INCLINE VILLAGE, Nev. - If you occasionally see a doctor, are planning surgery or (God forbid) are facing hospitalization, stand by for a ram. At the end of this month, Obamacare will crank still another notch toward its January 1, 2014, full implementation. The 2,000-plus page law, of which then Speaker Nancy Pelosi said: "We have to pass this bill to see what's in it," has so many moving parts it's hard to fathom what the final result will be.So when the Republican Men's Club of Northern Nevada assembled three top Reno area physicians and the CEO of a medical device company at their December meeting in the Atlantis Casino, I signed up. How better to get the straight scoop than hearing from those most directly impacted by the law.First to speak was Cardiologist Costa Arger (who is also co-owner of Arger-Martucci Winery). Dr. Arger's opinion is that Obamacare was designed to end the private practice of medicine. He said that Obamacare, which failed to gain a single Republican vote, ignored tort reform and anti-competitive prohibitions on interstate health insurance. He pointed out that 17 states (not including Nevada) are refusing to implement the state insurance exchanges, a provision of the law overturned by the US Supreme Court. Dr. Arger believes that Medicare patients will lose the most as the law gets implemented Obamacare raided the Medicare trust fund of billions of dollars because congressionally mandated, but not implemented, Medicare reimbursement cuts are supposed to reduce the agency's costs. Since Congress keeps postponing implementation of the cuts, the hit keeps getting bigger ... currently 27 percent. The politicians know implementation will be highly unpopular. Currently Medicare providers are required to put all patient data on computers at a cost ranging from $1,000 to $50,000 per patient. Then all those data are shared with the government and doctors are actually graded on the quality of their data input.Family physician Dulynn Hastings spoke next. He addressed the challenge from the standpoint of doctors as small business persons. Caught between rising costs and drastically reduced Medicare reimbursements he foresees a trend of physicians retiring followed by an influx of foreign doctors and an increase in physicians' assistants and nurse practitioners. He predicts the result will be an impaired quality of medical services available. He is also distressed about the Obamacare's "Accountable Care Organization" provision which will bar reimbursements for medical visits to clinics such as UCSF in San Francisco, Mayo Clinics and the like.Internist Ron Smith then spoke, also predicting the retirement of many physicians and also warning of the results of drastic cuts in Medicare reimbursement rates to medical service providers. He believes that most physicians will have to refuse new Medicare patients which will also apply to Medicaid patients, the largest group to become eligible for coverage under the law. His experience is that even at current reimbursement rates the costs associated with treating Medicare/Medicaid patients just equals the revenue. Finally brand new Nevadan Tim Duvall spoke. He is CEO of Neo Medical, a medical device producer which just moved to Sparks from California. His concern is Medicare reimbursement rates as well as a brand new 2.3 percent franchise fee Obamacare will levy on medical devices starting January 1. He said he moved his company in a cost-saving effort but may now have to consider manufacturing outside the US.It's too bad Pelosi and her colleagues didn't read the bill before they passed it.- Jim Clark is president of Republican Advocates and has served on the Washoe County & Nevada State GOP Central Committees; he can be reached at firstname.lastname@example.org.
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