How doctors protest politicians

Dr. Gerard J. Gianoli

Doctors in Michigan and across the country are protesting the government's intrusion into health care, but we aren't voicing our concerns using bullhorns and pickets. Instead, many of the state's 34,000 physicians are protesting silently through their practice decisions.

Having graduated from medical school 28 years ago, I have witnessed firsthand the transformation of our country's health care system. Then, medical practice focused more on the deeply personal decisions made between doctor and patient. Today, however, bureaucrats are inserting themselves ever deeper into every aspect of health care.

Physicians across the country are responding to this evolution — and most recently the Affordable Care Act — by shielding their practices from government interference. Chief among them: Opting out of Medicare and Medicaid, transitioning to practices that don't accept insurance and starting "concierge" practices that charge annual fees.

Consider the number of doctors opting out of or otherwise avoiding Medicare and Medicaid. In 2014, one in four physicians either refused or is limiting the number of Medicare patients each sees, according to a new study conducted by the Physicians Foundation.

In recent years, a similar number of physicians simply stopped accepting Medicaid altogether.

These ailments have become so acute that thousands of other physicians are dropping out of these government-run health care programs altogether. According to the Centers for Medicare and Medicaid Services, nearly 10,000 physicians opted out of Medicare in 2012 — a 160 percent increase over 2009.

At a time when 11,000 baby boomers are turning 65 every day, this population segment can ill-afford a shortage of physicians, yet that is exactly what government intrusion into health care is causing.

Physicians are instead embracing practice models that limit government interference. This meddling can come either directly through government-paid health care — e.g., Medicare and Medicaid — or indirectly through regulations applied to private insurance policies — e.g., the Affordable Care Act.

For evidence, witness the emergence of "concierge" medicine and third-party-free practices. The first charges patients periodic membership fees; the second refuses insurance coverage altogether, thus dodging the government regulations that come with it.

The Physicians Foundation study found that fully 20 percent of physicians either practice or are planning to practice some form of concierge or third-party-free medicine. This number has doubled in only two years. No wonder: By eliminating the cumbersome insurance billing process, doctors can save an average 40 percent in overhead expenses, leading to lower fees.

More importantly, doctors can spend more time helping patients rather than fighting with insurers and bureaucrats on the phone.

Doctors are reacting to government intrusion in other ways, too. Over the last decade, there has been a dramatic migration of physicians away from small private practices toward employed positions at larger hospital-owned medical networks.

This is a troubling trend. Hospital employment inserts yet another wedge between doctors and patients.

Through all of this, doctors' primary concern is for the well-being of our patients. Yet Washington's ever-increasing meddling in the medical profession only limits our ability to help.

Dr. Gerard J. Gianoli is a neuro-otologist

who practices in Covington, Louisiana.