The MDs ability to maintain individual practices is going away for a variety of reasons coming out of medical legislation over the last couple of years: breakdown in fees for service, bundling of payments, electronic records requirements, and incentive/penalties around medicare payments. All of these will force MDs to join up or "partner" to hospitals. (This may be good or bad for patients, but it certainly changes who will choose to be MDs).
I attended NASS (North American Spine Society) in Orlando a few weeks ago. I spoke with several surgeons who agreed the best artificial disc in use was available in Europe and the company has NO PLANS TO PURSUE APPROVAL in the US. That is because the path to approval has gotten so onerous and the future re-imbursement iffy. This will continue to happen without reform aimed at easying approval and offering companies some form of legal protection. (Though admittedly some companies have behaved badly).
In a separate discussion, if you practice medicine in NY/NJ, you face a much higher chance of getting sued. Is it because MDs are worse there? Does Obamacare reduce the risk of insurance for the MDs? No ... it just forces them into larger groups who will bear the cost.
Not worried yet? Look into the coming shortage of MDs and specialist MDs going forward. Not a pretty picture at all.
Obamacare isn't totally stupid, but it is based on looking away from some of our current biggest problems and homogenize/reduce care (I'll avoid the use of ration here).
What do we really need:
- A path for training more MDs that is cheaper and values MDs appropriately (E.g. fund higher education).
- Reform of medical malpractice and tort law - replaing it with a superfund to pay for legitimate medical cases. This will have set payouts and operate as a general insurance funding by fees across the system.
- Easing of approval process, but an increased tracking of product safety and value for response (this is something consistent with Obamacare).
So... Obamacare isn't all bad in concept ... but it will end private practice, fail to address MD shortages, and continues to lead toward a stifling of medical innovation. But we still need to big government solutions.... which no Tea Partier will like.