The one question on Obamacare that must be addressed in the presidential debate

In the upcoming debate, President Obama must answer how he plans to maintain the same level of medical acuity and acumen when under Obamacare there will be tens of millions of additional patients added to waiting rooms nationally Photo: AP

DALLAS, TX – October 1, 2012 – Sometimes politicians and academics get so tied up with the principles behind their beliefs (clearly important) that they forget to communicate the key practical consequences of their decisions.

On Obamacare, there are clear, dire consequences to the nearly three thousand pages of health reform law. Governor Romney should demand answers from President Obama, or risk losing the race and the hope for maintaining America’s future medical prowess:

Mr. President, please explain how you plan to maintain the same level of medical acuity and acumen, when, within a mere two years, there will be tens of millions of additional patients added to waiting rooms nationally?

The President should have a prepared answer to this key concern of healthcare providers and patients. It’s inconceivable that any question could be more primary to the intrinsic workings of our health systems in the United States. With all other concerns aside, nothing really matters if there are not properly trained physicians available to evaluate and treat the added influx of thirty million new patients.

Let’s assume that the polls are wrong, and that anywhere from thirty to sixty-five percent of practicing doctors will not, indeed, cut back their hours or retire early in the next decade. Let’s answer this question then, honestly, for the President in a stand-alone textbook-style essay response. There is really only one—albeit vague and evasive—answer that the President can give:

“…We will rely on ancillary healthcare personnel [non-physicians: nurses, technicians, physician’s assistants] to step up and do more of the supporting work now done by doctors.”

This is the answer that Mr. Obama’s handlers have likely prepared for him. There is only one problem, however, with this answer: it is disingenuous and factually incomplete.

First of all, the President’s men know very well that the decades-old slow decline in inflation-adjusted income of physicians has already squeezed every ounce of efficiency out of non-physician helpers in the workforce. There is no way these ‘non-M.D.s’ can be asked to simply ‘give more’ without sacrificing quality.

What will really happen in Obama’s new world medical order is that non-physicians will be charged with higher levels of functioning in patient care—assessment, treatment, and even prescription-writing, as more nurse practitioners and (state law depending) others are required to practice medicine without the benefit of a medical training and degree. Essentially, some will be given the equivalent of a medical degree through legislative and executive fiat. In other words, time-honored requirements and benchmarks for medical training will be lowered.

What will also happen is that doctors from outside of the United States—from places such as the Middle East, East Asia, and elsewhere—will be drawn in greater numbers into the U.S. post-graduate medical system. Lured by the possibility of greater incomes and a better lifestyle in America, many doctors with a depth and completeness of medical training that may very well be below U.S. standards will be inserted into patient care positions in record numbers.

If the laws of the various states do not change, and health systems and newly formed ACOs (Accountable Care Organizations) do not reduce their eligibility standards, one would assume there is nothing to fear. But this would ignore the President’s next plan of action. It is widely known within medical circles that the vast and deep new agencies and resources of the PPACA law will rely of ‘federal’-level clinics and ACO-adjunct facilities to deliver much of the needed new medical care to patients. As with current military institutions and public health facilities, the federal government can re-write its own new rules, and rely on new standards to incorporate these new, foreign doctors.

Rationing boards, decreased funding, factory-style care models, and decreases in innovation/research/pharmaceutical breakthroughs aside, the real question for implementation of Obamacare’s grand new designs is this: who, exactly, will be delivering our medical care in the near future?


Adam F. Dorin, M.D., MBA is a long-time commentator on American medical-political themes, and the founder of the non-profit educational organization, America’s Medical Society.

This article is the copyrighted property of the writer and Communities @ Written permission must be obtained before reprint in online or print media. REPRINTING TWTC CONTENT WITHOUT PERMISSION AND/OR PAYMENT IS THEFT AND PUNISHABLE BY LAW.

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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

Contact Adam Frederic Dorin, M.D., MBA


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