INBOX: Physicians Recommend Dumping ACA

October 6, 2016

In our recurring blog "Inbox" we share comments from physicians and practice administrators telling us what keeps them awake at night.

Editor's note: We work hard to write about issues that will help physicians run their practices in a manner that is both prosperous and efficient, while still delivering quality patient care. And we are delighted when our readers let us know what they are thinking. This month we are excerpting an article by managing editor Gabriel Perna on physician frustrations with the current state of healthcare and the perceived failings of the Affordable Care Act. The article has been edited for space and is followed by comments made by readers at PhysiciansPractice.com.

Physicians are Frustrated with the Affordable Care Act

In an election year it's not uncommon to hear candidates talking about the differences between the present time and four years ago. When it comes to the Affordable Care Act and how physicians' view it, four years can make a world of difference. In 2012, 54 percent of physician respondents to Physicians Practice's Great American Physician (GAP) Survey said they supported the health reform law, 29.3 percent said they didn't support it but thought there were a few good things about it, and only 16 percent said they were strongly opposed to it.

Jump ahead to the 2016 GAP Survey and 47 percent of respondents say the ACA has done a great disservice to Americans. Forty-five percent take the middle ground saying, "I think it's mostly good, but not all good," and only 7.5 percent of respondents say, "I think it has been great for Americans." Nearly half of survey respondents (45 percent) say they'd like the next president to repeal and/or replace the ACA upon taking office.

Jordan writes: Everyone seems to forget that BCBS used to be the "public option." I'm in New York and Empire BCBS was the best insurance. Then, in 2004 Gov. Pataki (R) made a deal with Empire to let them go for-profit and no longer be state subsidized. The payoff was $2 billion. Immediately Empire doubled its rates year over year until they were the highest priced insurance in New York. The rates they pay doctors have gone from $35 in 1980 with no copay for an indemnity plan to $55 in 2016 including the $20 copay for a PPO plan. If you are keeping score that means Empire has charged hundreds of times more for the insurance but paid the exact same amount.

… ACA is not perfect, in fact it's pretty bad, but the biggest reason it isn't working the way it should is that there is ZERO competition for the big insurance carriers, you know, the "too big to care" people. They persuaded Congressional Republicans to force the removal of the public option. So now all there is is "Big Insurance" vs. "Big Insurance" and they don't care how much profit they pull. Even with limits to profits they maneuver money into "consulting" expenses and other shady tax scams and then use the money for bonuses.

I mean I literally file complaints daily about these carriers, like United and Empire,  that deny screening services that are guaranteed under the law. Just one hour ago I had Empire tell me they didn't deny a claim and that they don't have any EOB on file even though I have the electronic EOB on my billing system. They lie and scam because the penalties, if any physician or patient cares to complain, are so low it mean nothing to them.

… We don't need to get rid of the ACA without a plan in place. No "repeal and replace" because that will cause more of a problem. If you want to give breaks for poor patients have them sign a financial hardship form and you are OK. Otherwise be happy they have coverage if they wind up in a hospital, because if they don't, eventually the hospitals will close like over 40 have in New York and everyone suffers. There is so much more, but don't complain if you aren't willing to be part of a solution, otherwise you are just whining and it's getting old already.

Michael says: I tell my patients that they voted for President Obama twice, even after many were warned about his healthcare plan. As far as a single payer [plan] for folks who don't work - we already have it - it's called Medicaid. Obamacare was one big plan to make working Americans pay for those who don't work by charging them $60 dollar copays and $6,000 to $12,000 deductibles.

Osvaldo comments: "The ACA kind of inadvertently consolidated the money and the power in the hands of the insurance companies." The ACA was done by and for the insurance industry, nothing [was done] "inadvertently."

Stephen writes: The problems with our present day healthcare systems, the Affordable Care Act or Obamacare, [is that they] are inextricably linked to the inception of Social Security and Medicare. Back in the 1960s, Medicare was an idea of providing social service [and] health insurance to those over 65 and disabled, [to be] run by the federal government.

