The CBO Score, Patients Losing Insurance Coverage and Other Myths of This Healthcare Debate


There are problems with the debate over healthcare and “reforming” it. The first is that the Progressive Left has defined the terms under which we discuss healthcare. The second is that the GOP is terrible at messaging their solutions.

Examine the CBO claim that 24 million people will lose health insurance coverage under the American Health Care Act (AHCA). The only way that people lose their coverage is if the government is giving it to them. Let this sink in. That logic may be true for the greater than 50% of healthcare already being provided through Medicare, Medicaid, CHIP, VA and Indian Healthcare. It may even be the case for the entitlements given to individuals in the form of taxpayer subsidized payments to cover private healthcare premiums through the Obamacare exchanges. However, these exchanges are collapsing and insurance companies are walking away from them. They will soon not exist.

Stating that Americans will lose their healthcare coverage is “progressive speak.” Any plan that moves people into insurance programs that are controlled by patients and not the government moves the country further away from progressive nirvana, which is a single payer system. The AHCA does not result in patients losing coverage. It provides a choice. If patients choose not to participate, it is either because they are unwilling or unable. If the latter, it should be determined if it is because of cost, and if so, then making healthcare more affordable must be the goal.

The GOP needs to reclaim the narrative from the Left. They need to articulate more effectively that government needs to be taken out of healthcare and that people need to find ways to be less dependent upon it. When the government provides healthcare, they can take it away. They have done this previously and it will only get worse. Take for example prostate cancer screening. A government agency, the United States Preventative Services Task Force, downgraded it and Medicare no longer will pay for it. Another problem is that the quality and availability of the healthcare received through Medicaid or “skinny” insurance networks, as was the case in the Obamacare exchanges, is inferior to that which patients get if they, and not the government or 3rd party payers, are making the decisions.

Defending the AHCA can be difficult because it is not perfect and it’s complicated. But contrary to Obamacare, it promotes individual freedom over government control. Watching this come together is ugly and uncomfortable, but that’s how government operates. To use a medical analogy to describe the American healthcare system, the patient is dying from cancer and needs chemotherapy, which will be difficult to take but will ultimately allow him to get stronger and live a healthy life.

Once the cancer is removed in the healthcare system, efforts must be directed at making it stronger. This can be done by removing our dependence on insurance, which will actually make healthcare more affordable, as counterintuitive as that might appear.

The best way to accomplish this is via Direct Primary Care (DPC), which is a delivery model in which a patient pays a fixed amount monthly, often as little as $50, and receives almost unlimited access to THEIR regular doctor. This fee includes services that can be provided in the office, such as basic preventative and diagnostic testing and minor emergency procedures. Services that fall outside of this are available at facilities where steep cash discounts have been pre-negotiated– like a CT scan for $150 or an MRI for $400. Even visits to specialists are a fraction of what they would cost under an insurance model. Thus, DPC is considered “concierge care for the average Joe or Jane”.

One might ask why are we not seeing more DPC? In large part because insurance companies are threatened by this model and spend vast sums lobbying lawmakers to lump DPC in the same category as insurance. Consequently, as the current law stands, patients cannot use their Health Savings Accounts to pay for this.

The Primary Care Enhancement Act (HR365) makes the clarification that DPC is not a risk bearing entity, but a delivery model, and that HSA money should be able to be used to pay for this. Seventeen states have already passed legislation to protect DPC, but federal clarification would be a game changer. This should be strongly considered as an addition to the AHCA.

Healthcare costs are unsustainable, but healthcare is not expensive, as DPC has proven. Unless we embrace disruptive innovation to drive costs down, healthcare insurance premiums will not substantially decrease regardless of what market driven innovations are created. This may be the only opportunity to begin to effectively drive down the cost curve in healthcare and it would be a tragic mistake to let this slip away.

This was originally published at Townhall.


