Obamacare rules – free drugs, free healthcare and free speech?

True progress in healthcare reform will only come with the expectation that leaders will heed the will of their constituents.

SAN DIEGO, July 26, 2012 -The fact that Big PhRMA worked with the White House in the run-up to the passage of the Patient Protection and Affordable Care Act, then summarily discarded many of their top executives and lobbyists to re-engage/re-challenge the new law once passed, is interesting (but not, as some have suggested—IBD, Galen Institute—collusion).

While big pharmaceutical companies will win under Obamacare if Accountable Care Organizations (ACOs) allow enough high-profit brand prescription drugs to remain on formulary, they will also take on an increasing risk with every new multi-billion dollar R&D plant they build because discovering the next big life-saving pill is risky business. Selling costly and innovative drugs at or below cost to tens of millions of new Obamacare customers isn’t exactly an attractive investment model for shareholders.

Physicians and currently insured patients, however, lose big under most aspects of the new health law. Due to bundled services and decreased, capitated reimbursements, doctors will get paid less from a shrinking pie; patients meanwhile will struggle with longer lines, delayed treatment plans, and less ‘face time’ with medical doctors. Although America produces the world’s best nurses and other allied healthcare providers, patients will miss their time spent one-on-one with a physician of their choosing.

Obamacare cannot succeed in lowering costs and expanding access to services without empowering non-medical “providers” with medical-degree relegated tasks.

This change toward non-M.D. trained individuals will not always be bad, and can lead to better task-specific allocation of our health system resources, but patients have only to look toward Canada, Great Britain, and other national health system countries to see that their healthcare will soon look uncomfortably different. Try telling a 60-year old daughter with a rare type of inherited cancer that she cannot receive the same arsenal of chemotherapeutic drugs that her older sister accessed only a decade earlier.

There is a reason that America out-competes nearly all other developed countries in older-life survival for almost all forms of cancer—it is that we do not yet require people to fall into statistical flow-chart templates before being approved by a mysterious ‘board’ to allow treatment to proceed.

One new aspect of today’s healthcare political landscape that will impact how busy doctors receive first-hand information about new drugs is called “academic detailing” (or “counter-detailing”). Here, government-contracted nurses and pharmacists will meet with doctors to offer the government’s point of view on expensive pharmaceutical treatments.

Any impartial observer will question whether neutrality and fairness at the hands of government ‘detailers’ will be preserved. In 2009, Senator Kohl introduced The Independent Drug Education and Outreach Act to put limits on how detailing programs receive funding and what educational materials can be disseminated by these federally-promoted detailers. This legislation never advanced to law. Is the government over-reaching by applying more of your tax dollars to not only expand the health system as a whole, but concurrently also promote informational spin on how to practice medicine?

Thanks to the new PPACA law, retail drug spending is projected to actually grow $35.2 billion (+7.3%) higher by the year 2020 than it would have been without healthcare reform. This is potentially good news for American patients because the free-market system will be fueled to increase competition to create newer and better drugs. This type of bio-pharmaceutical ‘evolution’ is virtually exclusive to the private sector, and we should hope that the government’s expansive new powers to tax and control the way medical care is delivered do not overstep the bounds of effectiveness.

Some believe that the health reform movement made a crucial mistake in placing the power of cost-cutting measures in the hands of those who are not actually delivering direct patient care. Likewise, many fear that the regional accountable care organizations will create community-based managed care power brokers, who will pit a select few potential profiteers (individuals and health systems) against the broader group of medical providers in American communities.

In the aftermath of the new health law’s passage, some have suggested that the best physician is a quiet one—that we, as privileged licensed experts, should dutifully tow the line of political discretion so as to avoid upsetting our elected medical and political leaders. What a negative reflection on the state of our Republic; this author, for one, has always believed that power in the United States flows from the people to their leaders, not the other way around.

All polls still support the notion that most physicians and patients have significant reservations about the government’s expansive new role in our medical system. May the health of Americans continue to improve through the dissent of the silent majority—and may our voices rise above the politics of power.

Doctor Dorin is a Hopkins-trained, board-certified anesthesiologist, practicing in a large group in San Diego. He is a small business owner, a Commander in the US Navy Reserves, and the Founder/President of America’s Medical Society, Inc., (AMS) a non-profit corporation created to serve and educate physicians and the general public in matters of national health-care reform and medical politics.


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Adam Frederic Dorin, M.D., MBA

Doctor Dorin is a Hopkins-trained, board-certified anesthesiologist, practicing in a large group in San Diego. He is a small business owner, a Commander in the US Navy Reserves, and the Founder/President of America's Medical Society, Inc., (AMS) a non-profit corporation created to serve and educate physicians and the general public in matters of national health-care reform and medical politics

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