All week we have looked at how Obamacare has impacted a small OB/GYN’s practice in Arizona. From cutting its revenue by more than half to the zero dollar checks sent by Medicaid plan providers, Obamacare has been disastrous. But we have yet to hear from the doctor himself. Today, Dr. Richard Benedict tells us in his own words how the implementation of Obamacare has impacted him.
Duane Lester: Since Obamacare has become law, what’s changed for you?
Dr. Benedict: Just about everything as it relates to the profession. This is increasing at a rapid rate. We’re told how to practice, what we’ll get paid for, what we won’t get paid for. And even what they tell us we’ll get paid they don’t pay a lot of the time. I think probably the biggest thing from a medical perspective, purely medical perspective, is the ignoring of the fact that we have patients. We don’t have, uh, you know I try to liken it to an auto mechanic, for example. You take a car that’s broken in to the auto body shop and you work on the car. Sometimes it works. Sometimes it doesn’t. They are trying to apply that analogy to medicine and you just can’t do it. People aren’t cars. People are dynamic, changing beings.
It’s not a static problem. What I mean by that is, for example, we do a procedure or a surgery in gynecology or a general surgery case and we put a catheter into the patient’s bladder to reduce urine because they’re bedridden. Well, those things are notorious for causing urinary tract infection in people that are debilitated. Well, you need to decompress the bladder. The bladder has to be drained. No doubt about it. The patient’s not ambulatory.
But, under the rules that have been promulgated by Obamacare, and this is just an overriding example, if that patient does develop a urinary tract infection, you don’t get paid for it. You don’t get paid for treating it, (plus) you don’t get paid for treating the patient on the original procedure that you did, even though we know that’s a risk factor for having a catheter.
Well, the answer would be, “Let’s not put a catheter in.” You can’t do that because you’re operating on a patient. What are you going to let them do, soil themselves in bed or worse yet have the bladder be full and compromise your surgical exposure? That’s what I mean by they are imposing rules.
DL: Are doctors putting together these rules?
DB: No, these are put together by young bureaucrats in Washington, DC. That’s probably the biggest problem that most physicians have with a lot of the rules that are being promulgated. They aren’t evidence based. It’s not taking into consideration that the patient is just that, a patient. He or she is a human being and human beings do certain things, voluntarily or involuntarily, that change the scenario as it goes along. It’s a very dynamic process.
Let’s take that back to the auto mechanic example. You come in and you’ve blown a gasket because you’ve run out of oil. Well, it’s very simple. Put the oil back in the car and replace the gasket and everything should be fine. Well, these patients will blow a gasket no matter what you do. And if that happens, something out of the control of the doctor, well, somehow the doctor is responsible and “we’re not going to pay you for it.”
I think the thing that is probably the most cynical about this is that most any reasonable person when you really ask them, “Well, the doctor couldn’t control this. Why are you penalizing the doctor?” They will realize that it’s not the doctor’s fault. The cynical interpretation of that is, “Well, you just don’t want to pay for care. You want care but you don’t want to pay for it.” And that’s really what we’re experiencing on multiple levels. They want patients cared for, they just don’t want to pay for it. And they’re finding any reason, they being the federal payers Medicaid and Medicare and of course the private payers follow suit, so they’re using a very cynical approach, in my opinion, to not pay you. And it’s happening all across the board. I can give you multiple examples of that. It’s just crazy.
In obstetrics, my area of expertise, there is another great one. There is a hard and fast rule in place now where there should be no elective induction before 39 weeks, unless you meet a certain criteria. Well that’s all well and good. Those would be medical conditions. The mother might have medical conditions. The fetus might have certain problems with pregnancy that would force your hand to deliver her before 39 weeks.
Well, there are some things that didn’t make the list that are well recognized complications of pregnancy. And if you do the right thing and get her delivered before the 39 weeks, you’re not going to get paid for that delivery. Even though you’re doing the right thing by the patient and by the fetus, if it didn’t make Washington’s list of officially approved reasons to deliver her before 39 weeks, they’re going to punish you for it. However, if you say, “Ok, I’m going to play it strictly by the book,” and wait until 39 weeks to deliver her, well then you’re risking compromise to the fetus, compromise to the mom, medical complications or possible even death of either one or both, the mother and the baby.
So what are you going to do? Well, if you went to medical school for all the right reasons, like 99 percent of the people that I know did, you’re going to do the right thing, and you’re going to deliver before 39 weeks and say, “Well, I’m just not going to get paid.”
And there’s something wrong with that.
DL: It seems like a damned if you do, damned if you don’t situation.
DB: It’s very much like that and again, it’s where the bureaucracy in Washington is very cynically forcing you into it. They’re using your own code of ethics, your own sense of what is the right thing to do by this patient. And the overwhelming majority of doctors, when they’re faced with a clinical situation, the ones that I know, they’re going to do the right thing. Contrary to what Barack Obama might say, rather than an EMT taking out a kid’s tonsils, rather than giving antibiotics, doctors don’t look at things like that. We do the right things by the patient and then you worry about getting paid second. I mean, that’s why we’re doctors.
But we don’t get credit for that. We’ve been so demonized by Barack Obama and Washington, DC that now we’ve got big targets on our backs.
