National Review Online
June 27, 2011
by Tevi Troy
The New York Times' Robert Pear has a front page story on a $350,000 sting operation by President Obama's Department of Health and Human Services to identify doctors who are reluctant to accept new Medicare and Medicaid patients. According to the article, the Obama administration is trying "to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates."
Secret-shopper programs themselves are not new. I recall Bush CMS director Kerry Weems briefing me on his experience putting on a plaid shirt and a baseball cap to participate in a CMS effort to see how well Medicare Part D open enrollment counselors were doing at explaining benefit packages to seniors. Weems told me that he was surprised that the counselors were not more curious about how well he knew the intricacies of Part D. That program, however, was about quality control, and not catching doctors engaging in behavior that the government dislikes.
What's going on here is more troubling. In the July/August issue of Commentary (dead tree only at the moment), my Hudson colleagues Doug Feith and Seth Cropsey characterize Obama's foreign policy as the doctrine of "constrainment." The word is apt for describing the Obama approach towards physicians as well. Doctors feel increasingly constrained by decisions being made about practice via IPAB, about organization via restrictive rules about accountable care organizations, and about reimbursement via the increasingly crazy quilt payment schemes of Medicare and Medicaid.
As Scott Gottlieb — an MD and former CMS official — has pointed out, such policies discourage entrepreneurship among doctors. This goes along with his warning that the Obama health-care law would "kill off private practice medicine," as doctors vote with their medical bags and choose to leave private practice for salaried work in larger institutions, such as hospitals, that will handle their growing bureaucratic burdens for them. Doctors might like the increased security, but patients won't like the colder institutional touch.
Having the federal government spy on doctors to see how they react to these "constrainments" is not the answer to the problem of fewer doctors in private practice; it's just one more spur driving doctors from having private practices to begin with. The real solution is to have the federal government change the policies that drive this behavior. Unfortunately, the spy program shows that the Obama administration is increasingly committed to its current problematic approach.
Tevi Troy is a Visiting Fellow at Hudson Institute and served as the Deputy Secretary of the U.S. Department of Health and Human Services from 2007 until 2009.
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