EDITORIAL: Obamacare forcing doctors out of private practice

Before Obamacare was signed into law in March 2010, the overwhelming majority of Americans had health insurance, and most of them were satisfied, if not very satisfied, with their coverage. One staple of that coverage: being able to see a physician at a private practice.

In the years following the law’s approval, President Barack Obama promised again and again that Americans would be able to keep their doctors once the greatness that is the Affordable Care Act was put in place. Now, not only are Americans learning they can’t keep their doctors, but that their doctors can’t even keep their practices.

Dr. Scott Gottlieb, a physician and resident fellow at the American Enterprise Institute, penned a commentary for The Wall Street Journal highlighting this problem — and how the ACA was written specifically to cause it. Dr. Gottlieb noted that reforms set to advance in the next Congress adopt many of the Medicare payment reforms already in the ACA, and that “both favor the consolidation of previously independent doctors into salaried roles inside larger institutions, usually tied to a central hospital, in effect ending independent medical practices.”

Simply put, Obamacare is making it financially impossible to run a private practice, particularly with regard to Medicare reimbursements. Dr. Gottlieb reports that Medicare pays far more for procedures at hospital outpatient clinics than at independently owned medical practices, including heart scans ($749 to the hospital, $503 to private practice), colonoscopies ($876/$402) and even 15-minute visits ($124/$70). Private practices are put on incredibly unfair financial footing, forcing them to sell out to hospitals, who are buying private practices to take advantage of the reimbursement difference.

Furthermore, Dr. Gottlieb notes, Obamacare’s payment reforms are all designed to favor hospitals, including this caveat: To comply with the payment plan, providers must control their own IT infrastructure — which can cost millions of dollars, making it all but impossible for independent doctors to take part. Obamacare is becoming so difficult and imposing so many burdens that doctors can’t make it pencil out, which inevitably will exacerbate the current shortage of doctors, especially those in family practice. In Las Vegas and everywhere else, doctors are retiring, refusing to accept insurance in switching to concierge-style medicine, selling their practices and consolidating.

Meanwhile, many prospective physicians who considered going to medical school are opting against it. American medical schools should have very high standards that weed out not only a large number of applicants, but poor-performing students, as well. It should take years upon years of training to become a licensed physician. But if this country continues to create an environment so hostile and expensive to navigate as professionals, why would anyone as bright and ambitious as a potential medical student put themselves hundreds of thousands of dollars in debt, and put their lives on hold for 10 years, for a profession so heavily micromanaged by a heavy-handed federal government?

The answer: They wouldn’t. Dr. Gottlieb rightly recommends that Congress turn this tide by enacting reforms that eliminate the favoritism the ACA bestows upon hospitals, and replace it with market-based reforms that allow doctors to keep their private practices.

Better still, this problem provides yet another argument for blowing up Obamacare in its entirety and starting over with not just market-based reforms for physicians, but for everybody.