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American doctors and ObamaCare

This is a RUSH transcript from "The O'Reilly Factor," March 4, 2014. This copy may not be in its final form and may be updated.

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O'REILLY: "Factor Follow Up" segment tonight, American doctors and Obamacare. Last November the medical firm Jackson and Coker surveyed American doctors about the Affordable Healthcare Act. More than 3,000 physicians took part; 61 percent of them say their opinion of Obamacare has changed for the worse. Even more damning, 44 percent of American doctors say they will not participate in the Obamacare exchange. A disaster.

With us now Dr. Ezekiel Emanuel, one of the architects of the Affordable Healthcare Act and author of the brand new big book "Reinventing American Healthcare."

So if almost half of the doctors opt out, I don't see how this possibly works.

EZEKIEL EMANUEL, M.D., FORMER OBAMACARE ADVISOR: First of all doctors will not opt out, not half of them that says they won't participate in the exchange. It's not doctors who participate in the exchange. It's insurance companies that participate in the exchange.

(CROSSTALK)

O'REILLY: Because they don't take the insurance companies.

EMANUEL: The doctors will take who is in the exchange because they have to. There is a large number of people who will be there. Furthermore if you actually --

(CROSSTALK)

O'REILLY: Wait, wait I'm confused. I'm confused I didn't get to read your book but your book explains a lot of this.

EMANUEL: Yes.

O'REILLY: But I'm confused. From what I understand from my own personal doctor who is going to opt out, they are going to set up boutique services. All right, many, many American doctors. And they are going to charge people to a certain fee a year to see them. They are not going to accept any insurance as many doctors don't now. This is what I think may happen.

So the pool of doctors then in America shrinks. You are telling me that's not going to happen?

EMANUEL: No, I don't think that's going to happen.

O'REILLY: You don't think?

EMANUEL: Look, you don't know the other. You are just making speculation, too.

O'REILLY: No, it's 44 percent say they are not going to participate in the insurance.

EMANUEL: In the exchange.

O'REILLY: Right.

EMANUEL: But they don't -- they don't actually participate in the exchange. That's a misnomer and the question is a bad question.

O'REILLY: They're not going to take Obamacare insurance.

EMANUEL: They will take Obamacare insurance. Very few doctors can go and just take people who pay cash. Because healthcare is expensive the vast majority, 98 percent of Americans cannot simply pay cash for their healthcare.

O'REILLY: They can take certain -- certain kinds of health insurance as you know. All right now --

EMANUEL: But look --

O'REILLY: Go ahead.

EMANUEL: -- when you do poll doctors, especially young doctors, the under 40s, 60 percent of them actually support Obamacare and like it and those who have actually begun to transform their practice so they are really focusing on giving people -- keeping people healthy. They are focusing on people with chronic illness and keeping them out of the hospital, they actually like that practice better than the current practice.

O'REILLY: All right you're generalizing but there are about 800,000 practicing physicians in this country right now.

EMANUEL: Right. That's correct.

O'REILLY: If 44 percent bail at this certain --

EMANUEL: We are not going to have 44 percent bail out of the system.

O'REILLY: (inaudible) also says that a lot of doctors are not going to get caught up in this. They are just not going to do it. So if they do and it cuts down to 500,000 or 550,000 it's going to be a problem. Now when I travel around, I travel a lot of places, all right? I see these clinics open up and I'm sure you do too.

EMANUEL: Yes.

O'REILLY: All right the healthcare clinics. And they are like walk- in clinics. You've got something wrong? Come on in and they are staffed by physician assistants.

EMANUEL: Right.

O'REILLY: And nurse practitioners and things like that.

I think that's where this Affordable Care Act is going into that kind of treatment. Am I wrong?

EMANUEL: That's going to be one part of a complex.

O'REILLY: I think it's a growing part. It's going to be big.

EMANUEL: It's going to be one part of a complex part of the healthcare system. So if your kid has a sore throat and you want to find out if it's strep throat or your kid has what appears to be an ear infection and you want to find out if it's otitis media. You really don't need to go to the pediatrician.

O'REILLY: So you go to these clinics.

EMANUEL: You can go to these clinics, these clinics because of electronic records which are now being widely used because of the healthcare reform. They'll send it to your doctor. They'll send it to your health system. And so we'll have a much more seamless operation. In fact CVS is expanding those kind of clinics --

O'REILLY: Absolutely. They are all getting into that business. But there aren't any doctors. There are not doctors.

EMANUEL: Well you don't need a doctor for every part of your healthcare.

O'REILLY: You don't need a doctor. If I want a strep throat diagnosis I don't want Lenny who just came out of the community college I mean you know you can call me crazy.

EMANUEL: Excuse me but those are nurse practitioners it's not Lenny out of a community college.

O'REILLY: Right.

EMANUEL: And it is just putting a swab back there and getting a strep throat assessment.

O'REILLY: Are you worried? Say you had VD, STD, I'm sure you don't.

EMANUEL: Please, don't insult me.

O'REILLY: I'm not, but say you had, you being generic, say you had it or I had it, ok? And so that's in your medical record and then all of a sudden you have all of these transfers of electronic medical records all over the place. I mean that's --

EMANUEL: We have laws to protect the privacy.

O'REILLY: Laws, kind of like the IRS thing?

EMANUEL: Listen, Bill, you know your -- Fox News claims oh we are going to have breaches of the exchanges. We haven't had a single breach of the exchange.

O'REILLY: Because they're not up yet. They are not up yet, they are not running yet.

EMANUEL: That's not true. The exchange has been up.

O'REILLY: You are not worried about that.

EMANUEL: You're just sowing fear -- you're just sowing fear with no grounds.

O'REILLY: No.

EMANUEL: I am not worried about that.

O'REILLY: You are not worried about that little privacy thing.

EMANUEL: Lots of problems that doctors have had electronic health records. And we had no such breach. You're just sowing fear with no actualization.

O'REILLY: You know me I'm afraid of everything. Say TMZ offers somebody like $5,000 to get a famous person's medical records. Is that unheard of? Is that unheard of? Come on, is that unheard of? You know it goes on all the time.

EMANUEL: They will not, they have high security and everyone is well aware of this and they are taking it seriously. And if they -- if they didn't, they would have already offered that for electronic health records and we would have seen the breach.

O'REILLY: I don't know I'm a little scared about that.

EMANUEL: You are just sowing fear with no basis you can't even cite one example.

O'REILLY: Because it's not up yet. This time next year we'll -- and I hope it doesn't happen.

EMANUEL: Electronic -- excuse me, electronic health records now 80 percent of doctors have them and there has not been that kind of breach.

O'REILLY: All right.

EMANUEL: You are simply sowing fear and you know it. That's not a fact here.

O'REILLY: You know I'm not sowing fear. I'm actually doing my job and that's asking the hardest questions I can think of.

EMANUEL: And there is not a single case, Mr. O'Reilly of those medical records being breached for things like STDs or a very famous Hollywood star's medical records.

O'REILLY: I hope it doesn't happen but with a lot of stuff going on here, you know, NSA they are listening to your conversations, doctors, they have all of yours. I know where they are, too. They're in Utah.

So now people will know about your book "Reinventing American Healthcare." Thanks doctor good to see you. Thanks for coming in.

EMANUEL: Thank you. Great to be here.

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