Physicians' Opinions Vary Widely on Health Care Reform

When President Obama invited 150 doctors to discuss proposed health care reforms in 2009, two of the physicians in attendance offered radically different views of the proposed legislation. They were Dr. Hershey Garner, an oncologist from NW Arkansas and Dr. Donald Palmisano. Garner is a member of Doctors for America, which backs the legislation. Palmisano represents the Coalition to Protect Patient Rights, which opposes the law.

Garner expressed his satisfaction with the Medicare system and dissatisfaction with health insurance companies. He stated that under Medicare, he is able to obtain the studies and procedures that patients need. The same is not true under for-profit insurance. Garner said, "Instead of this mythical government bureaucrat, I have an insurance clerk standing between me and my patient." He believes the new law will remove control from the hands of insurance companies and place it in the hands of patients and doctors, where it belongs.

Palmisano strongly disagreed. He said his colleagues "certainly believe there need to be changes in the current health delivery system...but...Congress ought to slow down." He is concerned that the legislation will "run the private insurers out" and result in a need for universal coverage by the government.

Almost two years after the Patient Protection and Affordable Care Act (PPACA) passed, it is still being hotly debated and physician opinion is divided. The legislation won the endorsement of an impressive array of physicians' organizations: the American Medical Association, the American College of Cardiology, the American Academy of Family Physicians, the American Society of Anesthesiologists, the American College of Surgeons, the American Academy of Pediatrics, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, the American Psychiatric Association, and the American Osteopathic Association.

Since these groups represent hundreds of thousands of doctors practicing several specialties, it would appear that doctors in general embrace the new law with enthusiasm. However, a recent Reuters poll of 2,958 doctors from 50 states indicated that 65 percent of respondents felt that health care would decline in the next five years. A full 74 percent believed that the changes in the law would make their reimbursement less fair.

What is causing the apparent discrepancy between these points of view? A blog from Dr Vivek Murthy, attending physician at Brigham and Women's Hospital and Harvard Medical School and her husband Harrold Pollack of University of Chicago examines this issue.They state that this is a time of anxiety among physicians who are now under pressure to join ACOs and adopt electronic medical records technology. They worry about how their reimbursements will be impacted.

Murthy and Pollack report there is widespread misunderstanding. Doctors are too busy running a practice to take much time to study the new law and its implications, and instead rely on news commentators and the advice they get from their associations on how to deal with the new regulations. Murthy and Pollack believe that as the law takes effect "physicians will see that it is, indeed, a big step in the right direction."

According to Dr Cecil Watson, president of AMA, the new law will:

- Extend affordable health plans to 32 million uninsured Americans

- Expand benefits for preventive and wellness services

- Close the Medicare doughnut hole

- Provide for continuing research to improve primary care

- Expand market competition

There is a great deal of uncertainty about both how well the new system will work and how it will be paid for. Increased efficiency will help. This still leaves a lot of money to be raised through taxes and Medicare premiums.