly delay an elective visit when my office schedule is full. An AMA survey in 2010 found that 17 percent of doctors were restricting the number of Medicare patients in their practice. Can you blame them? With reimbursements falling and restrictions rising for performing complex procedures on elderly patients with multiple medical problems, what doctor would rush to see them?

Many of my brethren feel that the same problem will soon exist for Obamacare. This is many doctors’ worst nightmare. You see, Obamacare is a multi-headed beast — it involves too many insurers for such an across-the-board mandate to be effective or workable. Recently, I decided to drop out of an insurance network that was paying me only $25 per visit and was refusing to pay for flu vaccines.

I can’t imagine losing the right to drop out of a bad insurance network any more than I can imagine what would happen if the new Obamacare insurances could be forced to include the best doctors.

The health-insurance situation is bad enough without adding any more mandates.

— Marc Siegel, M.D., is an associate professor of medicine at the NYU Langone Medical Center and medical director of the center’s Doctor Radio. He is a member of the Fox News Medical A Team and the author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health.


TOPICS: Constitution/Conservatism; Culture/Society; Government; News/Current Events
KEYWORDS: doctorsmandate; obamacare; obamacaredoctors; obamacarehospitals; obamacareinsurers; physicians
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To: FlingWingFlyer

Since medicine like cosmetic surgery doesn’t deal with insurance, I wonder if some cosmetic surgeons will just learn how to do things like tonsillectomies etc and do them for cash off the grid.


21 posted on 02/15/2014 10:53:44 AM PST by Yaelle
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To: Safrguns

They will not see you if you are self pay for some good resons. You may be able to afford the physician office visit, but what if you needed more complex treatment or scans? I have seen patients in the clinic where I used to work , who had no insurance and are able to pay for their first visit, but when surgery, MRIs, etc are recommended, they cannot afford it. it then becomes a liability for the physician, because what can he/she do? Deny treatment, and get sued? It opens a real can of worms when you accept patients with no insurance, but are able to afford the initial visit.


22 posted on 02/15/2014 10:54:29 AM PST by kaila
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To: SeekAndFind; Mom MD
Government may be poised to mandate that all doctors participate in Obamacare.

A little Karma for doctors?

Might be wise to be out of the country when the same government criminalizes quitting.

23 posted on 02/15/2014 10:57:54 AM PST by Navy Patriot (Join the Democrats, it's not Fascism when WE do it, and the Constitution and law mean what WE say.)
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To: cuban leaf

A lot of doctors close to retirement or financially sound will probably quit

Obama will FORCE them to work


24 posted on 02/15/2014 10:58:45 AM PST by molson209 (Hillary Clinton)
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To: SeekAndFind

I’ll bet any amount of money this doctor voted for obama.


25 posted on 02/15/2014 11:16:27 AM PST by Diplomat
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To: Mom MD

As a pre WWll baby I am with you. They may try to starve me, freeze me or they can kill me but they can’t force me to comply. When they come for me they better bring some extra Body Bags because I’m not going down alone!


26 posted on 02/15/2014 11:16:57 AM PST by TNoldman (AN AMERICAN FOR A MUSLIM/BHO FREE AMERICA.)
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To: Mom MD
A lot of physicians ‘participate” in Medicare, but do not accept Medicare patients. it is such a hassle to drop out of the program, it is just easier to not accept new patients instead. If I was a manager of an FP practice, I would not accept new patients on the phone. I would direct them to an online application, in which they fill out their health history, education, and employment. Based on that information, I would then determine who i would accept into the practice. When there are less physicians, you can be more selective. It would also prevent Medicare and Obamacare govt spys from trying to spy on your new appointment practices by trying to call the receptionist.
27 posted on 02/15/2014 11:17:56 AM PST by kaila
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To: Political Junkie Too

A dear friend, who was grew up in Romania under communism, finished her basic medical training and wanted to be a surgeon. She was interviewed and told she must become a dermatologist. No arguments!


28 posted on 02/15/2014 11:22:49 AM PST by Churchillspirit (9/11/2001 and 9/11/2012: NEVER FORGET.)
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To: Churchillspirit

For once, the government got it right there. Dermatology: no call, less stress than surgery, insurance does not cover cosmetic derm- so you can set up your own medi spa with cash only payments.


29 posted on 02/15/2014 11:27:07 AM PST by kaila
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To: SeekAndFind

Repeal or revolution.


30 posted on 02/15/2014 11:28:33 AM PST by july4thfreedomfoundation (I don't want to feel "safe." I want to feel FREE!)
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To: SeekAndFind

Wow! He adds a lot of details I knew nothing about but it is exactly what I’ve been saying since before 0bamaCare became law in ‘09. Doctors will be unable to comply with the ACA and remain in business. The costs for them will exceed their income. It’s not just lower reimbursements it’s added office expenses to comply with mountains of new regulations.