Physician leaders meet, set plans to address “crisis” in doctor-patient relationship

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Group establishes Galen Doctors Forum to coordinate efforts

Washington, D.C., March 17, 2017 — Physician leaders and patient advocates met yesterday in a forum organized by the Galen Institute to raise awareness of what some called a “crisis” of unprecedented interference blocking doctors from being able to prescribe the treatments they believe are best for their patients. During the conference in Washington, D.C., they heard presentations by fellow physicians and by a noted patient representative on how cost-cutting measures by third-party payers in both private and government health care insurance plans are interfering with the doctor-patient relationship. Regulatory policies in government and cost-cutting measures in private plans are overwhelming doctors with paperwork and forcing them to go through multiple rounds of negotiations to justify their prescribing decisions to provide what they believe is the best care for their patients.

Galen Institute President Grace-Marie Turner commented, “As I travel the country, I have become increasingly concerned as doctors say that their hands are being tied by bureaucrats who second-guess their clinical decisions. At this critical moment in the health care debate, I believe policymakers need to hear the physician point of view.” She noted that, typically, physicians are so busy caring for patients that they do not have much opportunity to take part in discussions of health care policy. “For this reason, we decided to bring this group together to begin a national conversation about this crisis in the medical profession, to ensure that policymakers and patients alike understand the barriers doctors are facing as they attempt to deliver the best care possible to their patients.”

The keynote speaker at the conference, Dr. Seth Baum, said that it is vital that patients become aware that their physicians face great difficulty in prescribing the best innovative treatments for them. “Patients should not have to wonder who is deciding which medicines they take, their doctor, or their insurer,” Dr. Baum said. “In my case, I am forced to complete intricate, 17-page documents so that insurers will allow my patients access to lifesaving new cholesterol medications, only to see them turned down, repeatedly.” He pointed to “fail first” policies, which require doctors to prescribe older, cheaper medicines for patients until those patients “fail” on those drugs, before being allowed to prescribe breakthrough treatments that would be more effective. “These decisions are best made between doctor and patient, not by bureaucrats,” he added. “Insurance should be there to take the worry out of healthcare, not tie doctors and patients up in red tape.”

Another speaker at the conference, Dr. Hal Scherz, a pediatric urologist, said that “Third-party interference has become endemic in the U.S. health care system, and is increasingly destructive to the patient-physician relationship. A recent survey by the Physician’s Foundation found that 53.9% of physicians surveyed claim that some of their decisions are compromised due to their current level of clinical autonomy. I am glad to take part in this discussion, and hope it will increase public awareness of the restrictions doctors encounter in their daily work.”

Meeting participants said that they were energized by the discussion, and pledged to continue to share experiences and ideas under the umbrella of a new Galen project, the Galen Doctors Forum. “We are excited to be able to provide this forum for physicians from a wide array of disciplines and geographical regions – people who might not otherwise have the opportunity to work together to improve conditions for current and future doctors who want only to practice medicine to the best of their ability,” Ms. Turner said. “We heard from many doctors who hope to join our discussion and be part of our efforts going forward. We plan to broaden our reach to develop policy recommendations and to educate the public on the need to put the doctor-patient relationship back at the center of the American health care system.”


Conned out of care


Imagine healthcare costs going down each year in the same way technology and retail costs do. Given congressional Republicans’ healthcare reform plan, this is no longer a dream scenario.

Based on the House Republicans’ plan released last week, the GOP plan will reduce healthcare costs in several ways. It offers refundable tax credits and expanded health savings accounts that encourage patients to become better shoppers for healthcare services. Rather than a one-size-fits-all federal standard for insurance, it encourages competition among insurance companies. And by focusing on patient (not Washington) customization of coverage, new and cheaper plans can be offered.

But there is still at least one piece of low-hanging, cost-saving fruit that the plan doesn’t address: certificate of need laws. Scrapping these government licenses required to provide care would increase healthcare supply, improve quality, and reduce price. Although these are state regulations, the federal government was responsible for their proliferation, and now must play a role their demise.

