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Doctors Differ In Diagnosing Supreme Court Ruling

Joe Cantlupe, for HealthLeaders Media, July 5, 2012

Physicians opposed to healthcare reform may feel like they're caught in a "Back to The Future" scenario. All that hope and hype over lawsuits against healthcare reform for the past two years has gotten physicians squarely back to 2010, when it all started. With the U.S. Supreme Court generally reaffirming the Patient Protection and Affordable Care Act, docs are trying to decipher their own diagnosis for what's ahead.

Many physicians who deride healthcare reform call it "Obamacare," just as disapproving non-healthcare professionals do. Should they now call it "Supreme Court care," too? In its 195-page decision, the court mentioned the word "physicians" only twice and "doctors" not at all.

In case you somehow missed it, the court was sharply divided, voting 5-4 to uphold the key provisions of the PPACA, including the controversial individual mandate that requires people to either purchase health insurance or pay a penalty. Chief Justice John Roberts was the deciding vote. The court also left it up to the states to expand Medicaid coverage.

Indeed, as the court was divided, so, it appears, is the population of physicians, much as they were before. Some say the court did the right thing, and the PPACA will properly bring millions more uninsured people into healthcare. Others contend it was a bungled effort at overregulation. Both sides seem to be uncertain over what the Medicaid ruling may bring. "It was the right thing to do," says one doc. "It was the worst decision ever," says another.

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4 comments on "Doctors Differ In Diagnosing Supreme Court Ruling"


R Daniel King (7/7/2012 at 11:05 AM)
The Center for Medicare and Medicaid Service has utilized price controls and regulations to control costs and quality respectively. Price controls for centuries have cultivated poor quality, fraud, lost talent, shortages, surpluses, organized crime etc. And federal regulations have extinguished innovation in the delivery system masked by the innovation in industries not subjected to price controls but sell great innovation in medical technology and drugs to the delivery system. Price controls have caused the quality chasm identified in the 1999 Institute of Medicare Report, and to this day, poor quality is still a cash cow as CMS uses savings from price ceilings to reimburse preventable medical errors (minus a few). When Intermountain Health System focused on preventing medical errors, it took a loss on every Medicare patient because CMS price ceilings underpay excellence. Price ceilings have caused a shortage crisis in primary care physicians. Plus, the limits in income contributes to the "less than stellar" medical school applicants in recent decades as the talented students choose price control-free careers. Price floors have resulted in overpayments to cardiologist (recently and painfully corrected) creating years of surpluses and waste. The same for CT scans because CMS's pricing system is slow to respond to technological advances that lowered costs while increasing value. Decades of CMS underpaying excellence has made excellence a cultural misfit in the nation's inefficient, quality challenged healthcare delivery system with few exceptions. And decades of government rewarding failure has filled the quality chasm with a culture of failure that ObamaCare puts on government steroids which makes ObamaCare a dead program spending just like Maine's Dirigo Health, Tennessee's TennCare, and Hawaii's employer mandates.

Tyco Brahe (7/6/2012 at 11:14 AM)
For those who decry government intrusion: The government ONLY has to step in when the private sector has failed. Medicare, SS, Medicaid are ALL programs that the government was forced to [INVALID] because the private sector ignored vulnerable populations. This healthcare reform law is the same. If 1/6th of the country weren't left uninsured because private insurance cost so much, the government would not have to step in. As for expanding Medicaid, just because some doctors don't take medicaid doesn't mean no doctors will. In fact, city hospitals and community health centers ALL take medicaid. If doctors won't take the insurance, watch nurses and PA's suddenly start getting the right to give direct primary care. You cannot leave a large chunk of America without care just because doctors won't take government insurance. The rules will all change. This is all a bump in the road to single-payer medicine. All the other developed countries have figured it out. We will too. Insurance companies and provider greed have forced the hand of the government.

Jay A. Hendrickson, M.D. (7/5/2012 at 5:02 PM)
The reason we are in the current Healthcare predicament is because of governmental intrusion. Where has the government stepped in to a business and made it more efficient, streamlined and overall better? That is correct- NEVER!!!!! As a physician I refuse to work for free, as I did during residency and fellowship. Medicaid pays about 9 cents on the dollar here in California. I can not run a practice without getting pain for the work that I do for the patients. Expanding Medicaid is USELESS. How many physicians, other than University physician, even take Medicaid? None in my area! I also find it amazing how some physicians are happy with this Federal Law. It is equivalent to having a prostitute teach your children abstinence- it makes no sense. As far as the AMA is concerned, I have not been a member for over 10 years now and 80-85% of my colleagues agree with me as only 15-18% of physicians are members. So all of you that think this is a good law, then you can see those patients for free, because your reimbursement will be ZILCH!!!!