I was in for a checkup today and asked him about the Obamacare plan. I really like him. He is an excellent physician. SWMBO (the RN) hand-picked him. Here is what he said.

1.  It will work out well for him financially – he’s a family practice, primary care doctor and this is the direction they are pushing. He will make more money.

2.  He really dislikes insurance companies. He has to work hard to get paid by them. They are a real pain for him. Getting approval for patient procedures is a pain.

3.  He said he only pays $15k per year for liability insurance. His position was that good defensive care prevents a lot of problems. Tort reform is insignificant he feels.

4.  He said that Medicare always pays and he never has any problems getting procedures approved.

5.  He felt that the insurance companies were fairly evil and would survive.

6.  He felt there are too many specialists who aren’t needed.

7.  He said the US lags behind the rest of the world (Canada, France and England) in the killer diseases and they have better life expectancies. He said cancer is not a major killer.

8.  The 30 million Americans without health insurance have a high proportion of people who simply won’t see a doctor enough to benefit from preventative care. He felt that this places a huge burden on the system to treat their acute cases which could be prevented.

9.  He told me that I would always be able to pay for premium care.

10.  He understands why a lot of doctors refuse to accept insurance and only care for the wealthy.

I was surprised to hear his opinions and have thought about them for a bit. Here is my response to him.

1.  I don’t really care if it works out to his advantage (I’m selfish). I’m not sure where he got the idea that Obamacare would funnel patients into the arms of primary care doctors, perhaps it’s tue. I also feel that he is still in the initial stage where everyone gets a B. I don’t think he’s thought through the implications of this system yet. If I were a businessman I wouldn’t want the government to control my income.

2.  I agree. Add this to the list of things to work on.

3.  $15k per year is small change to him. He hasn’t thought about how much of my premiums are going towards lawsuits. Car insurance rates are lowered when I agree to not sue. Wouldn’t this work similarly with medical coverage?  I almost missed the significance of this comment. There are two big factors here working against my interests – unnecessary procedures or tests and the fact that the doctor gets paid more if he does more. Dartmouth recently released a study that concluded that one third of all medical procedures were unnecessary (Dartmouth Atlas of Healthcare). Did you catch my doctor’s comment about ‘defensive medicine’ being a preventative measure against lawsuits. Do everything and you’re less likely to get sued – you get paid more to boot! Can anyone tell me that if the threat of frivolous lawsuits were removed, my doctor would prescribe fewer tests and procedures? I trust him, but this system is tilted against lowering costs. I agree that this system is broken and we need to make some changes.

Even the CBO sees some benefit to reforming the legal landscape –

CBO now estimates that implementing a typical package of tort reform proposals nationwide would reduce total U.S. health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of a direct reduction in spending of 0.2 percent from lower medical liability premiums and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services. (Those estimates take into account the fact that because many states have already implemented some of the changes in the package, a significant fraction of the potential cost savings has already been realized.)

Enacting a typical set of proposals would reduce federal budget deficits by roughly $54 billion over the next 10 years, according to estimates by CBO and the staff of the Joint Committee of Taxation. That figure includes savings of roughly $41 billion from Medicare, Medicaid, the Children’s Health Insurance Program, and the Federal Employees Health Benefits program, as well as an increase in tax revenues of roughly $13 billion from a reduction in private health care costs that would lead to higher taxable wages.

The benefit of tort reform isn’t for the Doctor. It’s for the insured. Hospitals would benefit greatly if law suits were limited. This would lower their costs and my insurance premium. Hospitals don’t have the advantage of practicing ‘defensive’ medicine. They can’t afford to perform ‘every’ test just to be on the safe side, unlike the doctor who gets paid more when he prescribes more tests. Crazy system, isn’t it?


Update –
Perhaps my doctor is unaware of the provisions in the proposed bills – the top 10% of doctors who refer patients to other experts (remember defensive medicine) will be penalized with lower (20%) reimbursements across the board. He may not be in the top 10% initially, but this ratio doesn’t ever change no matter how few referrals you make. The top ten percent get punished. I guess this also fits into his understanding of how the bills would benefit primary care doctors.

4.  Wow – this doesn’t agree with what I’ve read. In the AMA’s own 2008 National Insurers Report Card.  The chart below appears on page 5 of the 16-page report.


Of the eight insurers listed, Medicare is most likely to reject a claim, sending away 6.85% of requests.  This is more than any private insurer and double that of the private insurers’ average!

5.  I agree with the evil part, but as far as survival goes……..

6.  This may be true. Why does it matter? Wouldn’t this make them worth less? That Dartmouth study had some interesting data on this subject. The more doctors there were in an area, the more tests were performed. There is a tendency to perform more tests and procedures when there is competition. If you have less patients, you make up for it by performing more tests.

7.  He downplayed the top of the class cancer treatment we have in America. Cancer isn’t the real killer he said – heart disease, stroke and diabetes are. He felt that the countries with socialized medicine have much better quality of health than the USA.

From the CDC’s 2006 Death and Mortality (US) data:

  • Heart disease: 631,636
  • Cancer: 559,888
  • Stroke (cerebrovascular diseases): 137,119
  • Chronic lower respiratory diseases: 124,583
  • Accidents (unintentional injuries): 121,599
  • Diabetes: 72,449

From Carnegie Melon’s Death Risk Rankings:
(deaths per Million)

Death Risk Rankings

Cause of Death USA Europe
Total 8,931 10,375
Blood diseases 35 26
Cancers 2,075 2,562
Circulatory system diseases 3,444 4,514
Congenital defects 16 12
Digestive system diseases 318 474
Endocrine/metabolic diseases 363 268
Ill-defined symptoms/causes 100 348
Infectious and parasitic 230 116
Mental and behavioral 197 194
Musculoskeletal diseases 53 45
Nervous system diseases 370 241
Non-cancerous growths 50 72
Perinatal problems 0 0
Pregnancy/childbirth 2 1
Respiratory diseases 864 792
Skin diseases 15 16
Suicide 115 133
Urinary tract diseases 214 151


So my doctor was off a bit. Cancer is very significant (#2) and our death rates are lower overall than Europe’s.

8.  I agree on this point. Some people just don’t want medical care, but I’m not sure what we can do for them besides lowering the cost or force them to see a doctor regularly. They won’t be anymore anxious to see a doctor if there is any additional waiting involved even if it’s free. The bottom 4% really need our help though.

9.  Sigh, not all of us are doctors (he drives a Porsche) or small businessmen.

10.  Just like Canada – you can always pay and there will always be someone to take your money.

My doctor and I are just not on the same page in regards to this issue. He is looking at things from a business perspective and I look at it from the customer/consumer perspective. He reasoning that this will help his business is very thin. If he starts to make more money in a government controlled healthcare system, the government will surely see that as unfair and makes some adjustments. I’m sure the government will set medicare style rates for every procedure (lower than what he gets now). Perhaps he thinks that he’ll just make up for it in volume.

Interesting Update –

Nice essay by the One’s cousin (a doctor) on the looming Obamacare Fiasco. The difference between price and cost seems to be causing a first family feud….
Washington Times article – HERE

Leave a Reply