• Fails to fix the flawed Medicare reimbursement system for physicians as promised by the President and Congress. Thus, routine cuts in Medicare reimbursement will continue for physicians who are already paid over 45 percent less (in real terms) than they were in the year 2000. As a result, more and more physicians will opt out of the Medicare program.
• Does not address medical malpractice reform as promised by the President and Congress. The beneficiaries of the current system are neither patients nor physicians.
• Does not deliver administrative reform for medical practices. Healthcare reform requires medical offices to do more with less – not for the purpose of improving healthcare cost, quality, or access, but simply to empower over 150 new bureaucracies by requiring front-line providers’ offices to track, detail, and report a plethora of information for purposes yet to be disclosed.
• Further encroaches into the physician-patient relationship. The creation of the IPAB is the vehicle by which the government will determine what is not covered as a means of cost savings for the future.
• Fails to align various components of the health delivery system. Physicians and hospitals (and others) are now challenged to align through Accountable Care Organizations (ACOs). However, the teeth of a whole series of existing regulations remain in effect, thus, limiting the capability of real alignment to improve quality and access while lowering cost. 
• Limits genuine improved access to the uninsured. By opening the Medicaid enrollment floodgates as a major means to insure a large portion of the uninsured, real access to quality care is marginally enhanced. In addition, the new financial burden put upon states will break their budgets so that other essential services will have to be cut.
• Does not provide real assistance to small business. With cuts to the limits of existing HRA, HSA, FSA, coupled with severe employer and employee mandates, the new law adds huge administrative burdens, reduces existing healthcare access advantages, and adds cost to the typical small business.  Most medical practices are small businesses and are significantly impacted (as a business) by reform.
• Does not provide a survivable trajectory for the next generation. Those who come after us will rightfully ask, “Your parents saved the world from tyranny what did you do for us?” Our only answer will be, “We saddled you and your children and grandchildren with insurmountable levels of debt which ensured you a substantially reduced quality of life.”
• Fails to buttress the existing system that works well for the vast majority of Americans. Many citizens will find their healthcare benefits reduced to support the new infrastructure created by healthcare reform.
• Failure to reduce the long-term cost issues associated with aging population and low birth rates. While Europe is stating that one key to solving their massive debt crisis is to privatize healthcare, the United States is following the pathway that created the European crisis in the first place. Reality 101 tells us that the problem with programs of this magnitude is that they eventually run out of other people’s money. We have the benefit of others’ experience – yet, we choose to fulfill Einstein’s maxim – insanity is trying the same method over and over hoping for a different result.
• Fails to reign in government control. The most common phrase in the new Healthcare Reform Law is, “The Secretary Shall…”  This little phrase gives the Secretary of HHS a whole new level of unilateral and unchecked authority over the healthcare system. The result will be higher cost, lower quality, better access, and gross encroachment into the autonomous physician-patient relationship. Rube Goldberg will be envious of the outcome of all the final rules and regulations that emerge.

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