Some background: In 1974, Congress passed the National Health Planning and Resources Development Act, requiring states to implement CON requirements in order to receive funding through certain federal programs. Lawmakers believed that bureaucrats could dictate healthcare supply better than the market.

Roughly a decade later, it became clear that CONs failed on every measure and may have contributed to healthcare price inflation, so federal subsidies were stopped. But the hospital establishment, which enjoyed being protected from competition, has lobbied to keep them alive in 35 states and the District of Columbia.

In practice, CONs mean that healthcare entrepreneurs who want to open an MRI clinic, a surgery center, a nursing home, or a hospital must get government permission first. Even more outrageous is that often the state government committees that oversee approval of CONs are stacked with members of this same healthcare establishment. It’s cronyism in its purest form.

Unsurprisingly, data from the Kaufmann Foundation shows that states with CONs have significantly higher per capita healthcare costs than those without. The Mercatus Center at George Mason University recently published the results of their Healthcare Openness & Access Project, which measures access to healthcare in each state. As expected, states with CON laws ranked among the worst. Eliminating CONs would usher in a new supply of healthcare to bring down costs for small business and individual consumers.

States such as Oklahoma that do not have CONs have an environment where innovative, market-driven solutions can be implemented to drive down the cost of healthcare. The Surgery Center of Oklahoma, for instance, has a website where the cost for every procedure is posted. There are no hidden fees. The cost of surgery there is often 5 to 10 times less than the nearest competing hospital down the road, and in many cases, the surgeons are the same in both facilities. Medical tourism has reversed and patients can receive high quality care by board-certified surgeons for affordable prices right here in America. But only in states that permit it.

For patients who are asked to pick up a greater amount of their healthcare costs, such healthcare entrepreneurship allows them to become responsible consumers of resources. For businesses, it offers the opportunity to slash the single highest line item on their balance sheet — healthcare costs. Over 40 percent of businesses in America are self-insured; that is they pay the costs of care for their employees and do not rely on the third-party insurance system because it costs them too much. With CON repeal, more centers offering reduced cost services will open and business operators will see substantial savings.

Legislators need to begin to put their constituents ahead of the special interests who spend money to protect their turf. It is time for businesses to stand up to legislators and tell them so. There’s still time to make CON repeal part of federal healthcare reform.


This originally appeared in the Washington Examiner.


Letter To President Trump: You Have Missed The Best Resource In Fixing Health Care…Big Time!


Dear President Trump,

I have been watching your activities over the first month of your presidency with great interest and admiration. I applaud you for the energy that you have brought to the office and your desire and willingness to speak with experts representing groups that you need on board to make America great again. So you might understand why I am both puzzled and disappointed that despite the fact that healthcare and Obamacare repeal are top tier issues, you have failed to bring in the true experts who might give you real insight into the problems and possible solutions- doctors in active medical practice.

The choice of Congressman Tom Price for Secretary of Health and Human Services is excellent, because only someone with his background as a doctor, a legislator and a healthcare policy expert, can properly rehabilitate the healthcare system. He is the best possible person for this job. The fact that his confirmation was stalled for so long by Senator Ron Wyden and his Democratic colleagues, demonstrates the complexity of the problem. Politics aside, he and so many others in Congress are beholden to special interests that stand to lose a fortune if the changes necessary to return healthcare back to the patients are implemented. Insurance companies, for example, have made billions of dollars since the inception of Obamacare, thanks to changes that they had a hand in crafting. The industry has contributed over $600K to Senator Wyden’s campaigns over the last 5 years, and they have given the same or greater to other members of Congress. It is not surprising then, that a health care “solution” coming from Congress means a “replacement plan” that still allows the insurance companies to maintain their primacy in health care.

As the health care debate rages on, please remember that no one is actually discussing health care. The conversation is exclusively about insurance and coverage.

