Free Markets, Free People

Alfred Bonati

Will Doctors Opt Out Of Public Option?

It appears at least some plan too. Dr. Alfred Bonati, who heads the American Society of Medical Doctors, says he plans to say “no” to accepting patients under a government run plan and, according to a poll he cites, so do an awful lot of other physicians:

Perhaps this is why a nationwide, nonpartisan poll of physicians this month found that a full 70 percent oppose the health care reform proposals under consideration by Congress. Sixty-six percent feel that a government-run health insurance plan would restrict doctors’ ability to give the best advice and offer the best care possible to their patients. Perhaps most importantly, 60 percent said they would not accept new patients covered by a government insurance plan.

His reasons are based in experience:

Nearly all the doctors polled have worked with Medicare. Most have likely been denied Medicare reimbursement, or given minimal reimbursement, for a course of treatment that they prescribed that best fits the needs of a patient and that patient’s family. They know that government coverage does not allow for flexibility, creativity, or, sometimes, even compassion.

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I share the view of the 60 percent in the August poll — those doctors who are planning to “just say no” if government-run health coverage is implemented. Many of us already do not accept patients who are on Medicare or Medicaid because of restrictions those programs put on our decisions as doctors. It pains us to turn away a patient in need, but the narrow rules of government reimbursement programs stymie our ability to follow our oath, so we simply opt out and work with patients who are also in need but have more flexible, private coverage.

If a government option gains the popularity that is expected — after all, who would not choose the most affordable option available, and how could any option compete with one that is subsidized by taxpayers — millions of Americans will face severely limited options in choosing a doctor. As physicians reject working with a system that does not honor our oath, patients will be left opening their own checkbooks, or going into credit card debt, to get the treatment they need and deserve.

The law of unintended consequences again raises its head. The government may indeed put a public option in place – whether or not the citizens of the nation want it or not. And they may, through legislation, force insurance companies to take everyone without exception, but -at least not at this point- they can’t force doctors to accept patients under plans that don’t feel reimburses at a rate commensurate with the care given or doesn’t allow them to treat a patient in accordance with the oath they took.

Of course that then leaves that system with a problem and the government with a dilemma – does it then force MDs to take anyone who applies (as it will insurance companies) regardless of insurance plan? And if so, how do you suppose doctors and other health care providers will react?

It is these sorts of problems, dilemmas and unintended consequences that few are talking about in this great “debate”. What if it is doctors who become the Atlas that shrugs when all is said and done. What options would the government then have – in this land of the “free” and home of the brave?

~McQ

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