Limited Options: in the wake of Obamacare


What are they trying to prove?

With this Obamacare groove?

We have limited choice

And limited voice

If worst comes to worst, we can move.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. This summer included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, and two weeks a month working Urgent Care in suburban Pennsylvania. I’m attending a medical conference in Denver.  Any patient information has been included with permission.

After lunch I sat in on a round table with a group trying to get out the message on a single payer system.  Our insurance companies currently take between 20% and 25% of our health care dollar and return nothing of value (physicians get 9%).  For every doctor we have two people employed by the insurance industry.  Doing away with the insurance companies would not cure all, but it could go a long way.  A doctor at the table made the comment that we already have a model for a single payer system in this country, TriCare, which gives medical care to Department of Defense, and the Veteran’s Administration.

Yet American doctors love to hate the single-payer Canadian system.

We all voiced frustrations with currently available Electronic Medical Record (EMR) systems.  Updates uniformly brought progressive loss of functionality.  The VA’s system, in use for decades with no updates, continues to function well.

I talked about my experience in New Zealand, a polite society with a very good medical system and a single, nation-wide EMR.  Socialized medicine, but ruled by reason.

Doctors in the US have seen their productivity fall by 25% since Obamacare; we spend increasing amounts of time keyboarding and jumping through regulatory hoops.  We devote more time to documenting the visit than we spend with the patient.  We have few options:  live with the way things are, move, find another line of work, or go to Direct Patient Care (DPC).

DPC means that the patient pays the doctor directly.  In concierge practices, a fixed yearly amount brings the doctor’s promise to limit the panel of patients to a fixed number and provide quick access with unlimited long appointments.

Other DPC docs perform primary care services, take cash only, and give the patient a receipt.  The patient can, if they choose, submit the bill to the insurance company.  Dealing with insurance requires one employee per doctor; elimination of insurance means lower overhead.  More than that, senseless time-sucking regulations can be ignored.

I hear doctors speak seriously about moving.  They would take a cut in pay to spend more time with patients and deal with a more reasonable system, even a single-payer system.

I want to work in Canada to experience it first-hand.  And when I come back, I might work locums for the Department of Defense and/or for the VA.

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One Response to “Limited Options: in the wake of Obamacare”

  1. Jonathan Taylor, DO Says:

    The single worst example of a single payor system is in the US, and called IHS. If we accept government control over health care, then we lose as the insurance companies and the govt can cause us to jump thru many hoops.

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