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Well Healed ? Turf War


SACRAMENTO — Obamacare is supplying fresh ammunition for one of the oldest turf wars in Sacramento.

It pits doctors — represented by the politically powerful California Medical Assn. — defending their turf against other medical providers. They're nurse practitioners, optometrists and pharmacists.

In an article published in the Los Angeles Times by George Skelton he describes a ‘turf war’ breaking out over the monies the Affordable Care Act will govern.

The effects will certainly be inflationary, which is what every federal program creates, rather than diminishing expenses.

Contrary to what Mr. Skelton asserts that  the ‘well heeled doctors “ are holding their ground, the opposite is true.  Firstly the  docs are not well healed, after a ten year losing battle with insurance and medicare reimbursement cut backs and restrictions and the never ending increase in bureaucracy, chaos and confusion caused by the affordable care act. 

When the act kicks in next January, most Americans will be required to buy health insurance or pay a penalty.

In California, that is expected to swell the insurance rolls by 4 million to 5 million people. (About 7 million currently are uninsured, but that includes illegal immigrants, who won't be eligible for Obamacare.)

There simply won't be enough doctors to care for all the newly insured, contend the turf invaders.

But now the nurse practitioners, optometrists and pharmacists are attacking all-out, fighting for a larger chunk of the action to be funded by Obamacare, officially called the Affordable Care Act.


Bottom line……….More providers….more cost. Using telehealth and telemedicine as well as remote monitoring most of these tasks can be done remotely. Including

1. Electronic stethoscope

2  EKG

3  pO2

4. Vital signs

5  Blood glucose levels

6 Others in development using nanotechnology and microchips.

Location: Almost anywhere with a cell phone connection or internet


1.Little upfront cost

2 No additional provider licensing requirements

3. Assure one standard of care

4. Could be integrated into academic teaching programs.

There are cost effective means to expand accessibilty to primary care. CMS needs to open the door for effective reimbursements either on a per case basis or a flat fee model using a monthly schedule. There will be secondary gains, including fewer admissions to hospitals.


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