Since I am retired, and since before I retired I worked for the Federal Government as a physician, I am both in favor of a way to get medical care to those who truly can’t afford it, yet worrying that the result will be that all medical clinics and hospitals will resemble the Federal facilities where I spent much of my life.

Bean counters and government bureaucrats are not the best ones to make medical decisions, because they put the bottom line (i.e. the regulations and the cost) ahead of caring for our patients.

Right now, Drudge has a photo of the President with a bunch of folks in white coats around him.

Earth to the White House: Most physicians don’t wear white coats any more (you are more likely to find them on nurses or med techs, while physicians wear street clothing or “scrubs”).

And indeed, the caption on the WSJ editorial notes:

“Associated Press

President Barack Obama, accompanied by registered nurse Barbara Crane, speaks about health-care legislation on Wednesday.

Well, so much for white coats.

But the big problem is that no one is still sure what is in the bill.

For example, although Nancy Pelosi assured everyone that she had discussed abortion payments in the bill with Catholic bishops and they were positive about it, the press didn’t bother to tell you that the Catholic bishops promptly shot back: No you didn’t, and the bill is still a problem.

As for physicians, although the AMA and my own organization, the AAFP, are backing the health reform, if you check their sites now, the real issue is that 20percent cut in Medicaid funding that may or may not occur.

The AMA site even has a ticker to tell you when the cut goes into effect.

At one physician’s forum, a cynical doc spoke for a lot of us when he wrote:

This is a major mess! How about telling the lawmakers that they are about to take a 21% cut in their own salaries? I agree with the above doc’s comment on the terrible trickle effect across the entire industry. Less hiring of ancillary staff, less purchasing of equipment, and ultimately seeing more patients in less time. This will lead to physician burn out , less quality care and a spiriling down of health care in general. And not to forget that malpractice insurance premiums are not going down, and in fact going up! God help us! Obviously our elected officials can’t. Or won’t.

As for the AAFP, despite the fact that Family docs take care of a lot of indigent patients, especially in rural areas, there is an obvious split between the utopians on their committee for health care reform and the rest of us. Why do I say this?

Well, they have been emailing us with an “Action Alert” to send a letter to our representatives to pass health care reform, and they brag:

According to the AAFP Government Relations Division, more than 360 AAFP members already have sent more than 1,100 messages to Congress about the importance of passing health care reform since the Speak Out letter was posted.

The problem? The Academy represents 97,000 physicians, which means 99.7% of Family physicians either didn’t read the email or didn’t agree with the letter enough to take ten seconds to send the form letter on to their congressperson.

So while a secret health care bill is going to be slammed through a congress using what Republicans call a dubious procedure, the reality to docs is that those who still treat medicaid patients might now have to stop. Money is tight, and that means the ranks of those who can’t pay their bills will swell, and few of us like to turn away our regular patients when they miss a bill payment.

Greedy docs? Well, the last time I was in private practice, 20 years ago, the amount that it cost me to treat Medicaid patients was enough to cover my extra billing costs and some of the inflated “liability insurance” of doing Medicaid deliveries (the nearest OB, Pediatrician and most specialists were 40 miles away).

As for those who couldn’t pay at all: Yes they were seen, either in the office or in the Emergency room, but ironically if we tried to charge them a nominal fee, we could have been sued for Medicaid fraud (since their bills would be less than we billed Medicaid).

I figure that I wrote off 20 percent of my gross income to treat the indigent in those days, many of whom were illegal farm workers, yet the government wouldn’t even give me a tax credit for doing so.

Eliminating overhead, simplifying billing procedures, eliminating bureaucratic rules (heck, it’s impossible for a doc to do a simple dipstick urinalysis nowadays in the office without a lab tech who spends half her time doing “controls” and paperwork), delays in payment, huge liability premiums and other roadblocks to our patient care is not being discussed in the bill.

In other words, instead of discussing problems, we have an unknown quality that has to be passed now, or…

The President gives this reason:

“At stake right now is not just our ability to solve this problem, but our ability to solve any problem,” Mr. Obama told a crowd of white-coated doctors and nurses…

Yes, in the end it’s all about him.

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Nancy Reyes is a retired physician living in the rural Philippines. She writes on medical matters at HeyDoc Xanga Blog.

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