March 12, 2014

Federal programs turning doctors into bureaucrats

First Medicare and Medicaid and now Obamacare bind medicine with red tape.

As a general surgeon with more than three decades in private clinical practice, I can safely say that Obamacare is the culmination of the changes that I’ve seen in the way doctors practice medicine.

Unfortunately, these changes have been less progressive and more regressive, with medicine now the domain of pencil pushing rather than patient service.

This shift has been under way for decades. It began in the 1980s, when Medicare imposed price controls and a coding system on physicians who treated anyone over 65.

The regulators believed that such standardization would lead to more accurate processing of Medicare claims. Instead, it made doctors and hospitals wedge their patients and services into predetermined, ill-fitting categories.

Private insurers, starting in the late 1980s, began pegging compensation contracts to the Medicare code-based fee schedule, effectively extending Medicare price controls into the private sector.

The federal government imposed further regimentation on America’s physicians through a centralized bureaucracy known as the Centers for Medicare and Medicaid services — the same bureaucracy now in charge of implementing Obamacare.

Using so-called “evidence-based medicine,” CMS instituted protocols based on statistically generalized — rather than individualized — outcomes in large population groups.

It is easy to standardize treatment protocols. It is impossible to standardize patients.

Patients should worry about standardized clinical models that ignore the vital nuances of their conditions. Even more, they should be alarmed that the protocols being used don’t provide any measurable health benefits.

The spread of protocols and price controls has coincided with a steady ratcheting down of fees for doctors. Meanwhile, Medicare’s regulatory burdens on physician practices continue to increase, adding on compliance costs.

Independent doctors are increasingly selling their practices to hospitals, thus becoming hospital employees.

Enter Obamacare. Because Medicare’s price controls ripple across the entire health care industry, any changes to its fiscal stability will affect nearly the entire medical profession.

Yet in an attempt to keep Medicare fiscally stable, Obamacare pushes doctors to the sidelines through its “Accountable Care Organizations.”

Under this system, hospitals, clinics and health care providers are organized into teams that will get assigned large groups of Medicare patients.

These teams are hemmed in on every side by the practice guidelines and protocols approved by Medicare.

Once free to be creative and innovative in their own practices, doctors are becoming more like assembly line workers, constrained by rules and regulations. I want to serve patients, not fill out forms.

Thanks to ObamaCare, this is harder than ever before. It’s no surprise that many of my generational peers in medicine have gone part-time, taken early retirement or quit the medical profession for another field entirely.

Others are starting cash-only medical practices that accept no Medicare, Medicaid or private insurance.

As these old-school, independent-thinking doctors leave, they are replaced by doctors who need to know more about regulations and red tape than medicine or bedside manner.

Jeffery A. Singer practices general surgery in Phoenix and is an adjunct scholar at the Cato Institute.

Related content



Editor's Choice Videos