I can speak for my father, a physician of 30 years, as we regularly discuss issues in our respective fields. He is a private practice, triple board certified podiatrist who sees patients in his office four days/week & performs surgeries one day/week. He employs four full-time office workers who each earn about $30,000/yr with full benefits, none of whom have more than a high school education (no certifications, no advanced degrees, etc.). That is, he's not just a physician, he's a small business owner who creates good jobs. He is adamantly opposed to UHC for a number of reasons.
1. Increased government interference & decreased pay from the government will decrease quality of patient care.
2. Decreased incentive to become a physician.
3. Decreased incentive to innovate new medical technologies, including pharmaceuticals.
4. Fails to address ultimate reasons why the healthcare system in this country is broken.
1. As it stands now, health insurance interference with physicians' practices is nightmarish. More interference from the government will not make this better. Of course there must be oversight & regulation of any industry, & the optimal level of regulation is subjective, but there is already too much & more won't improve the situation. One of his four employees spends about 50% of her time fighting with insurance companies for reimbursement of procedures. The insurance companies as a rule fight tooth & nail to not pay for services - the longer they keep money in their bank accounts earning them interest, the more money they make, period. How does this cause a decrease in patient care? Simple. He charges his patients more money across the board because he will not get paid what he bills, & he must pay that employee to fight for payment. That's an increase in cost to the patient because their insurance companies do not have their patients' best interests in mind, they have their own bottom line in mind. This will not change when the government is writing the check. It will get worse - because the insurance companies can't do anything illegal & the government decides what's legal.
But, you ask, that's an increase in health care cost, not a decrease in patient care, isn't i? I think they're the same - paying more for the same service is a decrease in quality. But that's not the end of it. Out of his typical 9 hour work day, my dad spends at least a full hour dealing with insurance headaches one way or another - usually in the form of talking to his patients about how to navigate the insurance labyrinth. That's that much less time he has for actually being a doctor, & that's where the decrease in patient care comes from. The capabilities of modern medicine are astonishing, but most of what doctors can do needs to be done when the problem is incipient & small. If you present with a lump in your breast, your odds of recovery are good. If you present with cancer in your lymph nodes, your odds are a lot lower. For many diseases, a week or two is the difference between life & death. As a podiatrist, he deals with less life & death illnesses & more quality of life issues. For his patients, a few weeks is the difference between a toe amputation & being crippled or not, or more commonly, a few weeks of lowered productivity in the workplace - which has very far-reaching effects. The bottom line is this: the fewer patients per day any given physician can see, the longer you will wait to see them. This is the main criticism made by physicians about UHCs in other countries. The wait is too long. Productivity suffers & lives are lost because as Skoorb says, the workloads per health care worker are higher.
2. Physicians generally do not need to be geniuses, but as a rule, you want your doctor to be sharp. Physicians do not become doctors to make a lot of money. However, physicians spend their 20s & early 30s poor, studying late into the night, constantly taking exams, under constant pressure to perform, & graduate with $100,000+ student loan debts. Becoming a physician is a tremendous investment. When you're done, you have training & skills that few people possess but everyone needs. UHC, with its accompanying increased time not being a doctor & decreased pay, makes this investment far less attractive. Sharp, hard working undergrads will be that much less likely to become doctors & will instead devote their lives to something that is, simply, a better return on their investment. I can't stress enough that doctors don't become doctors to make a lot of money. As it stands now, many primary care physicians make less than $100,000/year. At this rate, it's simply barely economically feasible to even go to medical school. And no physician wants to spend his/her time dealing with paperwork. They want to be doctors. Back when Clinton tried to push UHC in the early 1990s, there was serious talk of forming a nationwide physician's union & there's been increased talk of this again with Obama's push for UHC. As JS80 asks, why the hell would you join a union for a profession that is inherently secure? UHC, that's why.
3. This is probably the most controversial aspect of our health care system, because we all know how much drug companies make. Drugs & medical tech are expensive. Really, really, really expensive. And they can do some really, really, really incredible things. If there is less incentive to develop new drugs & technologies (reduced compensation), companies will slow the rate at which breakthrough advances are made, plain & simple. Just look at the productivity of American vs. European pharm companies. And keep in mind that today's astonishingly expensive drugs are tomorrow's $4 WalMart generics. Again, it's reasonable to think that drug costs are out of control. Drugs are a lot cheaper in Canada. But when was the last time you took a drug that was developed in Canada? UHC is not the answer to this issue.
4. This is what gets my dad & other physicians I talk to really hot & bothered. When my dad opened his practice in 1979, the majority of it was treating accident & sports-related injuries. We looked through his records from the early 80s about a year ago & diabetes-related issues amounted to about 15% of his caseload. Today, that figure is >50%. The 'joke' is that my dad sees them first & cuts off their toes. Then he cuts off their forefoot. Then he removes the rest of the foot. Then they go next door & see the orthopedic surgeon, who does a below the knee amputation. Usually they die before the whole leg goes. The orthopedic surgeon I reference is known in town as the 'limb reaper.' Diabetes & smoking (smoking causes peripheral vascular disease, which often first presents as an illness in the foot) now account for an incredible amount of my dad's practice. 30 years ago, there were no wound care clinics. Now, most big hospitals have them to treat diabetic ulcers & pvd-related conditions. These procedures are costly, they are not 'one & done' procedures like setting a broken bone, & they result in massive productivity losses. Ask GM about those. And they are, for the most part, preventable. When was the last time you heard a politician stand up in front of a crowd & say, "You fat, inactive smokers are crippling this nation's economy?" You haven't, because fat inactive smokers make up a hefty voting bloc. Hell, Obama himself smokes. And this is just how my dad sees the issues of obesity & smoking - ask a cardiologist what they think. Open heart surgery is a bit more expensive than toe amputation. UHC does not sufficiently address this issue - preventable illnesses.
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