Dr. Dello Russo assess the effect of latest health care legislative changes.

The current wave of health care reforms following Obama's health care legislation is expected to bring many changes to the nearly 50,000 ophthalmology practices in the U.S, estimated Dr. Joseph Dello Russo, who owns the largest private network of Lasik and eye centers in the Northeast. He joins other doctors who believe that the severe changes will force many of their fellows to stop accepting new Medicare and insurance carrier patients and some physicians may decide to stop seeing existing Medicare patients. Eventually, this law may lead experienced doctors to retire early and will create a shortage in some medical specialties. Unless the proposed changes are softened millions of people will be barred from seeing competent, knowledgeable eye doctor ever again. This is one of the main eye doctors complaints Dr. Dello Russo also agrees to.

Seniors, who suffer from eye diseases such as Cataracts, would be affected by the new legislation. 3,500,000 seniors need cataract surgery every year, a number which only increases as the population ages. Who will be left to perform this surgery?

Dr. Dello Russo said: "We need our professional medical organizations to explain these unwanted effects to the government. So far these dangerous effects have not touched the average person. By the time that the average American realizes what had happened, doctors will modify their behavior and will limit the care they offer to patients." One of the major complaints Dr. Dello Russo will be facing is turning down insurance from new patients.

During the debates on the new law, unfortunately two medical organizations supported it, not for its ability to improve patient care but for the personal benefits to each of them (AMA and AARP). Only a small percentage of the nation's physicians belong to the AMA since it historically has not represented the interests of neither doctors nor patients. As for AARP, although the government "made it sound like it is another medical organization that backs up the law, it is actually an insurance company who mainly deals with seniors", says Dr. Dello Russo.

In the last decade, medical insurance companies as well as Medicare have realized that since nearly everyone has some type of insurance, the companies could cut costs by reducing payment to doctors, being supported by media stories about how doctors are "so rich". In order to contain its costs, Medicare has been systematically cutting reimbursements to physicians by a certain percentage each year, and the private insurance carriers have followed. In the last couple of years, 23% were supposed to be cut from payments to doctors. Some congressmen have realized that this large cut would cause doctors to operate at a loss and so far, each year this cut has been postponed but has not been cancelled.

Last week Senate leaders managed to approve a "doctor fix" which postponed again by one year the 23% cut. It seems that the political system does not have the will or the courage to find a permanent solution that would force doctors to retire or stop accepting Medicare patients. "Someone should check with the President and Congress, maybe they can hire some civil servants to go through 12-20 years of schooling and then not to be paid," remarked Dr. Dello Russo.

The Obama health care bill is supposed to improve care to all people, even those 30 million Americans who are not insured while cutting costs to all. "One has to wonder whether this even makes sense," says Dello Russo. "After all the years that doctors have spent in university and in training, now all of a sudden they will have to learn how to be businessmen. Judging from the doctors I met in my life, they are usually terrible in business."

Nancy McCann , director of government relations at the American Society of Cataract and Refractive Surgery (ASCRS), suggests that physicians "are going to have to change the way they deliver medical care." There will also be a move towards the integration of individual medical practices into larger medical organizations. So long for friendly solo practitioners and small doctor practices, "just as the law envisions", says McCann.