The past several months reveal how disconnected the plan for health care reform has evolved. There was little transparency regarding the evolution of the bill, except for political posturing. The present administration has no experience in business leadership, nor basic economic theory.
The fact that the flawed SGR formula, hastily conceived in the early 1990s, was not addressed in the health reform bill attests to the simple fact that cost is a major factor in the legislation. Universal care was never a top priority except to assuage the proletariat. SGR was and is held out as a bargaining chip and as a diversion for most physicians.
The effects of the SGR impact very severely on ophthalmologists, urologists, geriatricians, some internists and somewhat on cardiologists and pulmonologists. These practices serve a large medicare population, and the SGR impact as presently structured or not eliminated will be devastating.
Primary care physicians can select to minimize medicare or eliminate it all together from their business model, with much less impact on their practices.
Thus, some specialists will have little choice but to either quit entirely, or fire half their staff, and reduce the quality and accessiblity of their practices to senior citizens. These practices will ill afford to acquire new technology. The physical structures of medicine will decline, poor maintenance, bare floors, and peeling paint.