ACA/Obamacare: And About that Canadian Health-Care Model

"An Ontario doctor says health-care wait times have reached “insane” lengths in the province, as one of her patients faces a 4.5-year wait to see a neurologist.

When Dr. Joy Hataley, a family practice anesthetist in Kingston, Ont., recently tried to send a patient to a neurologist at the Kingston General Hospital, she received a letter from the specialist’s office telling her that the current wait time for new patient referrals is 4.5 years.

The letter said that, if the delay is “unacceptable” to Dr. Hataley, she should instead refer the patient to a neurologist in Ottawa or Toronto.

Dr. Hataley said she's used to hearing back from specialists who are unable to see her patients for months, and even up to 2.5 years. But a 4.5 year wait is "insane," she told CTVNews.ca in a telephone interview." -  'It's insane': Ont. patient told she'd have to wait 4.5 years to see neurologist, CTVNews.ca, 11/02/2017

Link to the entire report appears below:

https://www.ctvnews.ca/health/it-s-insane-ont-patient-told-she-d-have-to-wait-4-5-years-to-see-neurologist-1.3661114

U.S. Healthcare Delivery System: We Have Met Canada and We are Them

“Americans like to think that our health care system is very different from “socialized medicine” in Canada. In fact, the two health care systems are far more similar than they are different. In Canada, when people go to the doctor the visit is free. In America, it’s almost free.

On the average, every time Americans spend a dollar at a doctor’s office only 10 cents is coming out of our own pockets. The rest is paid by an employer, an insurance company or government. Like the Canadians, we do not primarily pay for health care with money. We pay with time.

According to a Merritt Hawkins survey:
The average wait time to see a primary care doctor in the United States is almost three weeks.
In Boston (where we are told there was universal coverage even before there was Obamacare), the average wait is more than two months.

Compare that with how long you have to wait to get your cellphone repaired.

Waiting in the US is becoming more like waiting in Canada and in some cases it can be worse.” - What Everyone Should Know About Rationing By Waiting, Forbes, 11/09/2015

Link the entire article appears below:

http://www.forbes.com/sites/johngoodman/2015/11/09/what-everyone-should-know-about-rationing-by-waiting/

ACA Architect Ezekiel Emanuel and Preventative Care

'One reason your insurance premiums have skyrocketed during the past year is that Obamacare requires all health plans to provide “free” annual wellness visits and 15 associated preventive services for which they cannot charge the patient a copayment. According to a key architect of PPACA, however, “the annual physical exam is basically worthless.” Dr. Ezekiel Emanuel, last heard from claiming that he wants to die at 75 in order to avoid becoming a burden on society, writes in the New York Times that “screening healthy people who have no complaints is a pretty ineffective way to improve people’s health.”

The good doctor says he’ll forego his annual exam pursuant to a desire to “make the world a better place.” But, as with his professed willingness to depart this vale of tears after three-quarters of a century, he makes it clear that all men and women of good will should follow his example “to ensure there is no doctor shortage as more Americans get health insurance.” This is where the rubber glove hits the road. Emanuel wants you to voluntarily give up a much-ballyhooed feature of Obamacare for which the “reform” law itself compels you to pay via new taxes and inflated health insurance premiums.

This is entirely consistent with Dr. Emanuel’s unique code of ethics. He is, for example, a long-time proponent of medical rationing for the elderly. Consequently, he probably doesn’t experience much cognitive dissonance when suggesting that, in order to forestall the physician shortage caused by a program he helped design, right-minded people should forego a “benefit” they were coerced to purchase. For him, this call for you to restrict your consumption of medical care is just another expression of his passion for rationing. The only thing new here is the exhortation for you to impose it on yourself

All of which raises a question: If annual physicals are worthless, why did Dr. Emanuel and his accomplices build them into PPACA?' - Ezekiel Emanuel: Go Ration Yourself,


The American Spectator, 01/12/2015

Link to the entire article appears below:

http://spectator.org/articles/61447/ezekiel-emanuel-go-ration-yourself

Obamacare’s Emphasis on Acquisition of Coverage Creates Supply Side Problems

"In addition to financial barriers to care, there are non-financial ones – mainly caused by the narrow networks that have emerged in the insurance company race to the bottom. These networks often exclude the best doctors and the best hospitals. A study by Avalere found that there were no cardiologists in the networks of plans offered in Los Angeles. There were no diagnostic radiologists in the networks of plans offered in Chicago. In seven of the nine urban areas, fewer than half of specialists sampled belonged to provider networks in Obamacare exchanges. Patients can be forced to pay 100 percent of the cost of out-of-network services.

