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Speak Out: What's your biggest concern about the Affordable Care Act?


Urologists' concerns about the Affordable Care Act include added bureaucracy and waste as well as the Independent Payment Advisory Board.

What’s your biggest concern about the Affordable Care Act?


“There is no doubt the ACA is a double-edged sword. On the good side, the act has awakened the entire country to the health care discussion, which if not addressed in a serious way will bankrupt the country. It will continue to create issues because programs are unsustainable the way they are now. So the act has awakened us that we have to look at care differently.

Our practice has changed the way we deliver our care to an integrated system of relationships and providing patients with quality care to get the result they want in the least expensive way possible.

We have two concerns. I think all physicians are concerned when the government gets involved because of the issue of bureaucracy and waste. The other piece is the issue of control-this Independent Payment Advisory Board. I don’t believe taking decisions out of hands of Congress and physicians and putting them into the hands of 15 individuals will reduce the cost of health care. Premiums are already increasing to 100%-150% of what they’ve been.”

Thomas Smyth, MD

Towson, MD


“The biggest problem is the federal government is broke and they’re proposing to expand Medicaid, so as a urologist who takes care of a lot of Medicaid patients, I have a lot of concerns about the long-term solvency of the program. They’re launching a massive new entitlement in the setting of federal bankruptcy. On top of that, it doesn’t address rising costs. The only thing that will address costs is to have market-based reforms, by giving consumers information about the quality and cost of care to make informed decisions about their health care and making them more responsible for the cost.

The biggest problem I have with the law is the Independent Payment Advisory Board, which cannot, by law, include practicing physicians. It’s unaccountable to Congress. It takes a super majority to override the IPAB.”

Cameron Schaeffer, MD

Lexington, KY


“There are still a lot of unknowns. I’m excited about the prospect of more people having access to health care. For me, that’s the biggest issue.

Of course, there are concerns about reimbursement, but I believe those will work themselves out as the bill gets enacted. My initial reaction, though, is that I am hopeful more people will get the care they need.

As for concerns, it’s such a huge piece of legislation, I am concerned it didn’t address the cost of care; it didn’t contain enough about malpractice concerns; and that the government might have more decision-making power in terms of health care decisions and physician reimbursement. Those are all competing concerns with the law. We’ll see whether or not those things will be issues as the law is implemented. It’s tough to know at this point.”

Gregory Adams, MD

Kalispell, MT

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