Much of what I keep hearing about from many fellow medical students and some teachers and/or mentors is how the new health care reform bill is going to ruin the way medicine is practiced. I consistently hear about how physicians are going to lose autonomy, that patients will lose freedom of choice, and that, ultimately, physicians will not be paid their due amount. Perhaps it is naivite and inexperience shining through, but I cannot reconcile these concerns with what I observe in the health care industry on a daily basis, and what is written in the recently passed health reform bill (http://thomas.loc.gov/cgi-bin/query/D?c111:1:./temp/~c111hQLRvd::).

First, I find it laughable that physicians think that a few more patients per month receiving Medicaid benefits will have any affect on their autonomy in discerning standards of care for different patients. There are two different arenas in which we will be able to observe the consequences of this legislation. In emergent situations, where standards of care are as established as death, taxes, and March Madness upsets, physician practice will not change at all. In fact, instead of having to render care free of charge at times, physicians will actually collect money for saving lives (novel, huh?). So this leaves us with the arena in which the majority of medical care is performed: non-emergent situations in clinics and private practice offices. And under no circumstances do I see evidence of the federal government asserting an influence on how this care is given. Certainly there will be new recommendations from Medicaid on what treatments/tests/therapies should be given and when, but will those recommendations be any different from the recommendations already laid out by the private insurers? Certainly any difference will not be drastic. Furthermore, it is ignorant to complain about the federal government and not about the private insurance industry. Run by what seems to be a gang of well-paid criminals, private insurers have systematically negotiated down prices for care given by physicians to the point that autonomy and just payment seem like ideals of a different era. Do not blame the young for not being able to relate to a time in medicine that existed three decades ago. To me, this bill is a step in the right direction for doctors to regain some of the autonomy that the cut-throats in the insurance industry have slowly sniped away from our grasp. After all, if a physician really does not want to be reimbursed by the Medicaid or Medicare, he or she can simply refuse to see those patients. It is not like that does not happen all the time with patients under different insurance plans.

The second argument I hear is that this bill will destroy patients freedom of choice in who their physician will be, and what course of treatment they will receive. To this I emphatically say bullshit! Nowhere in the bill (and I have not read it word-for-word, but have skimmed most of it) have I even picked up on the slightest suggestion of the federal government impairing the ability of the average person to elect a physician or treatment plan of choice. To the uninsured, the federal government is providing a source of funding to receive healthcare. And if one physician refuses to see patients on Medicaid/Medicare, then there will be another physician who will. Furthermore, for the privately insured there will be little in the way of changes. Perhaps the only tangible change for patients will come in the form of a safety net in case your insurer decides a pre-existing condition should alleviate them from having to pay for a bill – a stipulation that should actually increase choice.

Finally, out of justifiable self-interest I frequently hear physicians bemoan the inevitable decline in pay that will come with the passage of healthcare reform bill. This subject becomes tricky due to the inherent conflict of interest, and the concern is understandable. Unlike other nations that have nationalized health care, physicians in the US take on huge amounts of debt that typically requires years, if not decades to pay down. Therefore, doctors in the US ought to be paid more because they inherit an increased risk to undergo a long and arduous education. Having declared these beliefs, I cannot agree with the alarmists who claim that drastic decreases in physician pay are on the horizon. Just like Medicare reimbursement, Medicaid will payments will remain slightly less than private insurers. But is it not better to at least be paid for rendering services rather than be relied upon to care for people without any promise of compromise. Furthermore, while this bill may slightly reduce what specialists are to be paid, it increases the likelihood of primary care physicians receiving appropriate compensation. And in light of the quickly approaching shortage of primary care physicians, shouldn’t we be grateful for this necessary increase? Certainly I understand the argument put forth by the neurosurgeon who spends 10 hours in an operating room performing a highly complicated procedure that saves someone’s life – that given the complexity, duration, and risk in such a procedure, increased compensation is deserved – but it is innate to the modern practice of medicine that proper care be given to patients prior to needing emergency brain surgery. Herein lies one of the many reasons why health care prices have been spiraling out of control.

I am hopeful that the new health care legislation is simply a starting point from which we can build a more efficient and effective system. It is certainly not perfect, and like any new legislation, the flaws will become increasingly apparent with time. But to those who would argue that the status quo was good enough, I have two fundamental questions with which I will end: 1) does it do our economy any good to have 15-20% of our population unable to receive sufficient preventative care? and 2) seeing as predictions had our health care spending reaching near 30% of GDP by 2030, do you honestly believe that our nation’s economy could sustain such a lopsided investment?