Here’s a tip for those wanting to overhaul Obamacare: Ask doctors how to make health care more efficient. They can tell you where to find hundreds of billions of dollars in cost savings. But don’t imagine that you’ll get any useful insights from the American Medical Association (AMA), the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP) or most other big medical associations. Entrenched “professional” organizations like these are increasingly part of the problem.
These are depressing times for doctors in America. Real physician income is stuck in a decades-long decline. Adjusted for inflation, physician fees have fallen more than 25 percent since 1995. Indicators favorable to clinical practice are at or near record lows. The Physician Practice Environment Index for Massachusetts - the state model for Obamacare - has declined in 16 of the past 18 years. Once-routine clinical tasks have become bureaucratic nightmares. The average physician now spends more than four hours each week on insurance and regulatory paperwork. Frustrated and tired, doctors are cutting hours and giving up independent practices to become hospital employees. Forty-six percent of U.S. physicians are over the age of 55. One-third are considering career change or retirement.
Obamacare promises to make life even harder. The so-called Independent Payment Advisory Board is supposed to reduce Medicare spending by $500 billion but is powerless to do anything except cut payments to providers. Small Marcus Welby-type private practices are to be squashed. The White House has told doctors, “…Physicians need to embrace rather than resist change…The economic forces put in motion by the [Affordable Care] Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals….” In other words, forget private practice; prepare to be assimilated.
But it’s not just money at stake. Many doctors sense that “reforms” are undermining their integrity. While the Hippocratic Oath obligates doctors to act only in the best interest of patients, many health care activists and medical associations are pushing a “new medical ethics.” This says that physicians must consider “the needs of society” in their clinical decisions. In this new age, society’s needs are divined by government regulators. In his book “New Rules,” President Obama’s Medicare chief, Dr. Donald Berwick, explains, “Traditional medical ethics, based on the doctor-patient dyad must be reformulated…The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized individualized decision making.”
For many doctors, association support for Obamacare and this “new ethics” has been the final straw. Before, during and after passage of the Affordable Care Act (ACA), organizations such as the AMA, ACP and the AAFP worked hard to curry favor with the Obama administration and congressional Democrats. The AMA initially insisted on a fix for Medicare’s automatic sustainable-growth-rate cuts in physician payments; it then reversed course and prominently endorsed Obamacare without one. The ACP went further, calling the passage of the ACA “an extraordinary achievement” and “a cause for celebration.” Not to be outdone, the AAFP wrote every Congress member who had supported the law to “congratulate you on your extraordinary commitment to better health care.” Other associations simply chose to be intimidated. In a letter to members, the American College of Surgeons admitted that it had “been so quiet in voicing opposition to the legislation…[so as] to maintain a good relationship with policymakers.”
What explains this behavior? Money. Once genuine advocacy groups, many medical organizations have morphed into vendors that thrive on ever more credentialing, government regulation and administrative complexity. They fight to protect revenue sources, not physicians or the practice of medicine. The AMA is typical. Its membership has declined from nearly three-quarters of physicians to fewer than one-third today. Just 16 percent of revenue comes from membership dues; chicken feed when compared to product sales or its government-sanctioned monopoly on Medicare billing codes. Other associations rake in millions hawking products from medical education and certification programs to electronic records and liability insurance. Each new government initiative is an opportunity to sell new products and services to physicians who are forced to comply.
There are two take-home lessons. First, the public and our elected leaders should be talking to real doctors about real health care reform. Those in the trenches are in the best position to see the inefficiencies and insanities firsthand and to recommend practical solutions. They’ll tell you that what’s really needed is a massive simplification of the system, less administrative overhead and the substitution of efficient free markets for government price-fixing.
Second, it’s time for doctors to reform their own professional organizations. Powerful medicine is needed: mass membership cancellations and/or defections to true advocacy organizations such as Docs4PatientCare or the Association of American Physicians and Surgeons. The Great American Healthcare Debate is not yet over. Real doctors need to be included this time around.
Dr. Douglas A. Perednia is author of “Overhauling America’s Healthcare Machine: Stop the Bleeding and Save Trillions,” forthcoming from FT Press. He writes for the health care blog the Road to Hellth.