The real problem is that not a single replacement plan for Obamacare nor a single health care “expert” addresses the true cost of health care, which is obscene. There are many reasons why the actual cost of care is so high. Heading that list is the third party payer system, which is how the insurance industry took control of health care in the first place. This system disconnects patients and doctors from the true costs of care. There also exists a perverse payment system which pays more for care delivered in hospitals than for identical services outside of the hospital. Inasmuch as the hospital is the most expensive place in the health care delivery system to deliver care, it should come as no surprise that health care costs continue to soar. Moreover, Obamacare has created an environment where care is being driven into the hospitals while putting private practice doctors out of business. If you are the champion of small business as you claim, this should infuriate you.

I recognize that it is important to solve the insurance mess created by Obamacare, but addressing this alone will do very little to drive down costs, which were in large part the excuse for the creation of the misnamed, Affordable Care Act. The real key to driving down costs is to create an environment where patients can find value for their health care dollar and receive quality care. Quality cannot be measured by checking boxes, which is how Washington bureaucrats have addressed this issue. Health care is not expensive to provide. It only becomes so when doctors have to wade through red tape created by bureaucracy in order to take care of their patients. Or when the care delivered in hospitals costs five to 10 times the amount that it would cost at competing outpatient facilities such as the Surgery Center of Oklahoma, recently featured in a Time magazine article.

Eighty percent of health care can be delivered by primary care doctors. The fastest growing health care delivery model (except for hospital employment of doctors) is Direct Primary Care. This is “concierge medicine for the average Joe” because it costs less than a monthly cell phone bill and gives a patient their own doctor who will see them as often as necessary. The sickest patients can get the care that they currently are not receiving.

Although not a federal but a state issue, Certificate of Need laws restrict competition in the health care marketplace and exist because the federal government gave funding to states to adopt these laws. CON laws, which exist in 35 states, prevent the establishment of new facilities like surgery centers, hospitals, radiology or laboratory facilities without state approval. But before approval is granted, existing facilities must sign off, which of course never occurs. Health care costs will never come down until the playing field is leveled and the shackles are taken off of doctors who have the know-how to deliver better care for lower prices.

My hope and that of thousands of doctors, is that you will recognize that there are real health care experts taking care of your constituents, who know the problems better than the self-proclaimed experts. Please show them the same respect you have given to leaders in other industries and understand that the well-being of their patients is what drives them, and not allegiance to any special interests. Let us help you solve the real problems in health care.

This originally appeared on


D4PC responds to Aetna CEO Declaring Obamacare is in a Death Spiral


“Aetna CEO Mark Bertolini made headlines by declaring that Obamacare is in a death spiral. It is difficult to understand how this is a news worthy comment. The Obamacare death spiral began 2 years ago when state-operated healthcare exchanges began shutting down. It got worse last year when insurers began pulling out of many states, leaving some with a single insurer under Obamacare. Instead of reporting the obvious, the media should ask how Mr. Bertolini earned $27.9 million in 2015 in total compensation if Aetna was doing so badly as a result of Obamacare, or how his company posted $2.3 billion in earnings on $63 billion in revenues.” Hal Scherz MD, Founder- Docs 4 Patient Care.

This was posted in response to Aetna CEO Mark Bertolini recent comments in the Washington Post.


A Virtual Debate


 From CNN to Contentious Nominee Hearings

Michael Koriwchak, MD

The past weeks have seen a contentious health care debate on CNN and an interrogation style HHS nomination process.

Dr. Michael Koriwchak is hosting a special virtual debate and virtual nomination process this week by engaging the tough questions from a doctor’s perspective on the front lines of medicine.


Reflections on the CNN Healthcare Debate


The CNN healthcare debate between Senators Ted Cruz & Bernie Sanders on February 7 was dubbed a success by the network, ranking first in its cable time slot. With healthcare once again thrust into the headlines, and with two big personalities squaring off, this was certainly the marquee event, as was advertised. It turned out to be what one would have expected; a clash of ideologies, but a deeper look into what was said, and specifically what wasn’t, turned out to be most revealing.

