Friday, October 24, 2014

ACA/Obamacare: Same Zebra with the Same Stripes?

‘If there is one thing Republicans and Democrats agree on it’s this: Obamacare represents a radical change in the US health care system. Soon after its passage, some on the left declared that we had created a right to health care for the first time in our history. Some on the right predicted death panels and a march toward socialized medicine.

But what if they are all wrong?

Is it possible that we could spend $2 trillion over the next ten years, create hardship and anxiety for millions of families who already had health insurance they liked, cause buyer’s remorse for millions of newly insured, cause almost every business in America to change its employee benefits and at the end of the day accomplish not much of anything?

Yes that’s possible.

What brings this to mind is a new report by the inspector general at the Department of Health and Human Services. As summarized in The New York Times:

“… the Obama administration and state officials have done little to ensure that new beneficiaries have access to doctors after they get their Medicaid cards….”

“The report … says state standards for access to care vary widely and are rarely enforced. As a result, it says, Medicaid patients often find that they must wait for months or travel long distances to see a doctor.” ‘

‘The same problem arose under Romney Care. When he was governor, Mitt Romney told me that once people were insured, they would go to physicians’ offices rather than hospital emergency rooms. They would get less expensive care and more appropriate care as a result, he said.

There were two problems with that prediction. First, Romney Care didn’t create any new physicians’ offices. Second, the newly subsidized private insurance didn’t pay that much more than Medicaid. Bottom line: patients in Massachusetts are largely going to the same places they went before Romney Care. Emergency room traffic is higher than ever. The traffic to community health centers has changed very little. For reasons I don’t understand, those with newly subsidized private insurance have more difficulty seeing a doctor than patients on Medicaid. And waiting times in Massachusetts are the highest in the country. In Boston, the wait to see a new doctor is about two months!

Under Obamacare, things are likely to be even worse. Not only does the health reform law not create any new doctors, it will shrink the supply of doctor services as more physicians retire early (discouraged by a new raft of rules and regulations) and more of them become hospital employees (where they work nine to five and play golf on the weekends). At the same time the law will greatly expand the demand for care by the relatively healthy. Millions of senior citizens are now entitled to an annual wellness visit (of no medical value according to almost every expert) and everyone with private insurance will be entitled to a long list of preventive procedures (almost all of questionable medical value), with no copayment or deductible.

Giving preventive care to healthy patients is time consuming and it crowds out access by those who have genuine medical problems. In fact a Duke University study estimated that fulfilling the promise of preventive care to all Americans would consume almost the totality of the average doctor’s day.’ - What if Obamacare Doesn't Change Much Of Anything?, Forbes, 10/06/2014

Link to the entire article appears below:

1 comment:

  1. We know how this movie ends: the dumbing down of medicine through the use of nurse practitioners and physician assistants in place of physicians. I took my wife to the ER this year and we never laid eyes on a doctor.

    NPs and PAs cost less and are more easily managed in a corporate structure, while making unsubstantiated claims to providing equivalent care. They are corporate America's ideal solution and it is corporate America that's running the show now.