ACA is Unsettled, and so are Physicians

President Obama has pledged to reach across the aisle to address the nation’s problems. When it comes to healthcare, he needs to reach out to physicians.

Strip away the politics, ideology, and biases and achieving the ACA’s goals would lead to a much healthier country, fiscally and clinically, with a higher quality of life:

• Shifting from reactive medicine to proactive medicine tops my list.

• Focusing on prevention and wellness? Spot on.

• Spreading the insurance risk pool across the population? Another yes.

• Protecting patients from financial ruin resulting from serious illness? Sure thing.

This should be good news for everyone, especially physicians. So why does physician survey after survey overwhelmingly reflect the opposite?

Because how the ACA goes about achieving its goals inexplicably lifts physicians to the core of the solution while punishing them as if they were the core of the problem.

Although this and other miscalculations, including unintended and unanticipated consequences, create challenges, they are not insoluble; but a timely, or any, congressional solution is highly unlikely because:

• Public opinion, which has been forged and hardened by both sides with oversimplified, highly manipulative, and negative partisan politics, is now framed as wins or losses. This makes material changes untenable to both sides because they require taking on some of the “third rails” of politics such as tort reform, and, touching them can be fatal to political careers;

• The pols, pundits, experts, and functionaries heralding President Obama’s reelection as a vindication of the PPACA are just as disingenuous as those deriding it, further galvanizing public opinion pro and con; and

• The Republican dominated House is as committed to dismantling the program as the Democratic side is committed to stopping them. The stakes increase as states rebel mostly because they cannot afford to process millions of added Medicaid claims, which, among other costs, were dumped on them as unfunded mandates.

Congressional infighting and intransigence is likely to be further spurred as the rollout continues because:

• If even one of ten physicians, whether independent or employed, opts out of Medicaid, Medicare. or both when faced with the choice of opting out or failing financially, so much added financial pressure will be transferred to the rest, and opt-outs could quickly snowball;

• Credible studies show massive waste in the system, only one-tenth of which ACA purports to repurpose to expand coverage, and then by reducing Medicare reimbursements instead of effecting real reforms that would tap into trillions to expand coverage and spread the cost. Doing so would reduce per capita expenditures across the board would not only provide the resources to achieve the ACA’s goals, Medicare would be saved and annual cost increases would become reductions;

• The increasing cost of insurance, particularly the mounting financial bite of “consumer-driven” health insurance (huge deductibles dumping large, first-dollar preventative maintenance, episodic, and even some acute-care costs onto families) is a fiscal emergency in waiting for millions. Worse, it will accelerate to a population emergency as people forgo care and advance from preventable to chronic conditions; and

• Employers opting to pay far less expensive penalties in lieu of commercial coverage, tossing millions more into state Health Insurance Exchanges (HIEs), the cost of which, while being subsidized by up to 8 percent of income in tax credits, were calculated on the assumption that insurance costs would drop by $2,500 per year per family. Costs have already increased by $3,000, a $5,500 swing, and are rising, making the tax credit totally inadequate and pressing household budgets even further.

Add the looming “fiscal cliff,” and Congress and the president are facing very real and potent problems of their own making that no amount of rhetoric will solve.

The political and practical solution to effecting the change needed to achieve the ACA’s goals best lies not in congress or the president, but with the healthcare industry, particularly physicians.

How so?

Because practical solutions crafted by the people who have to succeed or fail by them are the best solutions. That’s why the president should challenge, and Congress should embrace, a solution by, for and from the health care industry, led by physicians, while honestly educating the public.

It is not only a workable political solution; it is an eminently practical one.