Senator Sanders’ positions contained very little substance as he clung to his talking points which reflected his belief that healthcare was a right and that the government needed to provide it for everyone. Senator Cruz countered with several lines of attack, first giving an explanation regarding his interpretation of the definition of rights, maintaining that government giving something to individuals, in this case healthcare, did not constitute a right. He asked “why would we want to give the government MORE control over Americans’ healthcare, when they have done such a miserable job managing things up to this point?” Cruz concluded with the point that individuals are better at making healthcare decisions for themselves than the government. When the government does so, as in socialized countries, it leads to rationing- the government deciding what kind of care a patient may receive.

It was interesting that both men agreed that a big part of the problem stemmed from greed and excessive influence of special interests. Insurance and pharmaceutical companies were specifically singled out. Where they differed was their approach to solving this problem, retreating to their respective corners of the ring, with government control on one side versus a free market solution on the other.

The Senators missed the biggest problem in healthcare however, which is not surprising because everyone else has as well – the high cost of care. The healthcare reform debate has focused exclusively on insurance coverage and access. What plan will the GOP create to replace Obamacare? Although a market-based approach to healthcare insurance as is being offered by the GOP will result in substantial savings, the current cost of healthcare is unnecessarily high and will continue to be a strain on the American economy. There is a way out of this, but it does not appear to be on anyone’s radar.

The third major special interest, which went unmentioned in this debate is the hospital industry. Obamacare accelerated a trend which was to drive healthcare into the hospitals- the costliest place of delivery. It is folly to believe that taking an approach which focuses only on making insurance more affordable without doing something about the high costs of the healthcare itself, will have a significant impact on overall costs. Why should services be 5-10 times as expensive in the hospital as they would in free standing facilities? It defies logic.

There are many other factors that contribute to the high cost of healthcare that also need to be addressed. The third party payer system hides the true cost of healthcare, which really is not expensive when all of the overhead created by government and insurance bureaucracy is removed. Medical malpractice and frivolous lawsuits has created an adversarial relationship between doctors and patients giving rise to the practice of defensive medicine- performing an extra test or procedure, “just in case something rare could have been missed.” This practice results in annual costs between $200- $600 billion of mostly unnecessary spending that could be returned to patients.

The other major disappointment with this debate were the questions from the audience. CNN undoubtedly had an agenda in the selection of the questions and those chosen to ask them. It appeared that they wished to showcase typical “victims” – the ones who would lose their coverage if Obamacare is repealed. While this is understandably a concern for millions, and people are nervous, it might have been more illuminating to hear questions about other problems that are damaging our healthcare system and how Washington plans to deal with these issues. CNN squandered an opportunity to bring a doctor into the debate; one who was sitting in the first row and happens to be an expert in healthcare information technology and its problems. He was prepared with an important and insightful question but CNN thought otherwise.

In this latest round of the healthcare fight in America, a prudent person would realize that the so-called “experts” on healthcare- the policy wonks, the politicians, the healthcare economists, didn’t do so well the last time. To go back to what Senator Cruz said in this debate- why would we want to give them another chance at it? It is time to hear from the real experts in healthcare; those who have had to deal with the misery created by these “faux experts.” It is astounding how once again, the medical community has been excluded from this debate. CNN had a chance to begin to change the conversation by bringing a doctor into the discussion, but chose not to. They simply blew it.

This was originally posted on


Doctors Disappointed at Debate


A fitting metaphor from a Doc who was there

m-koriwchakThanks to some undeserved serendipity I had the good fortune of being invited to last week’s live broadcast town hall debate on CNN between Senator Bernie Sanders and Senator Ted Cruz regarding the future of Obamacare. I was offered the opportunity to appear in person to ask a question to the congressmen and spent many hours in communication with CNN producers to formulate a question acceptable to them.  Sadly the event ended in disappointment.  As the congressmen got long-winded and Senator Cruz had already spontaneously addressed the topic of my question, time ran out with my question unasked.  I have no ill feelings towards CNN over this.  Such is the nature of live events. 

