I have been teaching the public about the Affordable Care Act (ACA) for three years. It is a complex law, seeking to improve one of the most complex systems – our health care system. It is understandable that Americans have questions about the law, as communicating thoroughly through the beneficial elements of the law in layman’s terms takes time. In my educational efforts, I usually speak about the overview of the ACA in a 30 minute presentation, followed by as much as 90 minutes for questions and answers from the audience. The Kaiser Family Foundation has released a couple of helpful videos, the first being nine minutes long and its most recent effort seen here:
Despite helpful information being available to answer everyone’s questions, Dr. Mary Ellen Gallagher, a pediatrician from Arlington, Virginia, appeared in this advertisement asking some very basic, and scary, questions. The advertisement is produced by Americans for Prosperity (AFP) and will be aired in states like Ohio, Texas, North Carolina and my home state of Virginia. AFP plans to spend no less than $1 million dollars to scare the American public into thinking the sky will fall once the ACA is working. If you are wondering why an organization like AFP would spend so much money advertising against the ACA, perhaps you are not aware of its partisan past or its overtly political agenda. Even the star of the commercial is a donor to the political opponents of the law.
So, I hereby volunteer to answer Dr. Mary Ellen Gallagher’s questions through this blog post.
Dr. Gallagher asks, “Can I still work with parents to decide what’s best for kids, or will the government be in the middle of things?”
This is a very manipulative question on several levels. It targets parents, mothers specifically, and tries to capitalize on existing fears created by longstanding and malicious myths such as “bureaucrats will run healthcare” and “government death panels.” Dr. Gallagher, I can assure you, you will still be able to decide what is best for your patients. Even better, after the ACA, millions more children are expected to gain health insurance. Since medical bills are a frequent cause of financial ruin, I am sure Dr. Gallagher sees the value of her patients obtaining affordable health insurance. Thanks to already existing Medicaid programs and the ACA, 95% of all American children have access to health insurance. But maybe Dr. Gallagher missed the fact that AFP is against Medicaid, too – and if their goals are achieved, millions of children would be without health insurance.
Asking if the government will be “in the middle of things” has been found to be the most effective way to scare the American public dating back to 2009. This infamous memo, crafted by Frank Luntz, the messaging guru for political opponents of the ACA, has been the guide to scaring Americans effectively since 2009. Never mind that several independent outfits have rated this assertion false, Frank Luntz would be the first to tell you that psychological research shows that a myth repeated often enough will be very hard to dispel. The Affordable Care Act will be largely administered through private insurance companies, not government bureaucrats, and the elements of the ACA designed to reduce costs are statutorily prohibited from reducing benefits to Medicare beneficiaries or the mythical, dreaded, “rationing.”
Dr. Gallagher also asks, “Will my time be spent navigating a complex system, or helping people get well?”
As a private practice primary care physician myself, I sometimes lament the administrative aspects of being a physician. Paperwork, insurance pre-authorizations, insurance denials and need for referrals adds time to my day that I would rather spend taking care of my patients. But as a Medicare provider, I have found that these hassles are not to be found caring for Medicare recipients. Hassles come with private insurance companies, who attempt to control costs by making physicians jump through hoops. But there is good news, Dr. Gallagher! The ACA has provisions aimed at reducing those administrative burdens on doctors. If you are looking to be more efficient, and have more time to care for your patients, I suggest joining the 21st century by dropping your paper charts and adopting an electronic medical record.
Dr. Gallagher finally asks, “What will happen to my patients if I have to close my practice?”
This question is designed to make viewers believe that somehow doctors will no longer thrive after implementation of the ACA. I have a very different experience. Since the ACA was passed, I have enjoyed a bonus from Medicare for being a primary care doctor, a bonus for using an electronic medical record, bonuses for reporting quality metrics, and newly increased reimbursements for services rendered to my patients designed to help primary care doctors’ bottom lines. I am the first to say that running a medical office is difficult. Having a good business sense is critical, and surrounding yourself with able staff is key. But nothing in the ACA is going to lead to the demise of physicians in practice.
But, if Dr. Gallagher chooses to retire or close her practice for reasons unrelated to the ACA, the good news is that medical school applications continue to rise and medical school classes are growing. If the politics of the ACA disgust you so much that you decide to leave our noble profession, there will be someone who appreciates the privilege of being a doctor ready to take your place.