New law ‘final nail in coffin’ for primary care docs: physician

Samaritan’s July 2009 newsletter featured Dr. Steven Knope, a pioneering direct-services doctor in Tucson, Ariz. He told us then he was adamantly opposed to the type of health care legislation being proposed in Congress. After the Senate health care bill became law on Tuesday, we asked him for his thoughts, and it was clear he is just as much opposed to it now as he was then. He says insurance does nothing to improve people’s access to quality health care.

What nobody is discussing is the simple truth that “health insurance” is NOT “health care.” Insuring people per se does nothing to improve their access to quality health care. In fact, insuring all Americans by government fiat will ironically lower the quality of care for all Americans, including the majority that previously had the best healthcare in the world.
This bill will add roughly 15 million people to the Medicaid rolls, yet there will be no new physicians who will be willing or able to care for them. I know of only a couple physicians in my community that accept new Medicaid patients. Medicaid and Medicare do not pay physicians enough to stay in business. Accepting these state-run insurance plans creates an unsustainable business model for physicians.
If this bill stands, it will be the final nail in the coffin for the future of internal medicine, pediatrics and family practice. The best and the brightest will no longer be attracted to these critical areas of primary care medicine. This will lead to a vacuum in primary care medicine. The vacuum will be filled by nurse practitioners and physician assistants. People will no longer see their doctor; they will see their nurse. This decline in the level of care will be only one of the unintended consequences of the de facto nationalization of medicine.

Dr. Knope is the author of Concierge Medicine: A New System to Get the Best Healthcare.