What If They Gave Universal Coverage and No Doctors Came?

Dr. Dale fears that the hassle factor that physicians experienced during managed care’s heyday that pushed many into retirement may be repeated under compulsory universal coverage, state or federal: You know your practice is being monitored and counted under some form of pay-for-performance reporting requirement. What if they get your information wrong? That happens and takes a huge amount of time and effort to get things corrected. Added to that, Medicare reimbursement is supposed to decline by 9.9 percent in 2008. If that happens we expect physicians near retirement to throw in the towel.

Kissimmee, FL-based Maurice Ramirez, DO, who is board-certified in family practice and emergency medicine, sees nothing but trouble caused by compulsory state insurance plans. He foresees a 30% to 35% income reduction for physicians based on lower Medicaid and Medicare revenues and possible newly imposed taxes on their revenues. I talk to colleagues all the time who are desperate about this, who now hate the profession they once loved, he said.

An unintended consequence of single-payer insurance may be the creation of two classes of physicians. Dr. Ramirez explained: The government now tries to keep physicians involved with public payers by enforcing a five-year opt-out provision if they don’t take Medicaid or Medicare patients. If they add compulsory state insurance plans to that, doctors will have to search their souls and decide if they want to be in or out. If they opt out, they’ll go to an all-cash basis practice. He also raised a chilling scenario from the SARS outbreak in Canada several years ago: Ontario doctors were forced to work, threatened with firing or jail time if they didn’t. More than 30% left the system.

The American Medical Association’s Position

Physicians may be flummoxed by the AMA’s recent jump onto the covering the uninsured bandwagon. Its campaign, Voice for the Uninsured, indicates to physicians that this issue will not go away. The AMA plan’s three key elements involve familiar ideas: enable purchase of individually owned health insurance, establish income-related tax credits for purchasing health insurance, and facilitate the development of markets for purchasing individually owned policies (visit www.ama-assn.org/ama/pub/category/17712 . html to see the full proposal).

Underneath the AMA’s proposal, though, is the recognition of the daunting political and regulatory realities that makes providing universal coverage so difficult. The AMA acknowledges that existing regulations often have unintended consequences….The combination of guaranteed issue, strict community rating and extensive benefits mandates has had disastrous effects on costs, coverage and choice. In contrast, the American College of Physicians doesn’t advocate a single-payer system because it increases the risk of patients and physicians losing control of care, and may build in delays to getting care. It targets the fat in the system-i.e., private insurers getting 20% to 30% for administration costs versus Medicare’s 2% to 3% overhead-as money that could be spent on caring for patients.