Ask a Scientist

Will health care reform affect medical decisions?

CorrespondentNovember 25, 2012 

Behavioral&Decision, Peter Ubel

Dr. Peter Ubel is a physician and behavioral scientist at Duke University and the author of “Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.”

LIN JONES — University of Michigan

Dr. Peter Ubel is a physician and behavioral scientist at Duke University and the author of “Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.” Here he explains what impact the Affordable Health Care Act might have on your next doctor’s visit. Questions and answers have been edited.

Q: Much of the debate around health care reform has centered on whether the government or the individual will control health care decisions. Is that a valid argument?

Most medical decisions are between clinicians and their patients, and will continue to be that way as the federal health reform law is implemented. Medicare bureaucrats aren’t going to decide who should take insulin shots. That will still be something for individual doctors and patients to determine together. Mainly, this fuss about the government taking over medical decision-making comes down to partisan fear-mongering. Few things are more politically powerful than scaring voters.

Q: Is health care reform likely to change the way doctors treat their patients?

I am not suggesting that doctors and their patients will have unrestricted abilities to decide whatever they want together. That hasn’t been true in medical care for quite some time now. At least since the growth of managed care in the 1990s, groups like third-party payers have been trying, on the edges, to influence medical decision-making. Even now, your insurance company might make you pay out-of-pocket for a particular brand of insulin or decide that a particular bypass surgeon is not part of your “network of providers.”

But there is a more legitimate reason people are worried about the government taking over medical decision-making: Medicare threatens to bankrupt the federal government, leaving legislators with no choice but to find ways to control health care costs. People are understandably concerned that the government will do this by denying patients the medical care they need.

But I don’t see this happening. For starters, Medicare will probably focus its cost-control efforts on physician and hospital reimbursement. American physicians make substantially more money than their counterparts in Europe or Asia. Our current payment system encourages physicians to do more things to more people, and more isn’t always better. By tweaking its reimbursement program, Medicare could cause physicians to think more carefully about whether any given procedure is necessary for any specific patient.

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