Tags: Exclusive Interviews | Healthcare Reform | Steve Malzberg Show | Richard Amerling | VA | doctors

Doctor: Fee-for-Service Approach Would Help Fix VA

Tuesday, 27 May 2014 07:15 PM

The Affordable Care Act is heading down the slippery path of the troubled Veterans Administration, says Dr. Richard Amerling, an associate professor of clinical medicine and an academic nephrologist at Beth Israel Medical Center in New York City.

"They are both large government-run bureaucracies and they all share certain things in common,'' Amerling told Dennis Kneale, guest host of "The Steve Malzberg Show" on Newsmax TV.

"[There's] a very heavy administrative load in terms of how much money is absorbed by that sector.

"It's harder and harder to actually get the money to where it's going to do the most good, which is with the doctors and taking care of patients and the hurdles that doctors go through in both systems to actually take care of patients,'' he said Tuesday.

Amerling said President Barack Obama's signature healthcare law is intended to eliminate fee-for-service medicine.

"That is a direct assault on primary-care, private-practice medicine. If a doctor can't just ask for a rate and get it in a direct manner, that ends primary-care, direct-pay medicine,'' he said.

"They want all doctors in salaried positions either working for the government directly or for hospitals, where they can then control them and sort of tell them what to do, and that's what Obamacare is going towards and that's why it's similar to the VA.''

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Amerling called the ACA "the bureaucratization of medicine in a major way.''

"Medicine has been going in that direction for many years . . . really beginning with third-party-payment Medicare, Medicaid, back in the 60's, the HMOs, etc. It's harder and harder to see a doctor and just settle up with them,'' he said.

"It's got to go through multiple layers of administration. The administrative sector has expanded massively compared to the actual clinical sector, and that's where the money is going.

"Obamacare is going to spend massive amounts of money on more and more administrators and less and less on patient care.''

Amerling said the ACA cannot be appealed outright, nor can the VA mess — in which up to 40 chronically ill veterans died after allegedly being placed on secret waiting lists — be solved overnight.

But major fixes must be made to both, he said.

"We're not going to get rid of government-run healthcare in one fell swoop, we're certainly not going to get rid of the VA system, it's a huge bureaucracy, a huge institution with hospitals all over the place,'' Amerling said.

"What we can do is try to improve the way they run these institutions by putting in correct incentives such as a fee-for-service system, for example, for physicians.

"You pay the physicians in the VA system on a fee-for-service basis, I guarantee you that those waiting lists are going to disappear very quickly.''

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