Obamacare continues to run into trouble in its translation from intent to practice. The biggest hurdle will be the physicians themselves. They don’t have to participate. Many predict that as much as 40% of the present physician force will quit practice should anything near full-implementation succeed.

Those who practice in the specialties will be affected foremost in my opinion. Why, you may ask? The reason is multifold. First, because they make the most money and have the largest financial stockpile, so to speak, that allows them to retire. Second, their practices depend the heaviest on those that qualify for Medicare which is where the greatest dependence on government care and where subsequent cuts in health care lie. Many of their services will now become “elective,” and this means not necessary.

Young people who depend upon private insurance rather than the government for health care needs don’t need hip, knee, or heart valve relacements.  And hysterectomies, compression fracture repairs, or prostate surgeries are not considered emergent health care needs either. They will be scaled back tremendously–see Canada.

Those of us practicing primary care have our own problems. We will be in the greatest area of need but our services will be overseeing cookbook style medicine with predetermined courses of care and managing healthcare assistants. How fun is that?