31 posted on 02/15/2014 11:43:39 AM PST by TigersEye (Stupid is a Progressive disease.)
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To: SeekAndFind

The real price, or the RICO guaranteed to them, inflated insurance-medical price?


32 posted on 02/15/2014 11:45:23 AM PST by Varsity Flight (Extortion-Care is the Government Work-Camp: Arbeitsziehungslager)
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To: SeekAndFind

It won’t be all doctors. Just those who have student loans out to the government. They will become wards of DHHS.


33 posted on 02/15/2014 11:47:34 AM PST by raybbr (I weep over my sons' future in this Godforsaken country.)
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To: SeekAndFind

“What if someone can show them the money first? :)”

The real price, or the RICO insurance-medical no competition price?

No competition RICO


34 posted on 02/15/2014 11:48:06 AM PST by Varsity Flight (Extortion-Care is the Government Work-Camp: Arbeitsziehungslager)
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To: kaila

>>> They will not see you if you are self pay for some good resons. You may be able to afford the physician office visit, but what if you needed more complex treatment or scans?

That is a GOOD Reason???

They will not see us because the news might be bad???

They won’t see us because they don’t want to get sued for not providing free service?????

Are you kidding me???

that is NOT a good reason.

It is pure and unadulterated COWARDICE!!!

an EXCUSE to hide behind big sugar-daddy insurance companies!

Well guess what... big sugar-daddy insurance companies are about to fall on their Obamacare sword.

What will be the doctor’s “Good” reason be then?.. Hmmm?

Like I said... some doctors are just as socialist in thier thinking as Obama is.


35 posted on 02/15/2014 11:56:33 AM PST by Safrguns (PM me if you like to play Minecraft!)
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To: Safrguns
You have never been in the situation in which a person with no insurance comes into your clinic, pays for his first visit, then upon being told he needs an MRI, becomes teary eyed and states he cannot afford it. Then, the patient is looking at you like “solve my problem for me”. Then , it puts pressure on the clinic physician to get an imaging company to scan this patient with no way to pay. It also puts pressure on the clinic to find a physician who can take that specialty problem with no way to pay, All the while, the uninsured patient is looking at you like “ solve it. Its not my problem.”
So, if you want an appointment with a clinic with no insurance, be able to communicate and prove that you can afford the care on top of of your initial visit. Otherwise, you become too much work and liability for them for the small amount you pay anyway. You can be outraged- but that's the fact,jack.
36 posted on 02/15/2014 12:05:30 PM PST by kaila
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To: Vermont Lt

“The paperwork requires massive staffs and complicated record keeping and data storage.”

This is the life blood of bureaucrats.


37 posted on 02/15/2014 12:06:53 PM PST by dljordan (WhoVoltaire: "To find out who rules over you, simply find out who you are not allowed to criticize.")
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To: Mom MD

“Absolutely. Government can’t force me to do anything”

Wanna bet?


38 posted on 02/15/2014 12:07:35 PM PST by Lurker (Violence is rarely the answer. But when it is it is the only answer.)
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To: alloysteel
And if the Current Regime, in its wisdom, simply points a finger at someone and says, “Make a doctor out of him (or her)”, there is by no means any certainty that the candidate will ever be much of a healer, or even very good at carrying out the instructions of how to dispose of medical treatment problems.

Holder wants to outlaw businesses being able to do background checks because so many black men are convicted criminals...

I suspect "health care" could become a nightmare beyond belief if criminals are put in charge of people who can't defend themselves.

39 posted on 02/15/2014 12:09:39 PM PST by GOPJ ( America's drifting into totalitarianism because of left's exploitation of social failures.Greenfie)
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To: SeekAndFind

There are some misconceptions in this thread.
1. A lot of doctors don’t accept new Medicare patients. As far as I know, there is no reg reqiring Medicare providers to take on Medicare patients. I know of no case where a doctor was fined or sanctioned for not taking a new Medicare patient.
2. There is a specific process to opt out of Medicare. However, relatively few do because they are employed by a large hospital group, or if independent, they may accept other plans that require Medicare participation, or the hospital requires it for hospital privileges.
3. Most independent physicians accept self pay at the time of service. IOUs are not typically accepted. However, large hospital groups don’t
cater to self pay patients because the secretarial staff are not typically instructed to give out price quotes to prospective patients. In the past, self pay patents for elective procedures were simply sent a bill. But with inpatient costs so high, most large groups have generally avoided these situations. I would imagine that if the volume of self pay and high deductible policy patients become more prevalent, the hospital groups will need to find a way to cater to this sector on a more systematic basis.
4. Doctors are not as altruistic as Dr. Siegel likes to think. I can’t think of a time when doctors have been more demoralized. Working harder for less, the ruinous rules and regs do not bode well for the future. Doctors will not cheerfully chant patriotic tunes while skillfully performing surgery in the FEMA camps and city hospitals.


40 posted on 02/15/2014 12:38:09 PM PST by grumpygresh (Democrats delenda est. New US economy: Fascism on top, Socialism on the bottom.)
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