… The constructs in the 60s were about surgical procedures and medications in the treatment of diseases. They left out any possibilities of treatments for the spirit, mental, brain, and the muscular system. Today in my solo family practice, I've discovered some enlightening treatments which were in vogue, vetted, valid, and highly therapeutic discovered by physicians between 1940 and 1990. These treatments are age-old hands-on physical therapy options that Hippocrates used in his everyday practice. From massage, hands-on therapies, spinal and skeletal manipulation, traction, and hot needling. All of these treatment modalities have a modern scientific iteration which are related to acupuncture, dry and wet needling, prolotherapy, trigger point injections, bio puncture, and the like.

… None of those therapies are offered completely under Medicare mandates. As you know Medicare is the infrastructure for most all insurance policies. Thus most all insurance policies have guided the hands of physicians and how we think. So instead of thinking lower back pain plus massage equals resolution, modern physicians think lower back pain MRI plus epidural steroid injections or surgery. Surgery and epidural steroid injections do not work for this pathology of pain. Matter of fact those procedures are absolutely worthless for any pathology of pain. Yet we use them like they are a perfect match, harmless, and 100 percent effective.

If you're wondering why we have massive opiate overdoses and 22 wounded warriors per day committing suicide, this is the reason. There is no hands-on physical therapy options which are readily available for those who suffer in chronic and complicated pain syndromes.

The ACA is a distraction for the fundamental flaws embedded in the minds of all healthcare providers and all Americans.

Susan says: I am insured under the ACA in Illinois with the most prominent insurer. This is a total failure for those who are "required" to have insurance, but do not need ongoing care. I see my physician twice a year for an exam and bloodwork. I pay $6,000 a year for my policy that has a $6,000 deductible. So, let's see - I am paying $12,000 per year for coverage that I do not need. Even prescription medication is subject to the deductible. So if I do not get hospitalized, need surgery, or have a catastrophic illness, I am being taken for a ride by the insurer. As an older woman, I do not need the same type of insurance or care as a women of child-bearing age, and yet I am being penalized for it. After the election, we should look at a national healthcare system (Medicare) that everyone can buy into and the insurers can offer an "Advantage" plan to those under 65 years of age. Let's face it, we already have a system for it under Medicare for those 65 and older - let's expand it to include everyone who does not qualify for Medicaid.

Clay responds: Susan, I am so sorry you can't see the folly in your plan. The ACA is a disaster. It is fundamentally flawed by equating insurance with care. As you smartly demonstrate, you are paying a ton of money for nothing (insurance coverage) and then paying out of your pocket for your ACTUAL care. The problem is not too little government control; it is too much government control. Medicare is truly terrible insurance. As a physician, I could not keep my practice open if all my patients were Medicare only. In fact, anything over 25 percent to 30 percent [Medicare patients] is probably too much. Plus, most of the regulatory burden that you don't see comes from Medicare. If we go to a government-run system, many doctors will simply stop practicing. It would collapse the system. Simply stated, the government failed us with the ACA, your solution grants them even broader power and control which would only broaden their failure.

Susan responds: Clay, I am a registered nurse and have spoken to many physicians who cannot understand why we have not gone to that model. They understand that they will no longer make as much money in private practice and that is why so many of them have joined groups, hospital foundations, and Federally Qualified Health Centers that cover their malpractice insurance. They are making more than a "living" wage, have their malpractice covered, medical insurance, etc., and can work somewhat normal hours as hospitalists take care of all inpatients and call is rotated between all physicians in the group. It is true that you will no longer bring in upwards of $200,000 [in compensation] but that is a chance some of us are willing to take. There are many inner city hospitals and physicians that more than survive on nothing more than Medicare and Medicaid and live very comfortably.

Do you think it is time to chuck the ACA completely, or can it be salvaged? Tell us what you think at bit.ly/dump-aca.