The law will also make it impossible for doctors to cut a deal with people who prefer to simply pay for their own care:
My self-pay patients get a 30 percent discount. It’ll be illegal. According to them, there won’t be any. There will still be self-pay, there will be some people; what are you going to do to them?
Moreover, Schoeling said, this makes the president’s assertion that people who want to keep their current doctor will be able to simply untrue:
We probably won’t see new Medicare patients for sure, but most doctors will have to get rid of Medicare patients. They say you can keep your same doctor, but if he can’t afford to see you then you aren’t going to keep him.
As it sits now, just billing the insurance companies and dealing with regulation is a significant expense for local physicians, who, it should be noted, are also small businessmen. Schoeling said the American Medical Association estimates that the average cost for physicians just to do the paperwork to be reimbursed by insurance companies is $85,000 a year:
I pay a little more than that. I pay about $110,000, but that’s because I’m in primary care and we have a lot more fights to do than specialists.
Dealing with regulations, he said, adds another $20,000 to $30,000 every year:
We are required to be on all these committees for the hospital, because they have all these federal regulations they have to meet.
I spend at least an extra five hours a week just on meetings to meet regulations, and some weeks it’s much more.
Most of his billing is sourced out, but it takes about one-half of a full-time equivalent each week, or about 20 hours, just to deal with regulations. Under Obamacare, the billing situation will get more complex. The legislation forces communities to set up something called an accountable care organization (ACO). With the ACOs, billing to the insurance goes to the accountable care organization, which then cuts a check to the doctor — which adds another layer of bureaucracy. Schoeling said that group then decides who gets paid what:
We all then have to figure out some system how we’re going to get paid and you can imagine how much that’s going to cost. We’re all going to have to figure out how much we’re going to get paid individually, what specialty is going to get a certain amount for office visits, and it’s obviously going to be less than what we’re getting now.