I’ll tell you another thing where Barack Obama has really seriously harmed Americans and it doesn’t get enough press. What he’s done to the hard working people of this country who are out there trying to do the right thing. They’re trying to buy the private insurance. They’re trying to take care of their families. Well, what has he done to them? He’s taken premiums and doubled and tripled them in some cases. And he’s raised the deductibles, allowed the raising of the deductibles to astronomical heights to where families can’t afford the deductible. That needs to be, I think, talked about more than, “Well, we (Obamacare) covered someone who has cancer and wasn’t able to get insurance. Isn’t that wonderful?”
Yes, we all agree that’s wonderful. We all agree that’s important and nobody wants to see anybody suffer. We’re all in the medical profession. I mean, we don’t like suffering. We try to heal suffering, so none of us are going to argue against that.
But, I mean, for every one person that had cancer or couldn’t get insurance for whatever reason, for every one person that you save there, you’ve penalized another 20, 30, 40. I don’t know what the numbers are but it’s huge. Of the people out there working, trying to do the right thing. You’re penalizing those people for the one you might have helped.
And if you don’t believe that, I mean, as far as the cost again, back to the promise of what Obamacare was. Look at the cost of your drugs. If you don’t believe this whole thing has Big Pharma and Big Insurance as big players in it, where they got to write a lot of that law, why are the cost of drugs continuing to skyrocket in this country? Why is that?
Well, there was no real reform in the health care system. Barack Obama, the trade off he needed was, “Let’s give the feds complete control of the system and in return for that, we’ll give you the right to price your drugs the way you want to price your drugs,” which I believe, I’m a free market guy, but he traded that off to Big Pharma. Now they are charging astronomical prices for drugs that don’t cost them anywhere near what they are charging. Insurance is the same way. Well, you can’t deny anyone coverage. Ok, well to do that, we’re going to jack our premiums up to where people can’t afford it and the deductibles are going to be right on the limits of breaking somebody. That’s the trade-off to Big Insurance.
Another thing that the left likes to talk about now and Obama was still talking about just the other night, he’s very proud of the fact that he’s limited insurance companies on, they have to put 80 percent, it’s something like 80 percent has to directly go to covering the cost of care. In other words, “I’ve limited their profits.” No he hasn’t. Look at what he’s allowed them to do. If you’re going to have your profits percentage cut, then what are you going to do? You’re going to raise your gross revenue to get the same amount of revenue. If you don’t believe me, look at the stock prices of health care companies and insurers.
These are the things that need to be talked about that are so bad. This is what Obama has done to this country. To the drug example I told you I was going to mention just a minute ago, in obstetrics, there is a wonderful drug that’s been shown to prevent pre-term labor, or be very effective in most cases. That is an injection that you give weekly from 16 weeks up until 34 weeks. There’s a mountain of science behind it. It works very well. I’ve had personal experience with this drug. Our cost for that injection used to be about $7 per dose. When Obamacare came out, it gave the exclusive right to one company, now this was in compliance with the FDA, to where they said there will be no more generics of this drug. We were buying a generic and worked just fine. It was the same drug. $7 a dose. That dose today is $1,500 a dose. You can’t buy a generic anymore in this country. It’s available in Canada. But all physicians were sent letters, I received two or three letters, saying “You do not buy drugs from Canada anymore. It’s a criminal offense. It’s not a civil offense. You will be charged criminally for that.”
You talk about seriously damaging this country, the guy did it. As far as health care reform, as far as it affecting us personally, there’s so many examples, it’s just incredible.
DL: Tell me about you personally. What kind of toll is all this taking on you personally?
DB: Well, it’s gone to taking a profession that was fun, fulfilling, worthwhile, you felt like you were doing some good, you felt like you were allowed to use your best judgement to now you feel like a cog in a wheel. Now they’re giving you the protocol you have to follow, even though it might not be founded in science, but here’s the protocol that you follow. If you don’t follow this protocol, you’re not going to get paid.
And this protocol, the worst part about that as far as it affecting me personally, you know that protocol probably isn’t worth a darn. In some cases, it even wastes money, which shows you the incompetence of Washington. In some cases, they’re not necessary.
You’re just not valued. You’re not a valued part of the system.
You’re forced to see more patients for the same amount of revenue, or less revenue. And I’m sure you’re aware of it, the new Medicaid rule. If you have a patient discharged from the hospital with a certain diagnostic code, and let’s just liken it to obstetrics. You’ve got her in the hospital for preterm labor. You’ve got her labor arrested and she goes home. If she returns for the same diagnostic code, if she comes back with preterm labor within 28 days, you don’t get paid for either admission. Now, as you know, there’s nobody that can control preterm labor. We don’t even know what causes it for the most part, but it is a very real entity and it carries with it a huge cost if that baby is born before 36-37 weeks. You’re looking at a million dollar NICU admission so you do your best to stop preterm labor. Sometimes it requires hospitalization. But if you put her in the hospital for it and she comes back within 28 in preterm labor again, you’re not going to get paid for either one. That’s how ridiculous some of these rules are. But, they got their care, didn’t they? But nobody paid for it.
You’re talking about a very big, broad subject here when you talk about how Obamacare has affected doctors and health care providers. The list is just so huge.
DL: Have you ever just wanted to hang up the coat?
DB: Oh yes. If I could afford to do so, I’d quit tomorrow. Absolutely. Absolutely, I’d get out of it. There’s no future in medicine.
The complete SamePageNation’s exclusive “Do No Harm: Inside Obama’s War on Doctors.”
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Part One of a five part series on how Obamacare is already impacting doctors, and what it means to you.
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