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No, Doctors Don't Hate Obamacare

[Guest post by Harold Pollack and Vivek Murthy]

Forbes has published another slam against health reform. This one is written by Sally Pipes, president, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. She is the author of a forthcoming book, The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare, put out by the conservative publishing juggernaut, Regnery. This follows Pipes’ previous volume, The Truth About Obamacare. We haven’t read this one; we presume the truth isn’t good.

Pipes fires standard broadsides against health reform, including the already-rebutted claim that because of the Affordable Care Act, “American families in the non-group market will see their premiums rise $2,100.” She also presents a more novel, in some ways more disturbing argument, when she claims that that America’s doctors oppose health reform:

Few people know more about our healthcare system than doctors working on the frontlines. Policymakers should pay heed to their indictment of Obamacare and revisit the disastrous law.

Pipes’ is probably right to say that “if physicians aren’t on board with Obamacare, it won’t work.” The rest of her argument is wrong.

To prove her point, Pipes cites a survey by the Deloitte Center for Health Solutions. This survey highlights physicians’ anxieties regarding both health reform and the broader trends within the health care system. It provides some intriguing results. Although Pipes implies otherwise, respondents actually split down the middle in their reactions to the new law. Forty-four percent believe that the Act is “a good start.” Forty-four percent believe that “it is a step in the wrong direction.” These responses strikingly differed across generational lines. Fifty-nine percent of physician-respondents between the ages of 50 and 59 believe that the Act is “a step in the wrong direction.” Only 36 percent of their counterparts between the ages of 25 and 39 gave the same response.

It’s hard to know what to make of these findings. According to Deloitte’s supporting materials, of the 16,537 physicians the firm contacted, 501 completed the survey. That’s a response rate of barely 3 percent. It’s not clear whom this tiny sample really represents.  

A better way to gauge these issues is to examine how physicians and the organizations which represent them actually behaved during last year’s health reform. One wouldn’t know from Pipes’ article that the American Medical Association, the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Osteopathic Association, the American Psychiatric Association, and the American College of Cardiology all endorsed last year’s health reform. These groups represent hundreds of thousands of physicians across a wide range of medical sub-specialties.

A key reason for these endorsements was the widespread recognition that our current health care system works poorly from the perspective of both physicians and patients – and the understanding that the new law was an important step in building a more effective health care system.

In the nearly two years since the Act was passed, we have heard many stories from colleagues around the country who belong to Doctors for America, an independent organization with which we are both affiliated. These physician are in private practice and academia, primary care and specialties, and in rural and urban areas. They are all seeing the impact of health care reform. 

Heidi Sinclair, an internal medicine hospital specialist in Louisiana, noted that her hospital set up a discharge clinic to reduce avoidable hospital readmissions in anticipation of the law's delivery system reform pilots.  Maggie Kozel, a pediatrician and teacher in Rhode Island, has seen more young adults - including her own children - who have now been able to get health insurance through their parent's insurance plans.  Chris Lillis, an internal medicine physician in Virginia reported that his practice has received an increase in reimbursement thanks to the law’s primary care support provisions. 

Particularly touching was a message we received from Ann Drum, a physician in Alabama, who has devoted her career to caring for the underserved.  Dr. Drum suffers from a chronic illness herself, and, because of the regular and expensive intravenous therapy required for her disease, she was in danger of losing her health insurance as she approached her lifetime cap on coverage.  The Affordable Care Act's provisions which ban lifetime caps mean that she and her patients need no longer live in fear of losing their health insurance because they are too sick.

There are many other stories too: A Tennessee specialist noted that his hospital has embarked on a major reorganization to focus on maximizing quality of care and reducing costs – all in anticipation of the law’s accountable care organization pilot programs. A Florida physician who owns a small private practice expressed relief that their state is finally getting grant support through the new public health prevention fund, to improve the screening and treatment of conditions such as hypertension. A North Carolina intensive care unit physician, who has seen heartbreaking cases of his patients denied care by insurers, told us of his sense of victory when he discovered the law provided his patients much needed protection. 

Our personal correspondence conveys but a few of the many ways that physicians are starting to see the beneficial impact of the Affordable Care Act in their working lives.  

That’s not to say physician enthusiasm for reform is universal -- far from it. Different specialties have different financial interests at stake.  Like everyone else, physicians also hold diverse ideological views regarding the proper role of government and private enterprise in the health care system. 

Physicians are also similar to the general public in another way: While physicians are extremely knowledgeable about the health care systems in which they work, they’re not particularly knowledgeable about health care reform. Having spoken to thousands of physicians about health reform, we can attest that this is the case across regions, ages and ethnicities, and specialties. An important reason for this uncertainty has been the ineffectiveness of public education efforts to explain what the Affordable Care Act really does.

This is also an anxious time for physicians, for patients, and for others with strong stakes in American health care. Physicians are under new pressures to join larger care organizations and to adopt new technologies such as electronic health records. Physicians are unsure how their reimbursements will be impacted in the coming years. Health reform provides a plausible target for these anxieties, even though the law often has little to do with the underlying causes of physicians’ worries. Additionally, when physicians see persistent or new problems (e.g. rising insurance premiums in the last year or continued political shenanigans over Medicare’s Sustainable Growth Rate “doctor fix”), many blame Obamacare.  Ironically, problems like these are often precisely the difficulties that the law seeks to address.

Will doctors support health reform? We suspect that the ultimate answer to this question won’t come from the thrust-and-parry of partisan debate. Doctors will support the new law to the extent that it becomes visible in their everyday lives, and make these lives better. 

We believe that physicians will embrace the Affordable Care Act because the new law helps to address many critical issues that have long concerned physicians and patients—abuses and market failures in the provisions of health coverage, rising numbers of uninsured patients, variable quality, poor coordination of care, the erosion of primary care, and the lack of focus on prevention and public health.  As the law’s main provisions kick in, physicians will see that it is, indeed, a big step in the right direction. We are sure that the new law will attract serious criticism. Real on-the-ground progress will provide the best rebuttal. 

Harold Pollack is the Helen Ross Professor at the School of Social Service Administration at the University of Chicago and advisor to Doctors for America. Vivek Murthy is an attending physician at the Brigham and Women's Hospital and Harvard Medical School, as well as president and co-founder of Doctors for America.

Update: The original version of this article included three groups that endorsed portions of the House or Senate bills, but did not support the final version of ACA: The American College of Surgeons, the American Congress of Obstetricians and Gynecologists, and the American Society of Anesthesiologists, as indicated here. We apologize to these organizations for our error —Harold Pollack