Here is another problem: millions of Americans are being forced to switch to the wrong kind of insurance. For example, many employees of fast food restaurants have mini med insurance, which covers the first few thousand dollars of care. These employees tend to be young and healthy and mini med plans pay for primary care – which is about the only care they are likely to need. The Obama administration considers that kind of insurance “under insurance,” however, and the new law insists that people have coverage for catastrophic care, with no annual or life time limits. Yet this kind of “comprehensive coverage” often has very high deductibles – forcing the young and the healthy to pay for primary care out of pocket.

About half the newly insured will get insurance through Medicaid, where there is little or no cost sharing. But here again, there are serious non-financial barriers to care. According to a study by the inspector general of the Department of Health and Human Services about half the doctors who are listed by insurers as serving Medicaid patients are not available to treat them. Those who are available often require long waits:

　

“For example,” the report said, “a number of obstetricians had wait times of more than one month, and one had wait times of more than two months for an enrollee who was eight weeks pregnant. Such lengthy wait times could result in a pregnant enrollee receiving no prenatal care in the first trimester of pregnancy.”

“Primary care providers, such as family doctors, internists and gynecologists, were less likely to offer appointments than specialists, the report said. But specialists tended to have longer wait times, with a median wait of 20 days, compared with 10 days for a primary care provider.”

These problems will almost certainly get worse in January when an end comes to a special Obamacare subsidy that has been enhancing the fees of Medicaid doctors for the last two years. According to the Washington Post:

“A study … from the nonpartisan Urban Institute estimated fee reductions will average about 40 percent nationwide. But they could reach 50 percent or more for primary care doctors in California, New York, New Jersey, and Illinois — big states that have all expanded Medicaid under the health law.

A system-wide problem will add to these woes: we are about to experience a severe rationing problem. If the economic studies are correct, the newly insured will try to consume twice as much health care once they have insurance and there may eventually be 25 million of them. Along the way almost everyone else is being forced to have more generous insurance than they previously had and with these new benefits they are likely to seek more care. The result: we are in the process of greatly expanding the demand for care while doing virtually nothing about supply.’ - Is Obamacare Working? John Goodman, Forbes, 12/15/2014

Link to the entire article appears below:

http://www.forbes.com/sites/johngoodman/2014/12/15/is-obamacare-working/



　

VA Hospitals Appointment Wait Times: 14 Days is 14 Days Except When It Isn’t 14 Days.

'A Veterans Affairs employee at the VA Medical Center in Cheyenne, Wyoming, has been placed on administrative leave after CBS News obtained an email showing an employee directing his staff on how to game the appointments system to make it appear as though veterans were being seen within the VA's 14-day directive.

The email, written by Telehealth Coordinator David Newman, a registered nurse, describes how patients at the Cheyenne VA Medical Center are always listed getting appointments within a 14-day window, no matter when the appointment was first requested, and no matter how long the patient actually waited.

The memo admitted, "Yes, this is gaming the system a bit..." because "when we exceed the 14 day measure, the front office gets very upset, which doesn't help us."

The employee further instructs staff on how to "get off the bad boys list" by "cancelling the visit (by clinic) and then rescheduling it with a desired date within that 14 day window."' - Email reveals deliberate effort by VA hospital to hide long patient waits, CBS News, 05/09/201

Link to entire story appears below:

http://www.cbsnews.com/news/email-reveals-effort-by-va-hospital-to-hide-long-patient-waits/


　


　

Health-Care Rationing and Socialized Medicine: Price Distortions, Demand Shock, and Overutilization

Will Socialized Medicine cause health-care rationing?

The economics are as follows:

(1) the attempt to limit price (health care price controls) then distorts price,

(2) demand and supply, for any good or service in the free market, is rationed by "price". That is, demand and supply intersect at price,

(3) if you distort price, then demand and/or supply become distorted,

(4) when demand and supply are not allowed to intersect at price, then price is not the natural rationing equilibrium,

(5) if price is not the established equilibrium of demand and supply and an artificial equilibrium is established through price controls, then the result is true rationing.

Introducing between 19-47 million new consumers to the demand curve of health care services, the supply of health care services then becomes swamped as the supply curve is constant. With a demand shock, and supply constant, price would rise as the rationing agent. However, price will not be allowed to rise. If price can not rise to act as the rationing agent, then true rationing occurs.

The 19-47 million new consumers added to the demand side of Health Care add yet another effect: over utilization. If you previously have had no health care coverage, you likely have pended-up-demand. Suddenly you want certain items looked into that you have put off.

Over utilization also occurs when part of the 19- 47 million are receiving free or heavily subsidized health care. The perceived free or low cost access causes over utilization.

The current Health Care Reform Bill also mandates low deductibles and low co-pays. Low deductibles and low co-pays create an environment of over utilization.

Hence Price Distortions, Demand Shock and Over Utilization will cause true rationing.