DO Family Physician’s View of PPACA Obamacare

claim: ACA will decrease the clout of insurance monopolies:
reality: The affordable care act (the ACA) empowers insurance companies and expands their power to control healthcare in a way that may be catastrophic for community based primary care doctors. The ACA does this by giving strategic preferences, through accountable care organizations, to large monopolies who can support and develop metrics necessary to run such organizations, and which further, can only be derived by institutions with huge IT and Mathematician (Statistical) budgets. The ACA seeks to structure healthcare competition in a way which will be profitable only for the monopolies which it seeks to create. These monopolies will then directly compete against community based physicians, in a patently unfair playing field. The ACA incentivizes these created monopolies to hire unqualified (but inexpensive) non physicians (nurse practitioners and physician’s assistance ) to directly compete against DO’s and MD’s in primary care, and perhaps in other fields as well. The above referenced phenomena are obvious and real, they will not decrease the clout of insurance monopolies, but instead will create new monopolies, and will strengthen previously existing monopolies many fold.

Claim: PCP’s will be aided by the ACA
reality: Funding for Medicaid will skyrocket under the affordable care (the ACA). A large portion of the patients, newly “created” by the ACA, will be covered only under Medicaid. Primary Physicians, will therefore, not be substantially aided, unless the PCP accepts a large mix of Medicaid patients. Not only is it not financially possible for most primary care osteopaths to accommodate a large percentage of Medicaid patients, but doing so will be exceedingly hazardous. I would like to bring your attention to the June 8 2013th issue of the American medical news, please see the article entitled: “Medicaid’s mounting audit pressure” in which the AMA alleges that “a new auditing program that rewards contractors for identifying improper payments” is being created and “healthcare professionals who treat Medicaid patients are being warned to prepare for more audit activity”.
Even if accepting Medicaid patients were miraculously to become “an aid” to primary care physicians, we would still be harmed by the ACA. This is because the ACA imposes upon community-based primary care physicians marked increases in unfunded governmental mandates. These massive overhead imposition include electronic health records whose costs can be astronomic, and who’s dysfunction frequently impedes patient care. To make matters worse, the enormous unfunded governmental mandates created by the ACA, comes synchronously with movements on the state levels to have nurse practitioners be given the same recognition, and rights to practice as primary care osteopathic physicians. This production of a large class of “pretend physicians” will further aid the monopolies which the ACA will create in competing against real and legitimate doctors. The ACA further empowers insurance companies, retail establishments ( Wal-Mart, insurance companies) to take the most profitable part of our practices ( upper respiratory tract infections, acne, low back pain) and leave us with only the most difficult and least profitable cases. I don’t see how that represent an environment in which PCP’s will thrive.

claim: small businesses and patients will benefit from the ACA
reality: the ACA offers little more than a convenient internet site through which consumers can organize and purchase insurance. The ACA had initially promised to decrease healthcare costs by creating mechanisms which would incentivize insurers to decrease their profits in order to participate in a system where they would be confronted with a simple choice: decrease profits and benefit from volume, or be excluded from the marketplace. That tact would have benefited physicians and consumers alike. Alas, this market strategy was derailed by the influence of insurance company lobbyists. As it stands, the ACA currently does nothing to increase competition among insurers, in fact, since the ACA mandates insurance coverage, and penalizes the lack of such coverage, and since the ACA does nothing to increase competition among insurance companies, then the ACA paradoxically destroys whatever diminutive current market incentive may exist among insurers to compete! This anti-competitive consequence of the ACA will NOT reduce insurance profits (and the subsequent cost of healthcare) but instead will increase the cost of care in a way similar to what we experience in NJ in the auto insurance arena

My concerns over the provisions and potential consequences of the ACA are not fatuous. The ACA will enable, incentivize, and give strategic advantage to monopolies. Insurance companies, retail businesses, and medical schools will compete directly against primary care doctors. I am fearful that this new medical economic reality will destroy the ability of community-based primary care physician to operate successfully. Because primary care community physicians remained the backbone of Osteopathy, the devastation of this cohort will, over the course of a couple of decades, lead to the extinction of the Osteopathic profession.

The concerns listed above, should lead prudent physicians to take an analytic approach to the ACA, and should compel all Osteopathic Physicians to think hard about how we should respond to its challenges.


Bradley Kline DO

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