Much has been written about Obamacare but little about what might be the most significant element of the legislation. The principle of ''results oriented medicine,' which sounds very reasonable, but could be the downfall of the patient-doctor relationship as we know it. This principle may not be explicitly stated in the legislation, but is most definitely implied in the text as well as verbally in the defense of the law.
Consider the word results, it must be asked for whom; patients, doctors, insurance companies, Wall Street, government? I can't answer that question and it's unsure if it has ever been answered directly, but there are hints that should be considered. Obama queried, during the 2008 campaign, ''Should grandma be given a pill or a hip replacement?'' That doesn't sound like he was thinking much about grandma, but rather government, who is responsible for cost control.
Another clue is the establishment of IPAB, or Independent Payment Advisory Board, which has the purpose of cutting payments to providers if costs rise faster than a predetermined rate. This board doesn't seem to be very concerned about patients, but rather costs. Another clue is that the announced purpose of Obamacare is to cut the cost of Medicare so that more people can get health insurance. The CBO has estimated that $500 billion will be cut from Medicare.
The creation of ACOs (Accountable Care Organization) is another matter of concern. ACOs are a subset of MSSP (Medicare Shared Savings Programs) and are to account for a patient population of a specific area, i.e. city, county or some similar geographic area. ACO Doctors (who must be approved by CMS (Center for Medicare Services) will get bonuses if they meet cost cutting goals and perform according to dictated procedures. There are thousands of pages in this law, but to me what all this means is that doctors will do ''cookbook medicine'' using recipes written by insurance companies, pharmaceutical companies, investment bankers and government politicians.
Doctors will be replaced by technicians who will feed data to a computer and out will come the low cost solution, thus the end of the doctor-patient relationship as we know it.
David E. Beadling