Healthcare for me, but possibly not for thee

President Obama recently checked in to Walter Reed hospital with a sore throat. During his visit, it appears he received a suite of treatments to aid in diagnosing his illness, including a CT scan, a fiber optic exam, and ENT consultation. Ultimately, the doctors concluded that he has acid reflux.  

As the leader of the free world, Obama certainly deserves top notch medical care. Yet the breadth and quality of medical care that he received starkly contrasts with the diminished care that too many Americans could soon receive thanks to the Affordable Care Act. 

{mosads}As a physician, I strive to give the best medical care to every patient who walks through the door. The ACA has the potential to undermine my ability to do this in a number of ways. 

One example is the Patient-Centered Outcomes Research Institute (PCORI), one of the many bureaucratic agencies created under the law. The institute’s mandate is to conduct government-sponsored research comparing the efficacy of medical and surgical interventions. It draws its conclusions not from individual patient outcomes but on the average outcomes of a pre-set population. Many observers fear that federal regulators might use this research to limit or refuse to cover treatments that it deems “ineffective.” Medicare, for example, could consider PCORI’s findings when determining what procedures it will or won’t cover and how it will reimburse those interventions. This would limit patients from getting the care that they need and want. 

PCORI’s methodology is contradictory to the ethos of healthcare. Our profession cares first and foremost for the individual patient, every one of whom is unique. Physicians need the flexibility to treat not the “average” patient but the actual patient. Yet under the PCORI, physicians’ professional judgment regarding treatments for individuals could be replaced with rigid rules set by regulators. This would ignore the crucial differences between different patients as well as the various cultural, religious, and life experiences that patients bring with them to the doctor’s office. It should go without saying that government-set treatment protocols can’t meet the unique needs of every patient. 

Another potential patient-harming ACA programs is the Value-Based Payment Modifier (VBPM), which establishes an arbitrary cost limit for physicians involved in Medicare. Doctors who transgress this threshold will be punished with fiscal retribution. 

This also threatens to compromise patient health outcomes and access. A doctor nearing the VBPM limit may face a perverse choice whether to administer a necessary treatment. It will put tremendous pressure on physicians to avoid ordering tests, consults, or medicines that their patients may need—almost certainly resulting in worse medical care. 

Compounding these problems will be one of the most-controversial bureaucracies created by the ACA: The Independent Advisory Board (IPAB). Composed of fifteen unelected bureaucrats, IPAB has the power to “recommend” legally binding cuts to Medicare in an attempt to hold down spending. Most of these cuts will take the form of lower reimbursement rates for doctors and hospitals. 

This, along with other provisions of the law, makes it highly likely that many doctors could no longer afford to accept Medicare. As a result, patients will have a harder time finding it. Ultimately, this will result in longer waits for the patients who need care the most. 

At first glance, the three examples I’ve named mainly apply only to Medicare. Yet trends in Medicare inevitably influence—and even dictate—trends in the private insurance market, as studies in recent years have demonstrated. Changes in Medicare reimbursement rates typically lead to changes in private insurance reimbursement rates. Similarly, insurers typically mimic changes in Medicare coverage. 

Given these trends, the Affordable Care Act is likely to lead to longer waits, restricted access, and worse health care for a significant percentage of patients. 

Which puts Obama’s recent medical treatment at Walter Reed in perspective. He received a series of expensive tests and interventions that helped identify and treat his acid reflux. Yet thanks to the Affordable Care Act, John Q. Patient may not be so lucky. 

Fodeman is an assistant professor of medicine at the University of Arizona and a board-certified internal medicine doctor. He specializes in healthcare policy.


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