Henninger: ObamaCare's Lost Tribe: Doctors

The practice of medicine is the Obama health-care law's biggest loser.

Back at the at the dawn of ObamaCare in June 2009, speaking to the
American Medical Association's annual meeting, President Obama said: "No
matter how we reform health care, we will keep this promise: If you
like your doctor, you will be able to keep your doctor. Period."

But will your doctor be able to keep you? Or will your doctor even want to keep you, rather than quit medicine?

For the longest time now, since day
one of the Affordable Care Act, we have been having arguments over the
mandate to purchase health-care insurance, requirements that insurance
companies accept policyholders regardless of health, and price
discrimination in insurance policies.

Corbis

And of
course this past week, the Supreme Court—or something resembling the
Supreme Court—outputted a decision on the tax status of the
insurance-purchase mandate, the states' obligation to pay for Medicaid
and as a bonus, the Commerce Clause.

Have you noticed what got lost in this historic rumble? Doctors. Remember them?

ObamaCare has been a war over the
processing of insurance claims. It has been fought by institutional
interests representing insurance, hospital and pharmaceutical firms. The
doctor-patient relationship, or what used to be called "the practice of
medicine," has sunk beneath these waves.

Barack Obama, a savvy pol, understood
from the start that rationalizing payments claims through the maw of
these private and public bureaucracies was not what the average person
thinks of as "health care." To any normal person, health care means that
when you or yours get really sick, the doctors and nurses who attend to
you will push all else aside to give you medical help.

Thus, the constant Obama chorus that
you can "keep your own doctor." No one knows better than Barack Obama
that his law sends the nation's doctors on a voyage into an uncharted
health-care world in which they are just along for the ride with their
patients.

A Wall Street Journal story the day
after the Supreme Court ruling examined in detail its impact across the
"health sector." The words "doctor," "physician" and "nurse" appeared
nowhere in this report. The piece, however, did cite the view of one CEO
who runs a chain of hospitals, explaining how they'd deal with the
law's expected $155 billion in compensation cuts. "We will make it up in
volume," he said.

Volume? Would that be another word for
human beings? It is now. At Obama Memorial, docs won't be treating
patients. They'll be processing "volume." And then, with what time and
energy remains in the day, they'll be inputting medical data to comply
with the law's new Physician Quality Reporting System (PQRS), lodged in
the Centers for Medicare and Medicaid.

Here's the Centers' own description of
what PQRS does: "The program provides an incentive payment to practices
with eligible professionals (identified on claims by their individual
National Provider Identifier [NPI] and Tax Identification Number [TIN])
who satisfactorily report data on quality measures for covered Physician
Fee Schedule (PFS) services furnished to Medicare Part B
Fee-for-Service (FFS)."

We're all pressed for thinking time
these days, but the one group we should make sure has time to focus on
what's in front of them is doctors treating patients. Instead, they'll
also be doing mandated data dumps for far-off panels of experts.

Doubts, even among believers, have
begun to emerge about what ObamaCare could do to the practice of
medicine. A remarkable and important piece by Drs. Christine K. Cassel
and Sachin H. Jain in the June 27 Journal of the American Medical
Association directly asks: "Does Measurement Suppress Motivation?"

The question raised by the article is
whether imposing pay-for-performance measurements on individual
physicians does more harm than good: "[C]lose attention must be given to
whether and how these initiatives motivate physicians and not turn
physicians into pawns working only toward specific measurable outcomes,
losing the complex problem-solving and diagnostic capabilities essential
to their role in quality of patient care, and diminish their sense of
professional responsibility by making it a market commodity."

This is an important piece, because
Dr. Cassel is part of the intellectual foundation for the
measured-directives movement. The saying that comes to mind reading
these misgivings is that it's better late than never to notice that the
core relationship between doctor and patient is being eroded. Except
that in the wake of Chief Justice Roberts's upholding of the Affordable
Care Act, it's too late and we're beyond never.

Mitt Romney needs a way to talk about
health care in America. This isn't just a fight over insurance
companies. It's about the people at the center of health
care—doctors. The Affordable Care Act will
damage that most crucial of all life relationships, that between an ill
person and his physician. Barack Obama's assertion that we all can keep
our doctors is false. You could line up practicing physicians from here
to Boston to explain to Mr. Romney why that is so.