Don't expect your doctor to stand up and protest about how the Affordable Care Act is responsible for so many of the health care problems that patients face today.
As a physician and a dentist in private practice, we have spent the past five years making the case that the ACA is harming our patients. While we get many varied and complex questions from them, the one question always asked is a simple one, but one with a more complex answer: "Why aren't more doctors speaking out?"
The primary reason is fear. Doctors are afraid of their new bosses — bureaucrats and their corporate employers whom the ACA empowered.
Thanks to the ACA, many physicians who have practiced as small employers have been forced to leave private practice to become corporate employees (a number that now represents more than 50% of all physicians). For physicians in this position, public advocacy against the ACA could be in violation of employment contracts or could be a source for dismissal.
Most doctors' contracts also include a two-year noncompete clause that essentially requires the doctor to move out of town once he or she leaves a specific job. So, running afoul of your employer by criticizing the ACA could result in not just losing your job but also forcing you to leave your hometown.
And that's not all. Many doctors are also afraid of losing insurance contracts. The vast majority of doctors who are still private-practice owners are dependent on a handful of large insurance contracts for revenue. Speaking out against insurance companies — which were complicit in the ACA's passage and are some of its primary beneficiaries — can result in cancellation of those contracts.
One insurance contract that represents 20% of gross revenue for a physician can result in a 40% decrease in take-home pay. When one of your customers controls that much of your income, you too would be reluctant to be openly critical of them and the federal law that empowers them.
Doctors are also afraid of increasing government audits. The government has been heavily involved in controlling health care since the introduction of Medicare in 1965, and along with that government intervention came rules and regulations that have mounted over the years into a byzantine set of contradictory laws — a system so huge and complex that no physician could possibly follow them completely.
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