Well, the initial firestorm about the Healthcare Bill has been extinguished. Now, the ashes must be cleared and a road forward constructed. In this debate, there was little, if any, substantive contributions from REAL practicing physicians as to the merits of this grand plan and how it would effect the day-to-day doctor/patient relationship that has been the bedrock of medical practice from ancient times (Hippocrates). These ten predictions are from me to help you understand where we will be once Mr. Obama leaves office in January 2017 (an eleventh prediction!!). These predictions are based on solid data and a 25 year practice experience.
1. Up to 200,000 physicians will quit or retire. The average age of the practicing physician in America is 49. Each one of these doctors will take four jobs with him. The New England Journal of Medicine (liberal as it comes in medicine) actually predicted 250,000 doctors leaving practice. Well, you do the numbers. I will be one of them.
2. The Federal government will continue to decrease reimbursement to physicians in the Medicare and Medicaid programs to unsustainable levels. Doctors will be forced to join the new National Physician Manpower Corps or face economic disaster. This will happen in primary care first and specialist physicians will follow.
3. Many states will be driven to the brink of bankruptcy as more and more individuals will now qualify for Medicaid. In South Carolina alone, the estimate is 480,000 more people on Medicaid. The state will be forced to make drastic cuts in education, transportation and other programs to support this. Taxes will soar here and elsewhere to support these programs. California is looking at 3.2 Million more residents on MEDI-CAL! Who would want to live there?
4. Hospitals across the USA will close because of unsustainable cuts in funding and increased lawsuits. The border states of Texas, New Mexico, Arizona, and California will be especially hard hit as more undocumented people from Latin America come to the USA for health benefits. More jobs lost.
5. Pharmaceutical companies will have massive layoffs. They have already started as they are forced to pay higher taxes and receive less for their products through government programs, especially Medicare. Drug R&D will essentially be non-existent in the USA due to lack of revenue and liability.
6. Healthcare rationing will be implemented in small steps. The first programs to be restricted will be dialysis, organ transplants, oncology care, and neonatal services. (KIDS DO NOT VOTE) Vaccines will be in chronic short supply, if available at all, as the reimbursement will not cover costs. Ultimately, the FEDS will take over almost all vaccination programs.
7. The additional taxes to support the massive expansion in Medicaid, pharmacy coverage in Medicare, and coverage of illegal persons in the USA will accelerate unemployment. A permanent unemployment rate of 12-14% here will be a reality.
8. Abortions and other progressive initiatives will be covered by the new plans.
9. The government currently covers 55% of all lives in the USA by Medicare, Medicaid, and the military programs. Once that number exceeds 85%, a single payer system will take it all just like England and France. Think of what that will really mean for you and your family who have been perhaps accustomed to on-demand medical care with excellence.
10. Finally, as 10,000 baby boomers go on Medicare daily starting in January 2011, the Federal deficit will explode and likely top $22 TRILLION by January 2017. And do not forget Social Security, pension bailouts, and the California bailout will be looming. OUCH!
I do not know one doctor who would turn a patient away. This is not part of our "culture". However, the current administration has a general distain for physicians and their generally conservative values. Despite what many in the progressive movement think, physicians are small businessmen who provide jobs, pay taxes, provide uncompensated care, and support their communities at many levels. The NEW doctor who is left will likely have all of the compassion of their predecessors, but in the final analysis, will expect the same entitlements generally provided to most Federal employees, i.e. time and a half over 40 hours, paid health, dental and disability insurance, six weeks paid vacation plus CME and, of course, retirement with COLA!! (cost of living adjustment) I am glad that I was able to practice medicine at a time when the doctor/patient relationship really had value. This will not be the case in a single-payor Federal system as the system design does not allow that type of special relationship. Please share with me your thoughts but please base any criticism on sound facts not emotion.
Bless you all,
Dr. Salvatore Moscatello
Elms Digestive/Endoscopy Center
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