June 29, 2012

What it means to doctors and patients

The Affordable Care Act hasn’t changed the doctor-patient interaction yet, and probably won’t in the near future.

The Affordable Care Act hasn’t changed the doctor-patient interaction yet, and probably won’t in the near future.

But some South Carolina physicians are concerned about the long-term fallout after the U.S. Supreme Court ruled the health care reform constitutional. Eventually the government will control many of decisions on what will be covered by Medicaid, Medicare and, by extension, private insurance, said Dr. Gregory Tarasidis, a Greenwood ear-nose-throat specialist and a past president of the S.C. Medical Association.

Many of those decisions will be made by the Independent Payment Advisory Board, which will not be made up of physicians.

“Bureaucrats will be rationing care based on dollars but not on quality of health care,” Tarasidis said. “Over time, people will see premiums rise. The bureaucracy will create issues, and doctors will begin to retire early.”

Now, physicians make most of the decisions on how to treat patients, what drugs or procedures are best to deal with individual problems. If those choices are severely limited, “you have lost the physician-patient relationship and you have people who are not physicians making decisions about care.”

The medical association hoped the Supreme Court would throw out the entire Affordable Care Act and start over with more physician input.

The S.C. Hospital Association, while saying now is the time to move forward and deal with the act’s provisions, fretted that the call for continued political debate could slow improvements in health care.

“The debate will now intensify as it moves from the courts in the political arena,” said Thornton Kirby, president and CEO of the S.C. Hospital Association. “Patients don’t have the luxury of waiting months and years for political solutions. They need the best care we can give them today, tomorrow, and next week.”

Some people who stayed away from doctors’ offices because they had no insurance will be covered under the act starting in 2014, either under the expansion of Medicaid rolls or through new health insurance exchanges. If the state doesn’t opt out of the Medicaid expansion and if health insurance exchanges open the market to low-income users, many of the nearly 1 million currently uninsured in the state will have more access to health care.

Even if they seldom go to the doctor, they’ll benefit.

“People with health insurance feel healthier, behave in healthy ways, and are more optimistic,” said Columbia health care economist Lynn Bailey. “Knowing you can access care when you are sick without bankrupting your family is a feeling of security. I think South Carolinians deserve that feeling.”

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