Observations on Politics, Profiteering “Incentives”, and the Struggle for a Profession’s Soul

Robert W Geist, MD

The new 2010 federal Patient Protection and Affordable Care Act (ObamaCare) attempts to control society’s rising cost of care, but does so by expanding on an ethically questionable payment system. The system increases the control of managed care “payers”, HMO corporations and government agencies, by paying physicians monetary incentives for reducing the amount of care they provide. The specific objective is to encourage all healthcare providers to limit patient use of private health insurance premiums as well as tax dollars.

The law calls for the creation of Accountable Care Organizations (ACOs) consisting of hospitals and staff physicians, merged into risk-bearing, gate-keeper insurance corporations with fixed global budgets. The amount of money allocated to each ACO is determined based on auctions of populations of insured lives to be serviced, on a per capita basis. When payers contract only with risk bearing ACO corporations, clinicians are effectively forced into gate-keeping contracts, since unaligned and independent clinics or individuals would be totally excluded from this type of payment program.

To implement these market controls, ObamaCare creates a powerful public-private cartel system. In the new system merged ACO-HMO insurance corporations are shielded by virtue of the sovereignty of the federal government from legal challenge for any activities that limit competition and/or fix prices. These shields were established through the 2011 waivers of federal anti-trust, anti self-referral, and anti fee-splitting patient protection laws.

Demand for healthcare services will naturally increase as a byproduct of this politically motivated and tax-subsidized system. Clinicians at the bedside will continue to be powerless to reverse this demand inflation unless coerced into the role of gate-keepers denying services. Likewise, there will be a continuation of the kind of quality distortions, which have resulted from decades of government price-fixing and previous failed managed care rationing methods. One can predict that these economic “fatal flaws” of this legally insulated, gate-keeping system will lead to a progressive deterioration in overall access to quality healthcare in America.

The pretext of ObamaCare as a “social good” to control cost and improved quality, has been used to justify highly questionable means, including patient auctions and monetary incentives, which reward rationed care. Under this system, patients can, and very likely will, lose the protection of law, as this law now legalizes corporate-government profiteering for rationing access. This is also how the medical profession and individual physicians can be coerced into losing their professional soul—the ancient covenant of loyalty to each patient.

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