Yet such an outcome is a fitting metaphor regarding the main problem with the narrative on health care reform.  My wife Amy said it first:  “This debate was no different from the ones we heard almost 10 years ago when Obamacare was first offered.”  She is absolutely right.  For decades we have heard – from both sides of the aisle – the same tired arguments from people who have never touched a patient and have no understanding of how health care should work.  There was nothing new offered Tuesday night.  On the Democratic side we heard that because health care is a right the government should provide “Medicare for all.”  On the Republican side we heard there is no way to finance such a big plan and that the government needs to get out of health care.  Familiar scapegoats – pharmaceutical companies and insurers – were dragged out with torches and pitchforks.  Both sides fight the war from the same trenches that were dug ages ago.  On Tuesday night no new hearts and minds were won for either side.

It is also fitting that the one opportunity to bring new life to the discussion – to bring physicians into the conversation – was turned away.  The one group who lives and breathes health care every day was ignored – as it has been for decades.  To be fair, some of the blame lies with us physicians – in the past we have as a general rule been averse to carrying our Hippocratic Oath beyond the clinic and the operating room.  But over the last several years that has changed.

Tuesday night’s debate may not have been the right time to engage.  We did not have as much time to prepare as we would have liked, and the exact rules of engagement were not clear.  But even with such apparent misfires we gain knowledge and wisdom.

The right moment to engage will come.  And we will be ready.


A Plan to Repeal and Replace Obamacare


Obamacare is a proven policy failure. Congress and the Trump Administration must completely repeal the law, beginning by seizing the opportunity to accomplish as much of repeal as possible through the reconciliation process. Congress must focus on the fundamentals: equalizing the tax treatment of health insurance; restoring commonsense regulation of health insurance; and addressing the serious need for reform in Medicare and Medicaid by adopting policies that give individuals control over their health care. High quality health care means all Americans should be free to choose a health care plan that meets their needs and reflects their values. Congress must act now to repeal Obamacare and replace it with a new set of options that empower Americans, not government.

Read the full report at


The Doctor’s Computer Will See You Now


By Sally C. Pipes and Michael Koriwchak

If you have visited the doctor recently, you probably noticed a new instrument in the examination room. It is a computer running an electronic medical records system, or EMR, that has been lauded by federal agencies as bringing a revolution to health care. But to patients, the computer has proven to be a nuisance rather than a blessing. It is hard to get quality health care when a patient must compete with the computer for his or her doctor’s attention.

Rest assured, most doctors do not like the computer coming between them and their patient either. Multiple studies demonstrate that roughly two-thirds of physicians are dissatisfied with their EMRs and do not think that they improve quality of care.1, 2, 3, 4

For physicians, the computer has become the instrument of obedience to a senseless body of regulations that directs not only the technology itself but also its use as a vehicle to “improve quality of care.” If your doctor pays attention to you instead of entering data, he or she will be penalized by Medicare regulations that reduce physicians to data-entry clerks.

The use of information technology as a Trojan horse for government-driven health care began with a part of the 2009 federal Stimulus Bill called Meaningful Use, or MU. Through a system of incentives and penalties, the architects of MU masterminded a major digital revolution of our health care infrastructure within five short years.

The developers of this system also force-fed physicians the unproven practice of using information technology to improve quality. Despite the mandated implementation of EMRs under MU, they have failed to deliver on any of the promises made in 2009, including a higher quality of care.5 By the end of the five-year program, doctors’ support for MU was waning.

MU would have disappeared quietly had it not been for a unique set of circumstances and timing related to Medicare, the federal healthcare program for seniors. The formula used to calculate Medicare payments to physicians — called SGR, or the Sustainable Growth Rate — had for several years dictated payment cuts of 20-30 percent.

Every year from 2003 to 2014, Congress had to act under duress to override SGR and pass a temporary “fix.” When Members of Congress became desperate for a permanent solution, the architects of MU seized an opportunity to re-brand their unpopular program by offering the repeal of SGR as part of a bill called MACRA — the Medicare Access and CHIP Reauthorization Act of 2015.

