A Commentary on Healthcare—The Perfect Storm

Malcolm Ing MD
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Malcolm Ing MD

BY MALCOLM ING MD – It may surprise the public to learn that the majority of doctors oppose Obamacare. These physicians are particularly in opposition to the section of the new Affordable Care Act that has created the Independent Payment Advisory Board, a 15 person committee of non-physicians appointed by the President.

In fact, even the AMA, which was acquiescent in the passage of the Obamacare before it became the Law, supported the failed House of Representatives effort to rescind this portion of the Law.


Unfortunately, this effort was defeated in the Senate. However, by now, everyone with common sense realizes that this section of Obamacare will forever threaten the sacred doctor- patient relationship

In addition,  thefailure to address steeply rising drug and technology costs and the absence of tort reform to decrease necessity to practice defensive medicine were important omissions in Obamacare.

Taking personal responsibility by maintaining a healthy lifestyle and health savings accounts are not encouraged by government control of medical insurance and payments to hospitals and physicians.

To make matters worse, Medicare now requires physicians to utilize expensive (at least, $35,000) electronic health records for patients to avoid paying a financial penalty.

Ironically, just when the country will need more physicians to provide medical and surgical care especially to the elderly, the government plans to add to the costs of providing that care. All this is taking place while Congress is failing to address the chronic problem of Medicare underpayment to physicians (SGR) which limits the number of elderly patients that doctors can accept in their practices.

It should be no shock to learn that, when surveyed, many physicians consider the increased bureaucracy as motivation to retire early which will aggravate the already recognized doctor shortage. By 2014, an additional half billion dollars will be removed from Medicare funds that are barely keeping the program afloat as it is.

Lastly, the medical insurance requirement for physicians to utilize the more complicated insurance coding also by 2014(ICD-10), necessitates more cost and personnel to maintain medical practice.

Anyone who has truly studied all these factors will realize that they are the elements of an impending perfect storm for medical care in this country.


Malcolm R. Ing, M.D. is a comprehensive family ophthalmologist with special training in the diagnosis and treatment of eye problems in children. Dr. Ing received his pre-medical training from Harvard University, graduated from Yale Medical School and completed his Ophthalmology training at Yale University.  Dr. Ing enjoys teaching at the John A. Burns School of Medicine at the University of Hawaii and serves as clinical Professor and Chair of the division of Ophthalmology.





  1. The health care profession has always been in favor of anything that will improve their incomes at the expense of everyone else. The same attitude is seen with all the professions. The professions rely upon the power of the government to prevent anything that might reduce their incomes through exposure to the free market. Thus we have prescription laws, restriction on the number of candidates accepted to medical schools, government licensing. Libertarians on the other hand support repeal of prescription laws, certification instead of licensing. Different tiers of medical providers so that people can select the level of skill they feel is required to deal with their problem. Not everyone needs "no limits 2013 technology". A lot of medical conditions could be dealt with at lower and less costly treatment levels. The doctor-patient relationship would be better replaced with a "contractor/client" relationship where the "client" makes the eventual decisions as to what is to be done. Especially today with much more medical information available via the Internet.

  2. AMA policy, set democratically by our House of Delegates, supports covering America’s uninsured – who live sicker and die younger. We are pleased that the new law extends coverage to millions of Americans, ends insurance company denials based on pre-existing conditions and promotes wellness and prevention – all while retaining our American health care system’s mix of public and private insurers. The law also includes increased payments for primary care physicians in Medicare and Medicaid and bonus payments for general surgeons in underserved areas. As the nation’s largest physician organization, the AMA is engaged in the implementation of the health reform law to achieve improvements and ensure the best outcome for patients and physicians. We are leading the charge to address problematic parts of the new law, including eliminating the Independent Payment Advisory Board, to ensure it meets the needs of patients and the physicians who care for them. An unrelated need is the elimination of the failed Medicare physician payment formula, known as the SGR. This is the necessary first step in making critical reforms to transition to a Medicare program that rewards care coordination and quality while reducing costs.

    • Dear Reader, I am glad the AMA according to Dr. Lazerus, its current President, was supportive of the House of Representatives' attempt to rescind that portion of the Affordable Care that would interrupt the normal doctor- patient relationships,namely, the Independent Payment Advisory Board. Many physicians, as well as myself, also regret that the AMA did not dig in its heels on tort reform and the public was not aware that government bidding for the control of drug costs, ala Canada, was not more heavily included, in the ACT. Without including these last two factors, it would be unrealistic to call the AC T –The Patient Protection and Affordable Care ACT.

  3. In addition, thefailure to address steeply rising drug and technology costs and the absence of tort reform to decrease necessity to practice defensive medicine were important omissions in Obamacare.

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