Back in 2010, the good doctor who covered my patients on weekends closed her private practice because she predicted she would never be able to make ends meet. She was prescient, knowing that we doctors wouldn’t have the strength to pull the Obamacare cart. This was the new law’s fundamental flaw: It never considered us.
President Obama’s promise that you would get to keep your doctor was propaganda to me from the first time I heard it. Health care doesn’t work this way. How can you keep me as a doctor unless I decide to keep you as my patient? Don’t I have the fundamental right to choose? What happens if your health insurance plan pays me too little and overly restricts the prescriptions I write or the tests I try to order for your benefit?
How can you keep me as your doctor if your new Obamacare insurance policy doesn’t include me in its shrinking network and restricts out-of-network payments? And even if I am in your network, what happens if my hospital isn’t? Cleveland Clinic and Cedars-Sinai, two of the top hospitals in the country for patient care, are accepting only one insurance plan each from their respective state exchanges. My own hospital, NYU Langone Medical Center, is accepting only a minority of the plans.
And even if you can somehow manage to keep both your doctor and your hospital, you may not be able to keep your expensive lifesaving treatment. Even as medicine itself is moving in a personalized direction of robotic surgeries and cancer vaccines and predisease genetic manipulations, Obamacare is moored in the one-size-fits-all disease model.
Those of us who can escape the Obamacare noose will. Even as the main provisions of Obamacare are being shakily enacted, a new poll by the New York State Medical Society finds that 44% of doctors say they aren’t participating in Obamacare, and 23% aren’t taking patients from the failing health exchanges.
Your doctor’s unhappiness is a catastrophic problem that the new law didn’t anticipate and is not prepared to address.
Keep in mind that doctors already have a substantial history of trying to escape from highly regulated, low-paying insurance. Back in 2010, when proponents of the new law bragged about the expansion of Medicaid as a core feature, many doctors were dropping out of Medicaid. The 2011 National Medical Care Survey found that 31% of doctors said they would not take new Medicaid patients.
And it isn’t just Medicaid. The 2013 Medicare Payment Advisory Commission report reveals that only 73% of primary care doctors are accepting new Medicare patients. Last year, the Physicians Foundation surveyed more than 13,000 doctors and found that 7% plan to switch to a concierge or cash-only practice.
If your insurance is “comprehensive” but your high-quality doctor is paid little for working with it, it is likely that you will have to change doctors.
The idea that you could keep your insurance plan was more propaganda. Back in June 2010, the federal Health and Human Services Department, the IRS and the Labor Department published draft regulations for the new law that set standards for insurance plans. It was predicted that from 45% to 66% of those offered by employers as well as from 40% to 67% of individual policies would no longer be legal by 2013.
I covered this report on TV and in print, and I wasn’t alone. How could the head of Health and Human Services and the President not know about it? Yet the myth that you could keep your insurance plan was perpetuated.
Will you be able to keep your doctor or your insurance plan? No, frequently, you won’t. In the health care world of the near future, the waits will be longer and your care provider will have less training and experience. Your plan will cover more in theory — but you will get less care in the doctor’s office for a higher price.
If only creative solutions hadn’t been obscured by propaganda and partisan politics, we could have avoided the worst of Obamacare.
Siegel is an associate professor of medicine at NYU Langone Medical Center.
