Daniel Henninger’s recent Wall Street Journal column, "Obamacare’s Lost Tribe: Doctors," outlined the deleterious effects of Obamacare on physicians and the implications for patients.
At issue, Henninger writes, is not merely if patients will be able to keep their doctors, as Obama promised, but, rather, if physicians will be able to keep their patients — or even stay in the practice of medicine.
The questions Henninger raises about physicians under the president’s Affordable Care Act are even more applicable to Catholic physicians.
Doctors just want to take care of patients. Catholic doctors, in addition, want to take care of patients in a way that is consistent with their faith. But both of these desires have been increasingly difficult to fulfill in recent years, and the future is looking bleaker than ever.
For years, financial and legal pressures have made the climate for medical practice stressful for physicians. In America, payment for health-care services is made overwhelmingly by third-party payers — government (Medicare, Medicaid, State Children’s Health Insurance Program and Veterans Affairs) and health-insurance companies — rather than by patients and individuals.
To prevent fraud and reduce costs, these third-party payers create increasingly complex regulations and demand discounts wherever possible. Doctors have been forced to hire ever more support staff to deal with the bureaucracies and to work harder, seeing more patients and performing more procedures, to make up for the expenses and reductions in reimbursement.
While American physicians earn more than their counterparts in other countries (and specialists can make from 60% to 90% more than primary-care physicians), they also have unique and expanding expenses to cover, not only support staff and malpractice-insurance premiums, but large loans from medical school.
Even before the passage of Obamacare, many doctors were struggling.
In a 2008 survey by the Physicians Foundation, less than 20% of physicians reported that their practices were healthy and profitable; the remainder had either low profits, were breaking even, or were losing money. That same survey reported that 78% of physicians said medicine is either "no longer rewarding" or "less rewarding"; 76% said they are either at "full capacity" or "overextended and overworked"; and 42% said the morale of their colleagues is either "poor" or "very low."
Obamacare has made everything much worse.
First, it did nothing to address issues important to physicians — lawsuit reform and the Sustainable Growth Rate (SGR) formula, which ties annual physician payment increases to the performance of the general economy. If Congress fails to forestall SGR cuts, physicians could see an immediate 27% cut in their Medicare reimbursement.
The president’s health-care plan makes physicians even more dependent on government programs for their reimbursement (since out of 30 million people expected to gain health insurance under the new law, 18 million will be put on the notoriously low-paying and bureaucratically complex Medicaid program). Obamacare promises exponentially more red tape and federal demands on physicians.
For example, a Physicians Foundation panel concluded that Obamacare "will drastically increase physician legal compliance obligations and potential liability under federal fraud and abuse statutes."
All these pressures are driving physicians out of private practice and into employment relationships, where their ability to exercise independent judgment will be reduced.
On top of all this, for Catholic physicians, attacks on conscience rights are increasing dramatically under the Obama administration.
During the passage of Obamacare, conscience protections in existing laws were left uncertain. In February 2011, the Department of Health and Human Services gutted the only federal regulation to provide concrete resources for applying existing federal conscience laws. Attempts by the House of Representatives to amend Obamacare to restore conscience protections have been stonewalled by the Democrat-controlled Senate.
Finally, the HHS mandate shows the extent to which the Obama administration is willing to coerce people to violate their consciences and deepest beliefs.
While the HHS mandate applies first and foremost to Catholic institutions that purchase health-care insurance for their employees and to all citizens who will be subsidizing abortifacients, contraception and sterilization with their health-insurance premiums, the other shoe will drop on many Catholic doctors and health-care professionals soon if nothing is done.
It will take little time or effort for the Obama administration to mandate that every health-care professional must offer or refer for all government "preventive" or mandated health services.
Such a mandate could spell the end for many Catholic doctors, especially those in primary care or specialties such as obstetrics-gynecology. Some will give up their faith; the rest will give up the practice of medicine.
The effects of Obamacare on physician morale promise to be devastating. Polls from the Medicus Firm and Investors Business Daily in 2009 show that anywhere from 30% to 45% of physicians plan to retire early or leave medical practice soon.
The Medicus Firm poll showed that 36% of physicians would not recommend medicine as a career, no matter what, and an additional 27% would not recommend it if Obamacare became law.
Finally, a 2009 poll of Catholic Medical Association members showed that 85% would cut back or cease to practice medicine if the government forced them to violate their consciences. All this comes at a time when a shortage of more than 130,000 physicians is projected by the year 2025.
So is there a future for Catholic doctors? There can be — if Catholics within the Church raise up members who can combine an authentic Catholic faith with the learning, skill and dedication required by physicians.
There can be Catholic physicians in the future if we, as a Church, support these physicians by becoming their patients. There can be Catholic physicians in the future if we refuse to allow our increasingly totalitarian federal government to define our faith and what constitutes health care based on its own secularist worldview.
George Orwell said, "At age 50, everyone has the face he deserves."
Now, and no doubt in the future, we will have Catholic doctors and health-care professionals if we deserve them. Will we?
John F. Brehany, Ph.D., S.T.L.,
is the executive director
and ethicist with the
Catholic Medical Association.