Jane Orient, a physician in Tucson, Ariz., says she’s never accepted a dollar of third-party medical payments, whether from a government program or a private insurance company. She has a “philosophical and ethical” opposition to the U.S. health care infrastructure, and she’s put it into practice for more than 20 years.
But with Obamacare set to take full effect in January, Orient says more and more physicians are joining with her in opting out of a payment system that she describes as co-opted by “insurance cartels” and the nanny state.
Orient is the executive director of the American Association of Physicians and Surgeons, a free-market group that claims 4,000 members nationwide, including Sen. Rand Paul (R-KY). Paul himself hasn’t endorsed physicians pulling out of the third-party system, but he has said that if a “right to health care” is invoked, then doctors could be conscripted against their will.
“It means you believe in slavery,” Paul said in a clip from a Senate committee hearing posted by the AAPS YouTube account.
More than half of AAPS members have stopped accepting Medicaid payments, Orient says, though she stresses that they’ll still see patients if they either pay for themselves or come to a free charity clinic. A smaller number of her membership is also bucking the private insurance industry, asking for direct payments from customers and telling them to seek reimbursements from their insurers on their own.
They see themselves as the front lines in the fight against a “plan … to destroy the current infrastructure,” as Orient put it in a recent interview with TPM. Winning that fight starts with convincing their peers and patients to break away from the system set up under the health care reform law.
“Coercion, central planning, socialism if you will does not work. It kills the incentive to work. It misallocates all of the resources so that everybody is worse off than they would have been if they had just allowed free men and women to make their own decisions,” she said. “The remedy is for patients and physicians is to decline to participate in the system, go for a true free-market alternative.”
She said that the federal government could eventually “outlaw private practice, just like they did in Canada.” Those are the stakes in the eyes of AAPS.
“Physicians just should not participate,” says Kevin Smith, an Oklahoma City surgeon who said he has whittled his third-party payer list to a handful of “honorable” carriers ahead of Obamacare’s January launch. “It’s time to step up and tell their patients: ‘Listen, you’re sick. You come on in, but I’m not playing with your insurance.’ It’s time for physicians to join the other resisters and I think that’s what we’re seeing right now in anticipation of this disaster.”
How Obamacare will affect the medical profession is one of the law’s still outstanding questions. Reports are circulating of insurance companies cutting down their provider networks for plans purchased through the law’s insurance marketplaces. Some warn of doctor shortages as millions of new people come onto Medicaid, which has already seen a significant number of doctors stop accepting its patients because they say its reimbursements aren’t sufficient.
But Orient and her group are different. They’re not grappling with a new status quo being introduced by Obamacare — they’re actively rebelling against it.
They’re doing it for the reasons that you’d probably expect. They describe health care reform as “central planning” or “a government-controlled system.” Orient warned that the law was effectively a “rationing mechanism” that could prevent Americans from receiving the care that they need (or being left to pay for it on their own) if their insurance company denies their claims to keep its bottom line afloat.
They see nefarious maneuvering at every turn. Smith predicted that, by popularizing the use of electronic medical records, Obamacare would eventually result in rationed/government-dictated health coverage if the government is able to use that information to determine which conditions or procedures are causing the high medical costs in certain areas as a “budget balancing tool.” He theorized that government scientists would manufacture research discouraging the use of particular preventive care, like pap smears or mammograms, if the law’s promise to pay 100 percent of its costs proved too burdensome for the government.
“It’s very sinister, very sick,” he said. “But Obamacare is just a logical extension of what we already have. It’s crony capitalism.”
These conservative physicians acknowledge that they’re aren’t necessarily winning over their more mainstream colleagues (estimates place the number of licensed physicians in the United States between 850,000 and 900,000). But they are convinced that as the reality of Obamacare sets in, more patients and their doctors will seriously consider abandoning the law.
“They’re not doing it in droves. It’s very hard to change your direction,” Alieta Eck, a New Jersey physician and former president of AAPS, told TPM. “You have to be kind of brave.”
But there’s one fundamental tension in what Eck, Orient and others are advocating. A doctor’s mission, as described in the Hippocratic oath, is to first and foremost treat people in need. By not accepting the traditional means of medical payments, they could be, intentionally or not, driving people away from their practices.
But they see it differently. Eck, who lost in the GOP primary for U.S. Senate this year, believes Obamacare could be a boon for business for physicians who resist. Why? If people have the maximum deductible allowed under the law ($6,350), they might never reach it — and might therefore prefer to seek out a practice like hers, where they can pay a “fair price” for health care without the intrusion of the insurance bureaucracy. The AAPS New Jersey chapter is also sponsoring a bill to require physicians to spend a minimum amount of time (48 hours over three months) working at a free non-government health care clinic to provide care to low-income populations.
So these doctors have ideas, and none of them involve complying with the creeping socialism they see in Obamacare. They see no obligation to become part of that system. As Orient tells it, it’s not a doctor’s fault if a patient is participating in an insurance construct that she called a “ripoff.”
“It’s really kind of tragic, isn’t it? There is a patient coming to you who has spent a huge amount of his income buying a so-called insurance plan that provides such lousy coverage,” Orient said. She argued that Obamacare would result in such low payments to doctors through Medicaid and private coverage that those physicians would either have to “subsidize” care or close their doors.
“What are you saying, that the doctor is responsible? It’s really not his fault that the patient has spent money on this ripoff.”