The MU program found a safe haven within MACRA. Its proponents even changed its name to camouflage it. Congress passed MACRA in April 2015, mere hours before another SGR-mandated payment cut was to go into effect.

The implications were not clear until the Centers for Medicare and Medicaid Services issued the MACRA regulations the following year. The centerpiece of the rule is a draconian compliance scoring system that pits small medical practices against large healthcare institutions to compete for a place on the upper half of the MACRA compliance bell curve. Physicians on the lower half of the bell curve who do not meet the requirements must pay penalties to cover the incentives paid to physicians in the upper half who meet more of the requirements.

CMS’s own data predicts that 87 percent of solo practices and 70 percent of practices with 2-10 physicians will receive penalties under MACRA.6

Physicians in independent practices cannot compete, so they are being driven to become employees of large hospitals. It is inevitable that costs will increase as these large institutions gain market share. Quality will suffer as care is depersonalized and unproven “value based reporting” consumes resources formerly directed towards patients.

Physician burnout will continue to increase as doctors must spend more evenings and weekend time on data entry.7,8 And the information technology itself, designed first and foremost to comply with MU certification requirements, will remain useless relative to the needs of individual patients and the doctors who care for them.

The irony is that quality of care was not the original problem. The healthcare reform narrative that began in 2008 was based on legitimate issues regarding cost and access. But the architects soon realized that their agenda would be better served by pivoting the discussion to quality and value.

Cost and access are easy to measure; the latter two are not because they lack well-established definitions. It is impossible within a quality/value paradigm to measure the performance of any program and judge its merits.

The cost of quality reporting alone has been estimated at $15.4 billion per year, according to a March 2016 study published in Health Affairs.9 The total cost of MACRA will significantly exceed that figure.

Reporting quality data to CMS has never been shown to improve outcomes. At a time when cost and access are the real problems facing our healthcare system, our limited resources would be more wisely directed to cost and access problems.

Is there a politician or a bureaucrat that has the chutzpah to face several million Americans and tell them we can’t afford their health care because of our devotion to a program whose benefits are completely unproven?

It is time to make participation in MACRA voluntary. Dropping the penalties and preserving the incentives will allow MACRA devotees to continue their work while unshackling other doctors from unproven quality measures and EMR mandates. Every physician, MACRA supporter or not, will be free to pursue his or her own vision of health information technology — the one that is best for patients.

Understanding exactly how MACRA was passed makes clear that it did not and does not enjoy “bipartisan” support and protection. A new administration should have the incentive to promote and introduce legislation that would make effective changes.

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Dr. Michael Koriwchak is an ENT physician in Atlanta, co-host of “The Doctors Lounge” radio show, and Vice President of the Docs4PatientCare Foundation.


1Medical Economics and MPI Group. EHR Survey 2013.  

2Medical Economics. 2016 EHR Report.

3Deloitte Center for Health Solutions. 2016 Survey of U.S. Physicians.

4American EHR Partners and the American Medical Association. Physician Use of EHR Systems 2014.

5Kellermann, AL and Jones, SS. What It Will Take to Achieve the As-Yet-Unfulfilled Promises of Health Information Technology. Health Affairs 32(1) 2013: pp 63-68

6Proposed Rule, The Medicare Access and CHIPS Reauthorization Act of 2015, Table 64, April 2016

7Shanafelt, TD; Dyrbre, LN et al. Relationship Between Clerical Burden and Characteristics of the Electronic Environment with Physician Burnout and Professional Satisfaction. Mayo Clinic Proceedings 2016; 91(7) 836-848.

8Shanafelt, TD; Hasan, O et al. Changes in Burnout and Satisfaction with Work-Life Balance in Physicians and the General U.S. Working Population Between 2011 and 2014. Mayo Clinic Proceedings 2015; 90(12): 1600-1613.

9Casalino, LP; Gans, D et al. U.S. Physician Practices Spend more than $15.4 Billion Annually to Report Quality Measures. Health Affairs 35(3), March 2016.