From Raymond Kordonowy MD
March 25th, 2012

I just attended for the second time the Physicians' Counsel For Responsible Reform (PCRR ) in Washington DC.  I know I just sent out the latest Newsletter but I wanted to send this letter before my workweek starts.  Since the Supreme Court will start hearing testimony about the Patient Protection and Affordable Care Act on Monday, I felt it was important to get this out ahead of " The Greatest Show On Earth".


The Patient Protection and Affordable Care Act of 2010 is anything but affordable

Dr. Raymond Kordonowy MD 

This is the second time I have had the opportunity to sit and discuss the issues of delivering health care in the present economic environment to PCRR. There are now several physician congressman in DC who, like me, understand that individuals will not get good or affordable health care if it is controlled by the central planning methods outlined in this legislative debacle.
It is only partially in effect and already the Congressional Budget Office has on record stated that the tab is already running (upward) at 1.8 trillion dollars in costs to enact this legislation.  We were told it would (only) be 998 billion when this 2000 page tome was passed- what a joke!  By tome I mean a large work, but in this case certainly not learned.
As Americans, we have to ask ourselves "are we going to allow Executive branch designees/boards to force all of us into the activity of insurance commerce as they decide what things our forced purchases are going to cover"?  That is what this law does. It is completely absurd that we as citizens would relinquish our rights to be engaged in a free health care market in order to pay for what some appointed board decides is defined under health care. 
What if the board decides we all have to pay for each other's massages or Tylenol?  Are we all ok with having that wrapped into our "forced insurance premiums"? They already are trying to tell us we have to pay for all use of birth control -under the guise of preventive services, yet the individuals getting the pills can't pay anything out of pocket at the time of getting the service!  I guess one could define the prevention of the birth of a human being as a preventive service?!?  It doesn't matter if you might disagree with that being included in the definition because under this law, the Health Secretary has made that decision for you and me. This is much more than a religious issue, this is about Life, Liberty and the Pursuit of Happiness-and plain old common sense.  This birth control thing, by the way, is just one of the first "to be approved by the Secretary of Health" policies.  With the authority provided in this law, the Secretary of Health will be able to get into all aspects of your life, if it can be construed in any way as health related.  Is this freedom?
I am flabbergasted at the apathy of the American public and the physicians in this issue.  One of the physician attendees stated some Scottish philosopher (couldn't quote a name) had taught us that democracies tend to die out specifically because of the populous apathy that evolves over a democracy's life-cycle; I guess perhaps we are there?  If more of us, like myself, can wake out our slumber and understand what an absolute takeover this is, we can help our government retract this disaster and re-evaluate health care policy.  
The forces that need to be dealt with include: engaging true cost accounting/price disclosure in the market place, limiting monopoly and oligopoly forces that have gotten us into such an expensive, inefficient payment/contracting system and putting a stop to all the regulatory burdens that are creating provider inefficiency and increased delivery costs. 
Let me provide one example of how regulatory burdens affect efficiency and delivery costs. I can't provide you a less expensive professional visit if I am mandated to provide additional services at the behest of our government.  Before the government mandated the use of Electronic Medical Records, our group considered it a competitive advantage and thus we voluntarily purchased a system years ago.  Now the government has mandated the use of EMR.  Specifically because there is price fixing in place for Medicare, the government had to create a subsidy incentive to entice providers to buy these record systems. In order to justify getting the subsidy (and I suspect it was also a give away to the hardware and software companies), policymakers created a work list of rules that all approved EMR systems will have to be able to do. They did this in order for the providers to get a rebate (the government subsidy) on their forced/mandated EMR purchase.  The investment cost far exceeds the subsidy without including the time element that our administrative staff will dedicate to "prove we are worthy of the subsidy".

Because they decided the rules (rather than the providers and patients), our prior EMR company abandoned our product and we had to go to their newest version.  The is the one that will meet all the standards set by the federal government. We as physicians were forced by law to purchase an upgraded system at well over 6 figures for our four physician practice. It now takes more time to use the product than before and this translates to less doctor time for actual patient care. That is a drag on efficiency. Furthermore, because of our government price-setting, combined with a law that doesn't allow us to bill Medicare patients above that set price, your doctors are paying out of pocket for these upgrades (that's a direct tax on your doctor). Now patient consumers wonder why they can't find private practice physicians in the outpatient setting? If you have noticed the local newspaper ads, virtually all new doctors in the area are either Hospitalist or hospital hired physicians. Without the hospital subsidizing these infrastructure costs, new doctors can not make this financially work. Presently, hospitals can subsidize physician employees because hospitals get paid substantially more for the very same services physicians in stand alone operations get paid.  CMS, a board that advises Medicare patients, has decided to compensate hospitals substantially more than physicians. Hospitals aren't getting cut by the SGR formula, doctors are. Unless physicians can charge more than what the government is paying we will all slowly go out of business- it is that simple. 

Now with the mess Medicare is in, we are ok with the Patient Protection and Affordable Care Act?  This Act is nothing more than attempt to force a Medicare type (price fixing) model on all citizens.  It is such a predictable disaster that the Obama led legislation created an authoritative overreach by mandating we all buy this bill of goods (hogwash is a better word). That is why the federal government is mandating we all purchase health insurance from birth to death.  No rational person would buy this crap otherwise.
While on the plane to DC on Monday morning, I read Congressman Michael C. Burgess, MD's book titled 'DOCTORx in the HOUSE, a Physician-Turned-Congressman Offers His Prescription For Scrapping Obamacare... And Saving America's Medical System'. " 169 pages of a very readable book that explains what happened in Canada after it nationalized its health care system and how what is happening now is very similar. He is credible because he is a third generation physician who's father left Canada and whose grandfather thrived there as a physician before the government started running the health care system.  He was in Congress as a Texas member of the House of Representatives when the Obama administration decided to force this Healthcare agenda on America.  President Obama and his administration did this while the nation was dealing with one of the worst and expensive financial crises in our history.  Dr./Congressman Burgess very calmly explains the politics behind what happened.  He explains what insurance really is and why it is financially impossible for the President to make the claims he does. The President says that he can give us all more while it will cost us all less.  Only an apathetic or ignorant society could believe such panhandled hogwash.  I ask that you read his book so that you aren't ignorant to this most important modern issue. I learned a lot from reading this well written book. Besides being a 30 years in practice OB/GYN doctor, he has a Masters degree in Medial Management from the University of Texas at Dallas, which further adds to his credibility. He finishes the book with 9 common sense, doable policies that would go a long way to changing health care for the better, and bolstering the patient physician relationship, not abolishing it as the Patient Protection And Affordable Care Act will do.
Hopefully next week, after the Supreme Court hears the case about the unconstitutionality of the Patient Protection And Affordable Care Act this whole thing will be deemed unlawful and thus clawed back. The executive branch (yes folks, that's the President) needs to be handily told that forcing individuals into commerce is not a power our constitution gives the President or the Federal Government/Congress.  Hopefully when we vote for the President in November and hear further debates in health care, we are all mindful of this Act and the lessons to be learned surrounding its history.

Raymond Kordonowy MD
Internal Medicine Of Southwest Florida