Doctors in Nevada and across the country are protesting against the government’s intrusion into health care, but we aren’t voicing our concerns using bullhorns and pickets. Instead, many of the state’s 5,400 physicians are protesting silently through their practice decisions.
Having graduated from medical school 28 years ago, I have witnessed firsthand the transformation of our country’s health care system. Then, medical practice focused more on the deeply personal decisions made between doctor and patient. Today, however, bureaucrats are inserting themselves ever deeper into every aspect of health care.
Physicians across the country are responding to this evolution — and most recently the Affordable Care Act — by shielding their practices from government interference. Chief among them: Opting out of Medicare and Medicaid, transitioning to practices that don’t accept insurance, and starting “concierge” practices that charge annual fees.
All of these options ultimately serve the same purpose: They free physicians to spend more time with patients.
Consider the number of doctors opting out of or otherwise avoiding Medicare and Medicaid. In 2014, one in four physicians either refuse or are limiting the number of Medicare patients they see, according to a new study conducted by the Physicians Foundation. In recent years, a similar number of physicians simply stopped accepting Medicaid altogether. This is because of many factors, including unpredictable reimbursement rates and burdensome regulations, and more.
These ailments have become so acute that thousands of other physicians are dropping out of these government-run health care programs altogether. According to the Centers for Medicare and Medicaid Services, nearly 10,000 physicians opted out of Medicare in 2012 — a 160 percent increase from 2009. At a time when 11,000 baby boomers are turning 65 every day, this population segment can ill afford a shortage of physicians. Yet that is exactly what government intrusion into health care is causing.
Physicians are instead embracing practice models that limit government interference. This meddling can come either directly through government-paid health care — e.g., Medicare and Medicaid — or indirectly through regulations applied to private insurance policies — e.g., the Affordable Care Act.
For evidence, witness the emergence of “concierge” medicine and third-party-free practices. The first charges patients periodic membership fees; the second refuses insurance coverage altogether, thus dodging the government regulations that come with it.
The Physicians Foundation study found that fully 20 percent of physicians either practice or are planning to practice some form of concierge or third-party-free medicine. This number has doubled in only two years. No wonder: By eliminating the cumbersome insurance billing process, doctors can save an average of 40 percent in overhead expenses, leading to lower fees.
More importantly, doctors can spend more time helping patients, rather than fighting with insurers and bureaucrats on the phone.
Doctors are reacting to government intrusion into health care in other ways, too. Over the last decade, there has been a dramatic migration of physicians away from small private practices toward employed positions at larger hospital-owned medical networks.
As recently as 2008, fully 62 percent of physicians described themselves as independent practice owners. Today, that number has dwindled to just 38 percent. During that same period, the number of hospital-employed physicians surged, from 38 percent in 2008 to 53 percent in 2014.
This is a troubling trend. Hospital employment inserts yet another wedge between doctors and patients. On top of Washington’s regulatory burdens, hospitals make still greater paperwork and compliance demands. Physicians are thus dealing with multiple and compounding intrusions into the doctor-patient relationship — yet they have to accept it. Thanks to the Affordable Care Act and other bureaucratic attacks, they can’t financially survive as private practitioners.
Through all of this, doctors’ primary concern is our patients’ well-being. Yet Washington’s ever-increasing meddling limits our ability to help them. Until politicians and bureaucrats stop encroaching on the waiting room, the treatment room, and everything and everyone in between, more doctors will seek to help their patients by avoiding the government.
Gerard J. Gianoli, M.D., is a neuro-otologist who practices in Covington, La.