Doctors Not Excited About Affordable Care Act

Ask the professionals in the middle of federal health care reform their opinions about the future impacts and the answers are downright scary. In a new survey, doctors fear both short-term and long-term declines in the quality of care, while costs will only continue to increase. The National Center for Policy Analysis concludes:

America’s doctors have conducted a full examination of the president’s health reform law, assessing it in a number of variables, and have concluded that it will fail to live up to many expectations and will aggregately hurt consumers in the short and long runs.  Few people know more about the health care system than doctors working on the frontlines.

Policymakers should pay heed to their indictment of the Affordable Care Act and revisit the disastrous law, says Sally Pipes, president and CEO of the Pacific Research Institute.

• Nearly two-thirds of doctors expect the quality of care in this country to decline, according to a new survey from Deloitte.
• Nearly seven of every 10 doctors believe that medicine is no longer attractive to America’s "best and brightest."
• Seventy percent of doctors believe that long wait times will plague emergency rooms.
• Further, 83 percent of physicians foresee increased wait times for primary care appointments.

And doctors did not stop at criticizing the quality of care that health reform will deliver — they also addressed its likely impacts on the cost of health care.

• While Obama pledged $2,500 in health insurance savings for the typical American family, 90 percent of doctors believe that insurers will raise premiums for employers and individuals.
• This argument is supported by the non-partisan Congressional Budget Office (CBO), which estimates that premiums will actually rise for families in the non-group market by about $2,100.
• Richard Foster, the Chief Actuary of the Centers for Medicare and Medicaid Services, concluded that American spending on health care through 2019 will be $311 billion higher than if the law had never passed.

Many of these results stem from two large impacts of the law: shutting down health care facilities and sharply increasing demand as it extends coverage to millions of people.  Doctors respond to this latter "benefit" by pointing out that coverage counts for little if patients are unable to see doctors due to increased demand.

Laws Don’t Alleviate Doctor Fears

Fact: Doctors are worried about malpractice lawsuits.

Analysis: Such worries can increase actions that drive up health care costs. And a new study says that caps on economic damages are often not enough by themselves to take care of the problem. Health System Change reports:

Even in states with economic damage caps in malpractice suits, physicians remain highly concerned about being sued, suggesting that many popular tort reform proposals may do little to deter the practice of defensive medicine that contributes to unnecessary health spending, according to a study by researchers at the Center for Studying Health System Change (HSC) in the September Health Affairs.

“Our results suggest that many popular tort reforms are only modestly associated with the level of physicians’ malpractice concern and their practice of defensive medicine. The results raise the possibility that physicians’ level of concern reflects a common tendency to overestimate the likelihood of ‘dread risks’—rare but devastating outcomes—not an accurate assessment of actual risk,” according to the article.

“Whether justified or not, physicians’ liability fears are a policy problem because defensive medicine raises health care costs and potentially subjects patients to unnecessary care,” said Emily R. Carrier, M.D., senior HSC researcher and coauthor of the study with James D. Reschovsky, Ph.D., senior HSC researcher; Michelle M. Mello, Ph.D., J.D., a professor at the Harvard School of Public Health; Ralph C. Mayrell, a former HSC health research assistant; and David Katz, M.D., an associate professor at the University of Iowa.

The authors point to recently funded demonstration projects to test new approaches to liability reform, including alternatives to litigation that emphasize early disclosure and settlement of claims through less adversarial processes, as a way to address physicians’ liability concerns more effectively.

The Health Affairs article, titled “Physicians’ Fears of Malpractice Lawsuits Are Not Assuaged By Tort Reform,” is based on findings from HSC’s 2008 Health Tracking Physician Survey, which is sponsored by the Robert Wood Johnson Foundation, which also funded the study. The survey includes responses from 4,720 physicians who provide at least 20 hours per week of direct patient care and had a 62 percent response rate.

The survey asked physicians to indicate how strongly they agreed with the following statements based on a five-point scale, ranging from “strongly disagree” to “strongly agree:” (1) I am concerned that I will be involved in a malpractice case sometime in the next ten years. (2) I feel pressured in my day-to-day practice by the threat of malpractice litigation. (3) I order some tests or consultations simply to avoid the appearance of malpractice. (4) Sometimes I ask for consultant opinions primarily to reduce my risk of getting sued. (5) Relying on clinical judgment rather than on technology to make a diagnosis is becoming risky because of the threat of malpractice suits.

Between 60 percent and 78 percent of all physicians agreed or strongly agreed with each of the five statements related to malpractice concerns. Physicians agreed most strongly with the statement that it is becoming increasingly risky to rely on clinical judgment rather than diagnostic testing, with 78 percent either agreeing or strongly agreeing.