I’ve been compelled to stop posting stories from the Boston Herald due to their “archiving” stories after roughly a week, the links I put up pointing to the original stories then go stale.
However, I can’t find another source for this important story so I’m (uncharacteristically) putting up the their whole page on it. So I’m not really covered by “fair usage”, wonder if I’ll get yelled at?
One week ago Gov. Deval Patrick signed a powerful piece of legislation targeted at the obscene earnings of the profiteers and plutocrats among us.
Ah, you say, he’s finally going after those hedge fund managers paying a paltry 15 percent tax on their income?
Then it must be the ballplayers making millions while batting .220?
Um, not quite.
CEOs of health insurance monopolies with $20 million golden parachutes?
State legislators running lucrative part-time law practices charging hundreds of dollars an hour?
Nope: He’s going after the . . . doctors! You know, the folks who come out of medical school a couple hundred thousand bucks in debt and then do a form of indentured servitude called residency lasting three to 10 years while earning janitors’ wages.
Following this, their reimbursement for working 60 to 80 hours while being on call two to three 24-hour days a week is tiered in such a way that the ones in shortest supply, the primary care docs, make about as much money as an MBTA bus driver while spending half their time doing paperwork to ensure “compliance” with 80,000 pages of regulations meant to keep them properly in line.
As of last week, thanks to our enlightened overlords, a medical practitioner in Massachusetts must, as a condition of licensure, agree to report his or her fees to the Board of Registration in Medicine and is subject to an arbitrary limitation to any increases in those fees annually. The state is my new employer; what’s to complain about?
Well, a couple of things come to mind.
For one, most docs in this state (and in the United States as a whole) keep their heads above water financially by charging higher fees to their private pay patients than the already price-controlled rates allowed by Medicare, Medi caid and commercial insurers.
This has allowed for a tenuous balance between the supply of front-line doctors and the demand for their services by the most labor-intensive patients — those on the public insurance programs who pay almost nothing for their medical care and have no market incentive to limit their demand for such care.
This balance has already been stretched to the limit by Massachusetts’ famous insurance mandate, which has jacked up the proportion of the insured to 98 percent (many of the new arrivals being placed on Medi- caid rolls) — all of them now looking for services from a stagnant (and soon to be shrinking) pool of primary care providers.
Your new “doctor” will be a nurse practitioner or physician’s assistant — not that there’s anything wrong with the services provided by those paraprofessionals, but many will be chagrined by this bait and switch.
Next, the push toward equalizing reimbursement rates across specialties by limiting the fees of specialists — which is where this legislation is inexorably taking us — will further commodify the provision of specialty medical services.
It will come as no shock to savvy patients that some surgeons are, well, better than others. Amazingly, they charge and get more for their work. Good luck with that from now on.
This is a bureaucrat’s dream and a patient’s nightmare in the making.
Finally, this legislation will over the next few years transform Massachusetts from the incubator of the nation’s finest physicians to the feeder of the new network of high-quality medical institutions about to sprout up in southern New Hampshire, northern Connecticut and Rhode Island.
Not a bad day’s work for a one-party state seeking to be on the cutting edge of health-care innovation!
And in case the point is not clear, this will all be coming to a medical practice near you, wherever you live, courtesy of the monstrosity known as Obamacare, as early as next year.
It is only fitting that the guy who got the ball rolling on really bad health care reform in this state will have the opportunity to stop the madness in its tracks — assuming Mitt Romney is given the chance!
Alex Vuckovic, MD, is clinical assistant professor of psychiatry at Harvard Medical School and has been medical director of The Pavilion at McLean Hospital for the past decade.