American Elephants


Rollout: Fail. Access to Care: Fail. Higher Premiums, Huge Deductible: Of Course. by The Elephant's Child

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Remember this photo? Obama had called all the physicians together from their busy rounds to help him make a push for the wonders of ObamaCare, and rushing right to the Rose Garden from the hospital, they naturally didn’t take time to change, but all wore their white coats so you could be sure that they were doctors and not just a bunch of White House aides dressed up in white coats…….oh!

Well they may not get the policy right, and the regulations will be all screwed up,  and the roll-out will be a fiasco, but they will get the theatrics right. You can fool some of the people some of the time…

Zeke Emanuel and Scott Gottleib wrote an op-ed in the New York Times making light of the claim about shortages of physicians. The prospect of 30 million newly insured people added to the rolls plus the increasing numbers of baby boomers, the pig in the python of demographics,  reaching retirement age is going to put enormous strain on Medicare, and on the medical profession. The Association of American Medical Colleges says their members aren’t able to train enough physicians to fill the need. Dr. Gottleib clarified his remarks in a later post to point out that there will be plenty of doctors, but you may not have access to them. And now we’re reading about doctors who just won’t participate. Let’s call the whole thing off!

Gottleib and Emanuel cite Massachusetts “where Obamacare-style reforms were implemented beginning in  2006, adding nearly 400,000 people to the insurance rolls.”

My understanding, and I’m unsure of this, is that the Massachusetts reform was intended only to force the uninsured to sign up for insurance — and that mandate is what ObamaCare tried to copy. Massachusetts didn’t attempt to reform the entire practice of medicine, they just wanted people to get insurance and stop the drain on emergency room costs. The insurance mandate went into force in 2006, and a 2009 survey showed that wait times to see a specialist in Boston were nearly double those in other major cities.

Emmanuel and Gottleib believed that although the numbers showed shortages of doctors, doctors would just be forced to be more productive, and their numbers could be supplemented with nurse practitioners; but we are also facing a shortage of nurses, and a shortage of professors in nursing schools. They seem to expect technology — televised short appointments with people at a distance or at home to replace office appointments with all the time involved. And there is good news on the technology front, I wrote about new diagnostic tools just entering the marketplace back in September, and there is big prize money waiting for whoever can develop Dr. McCoy’s medical tricorder, but we’re not there yet. Depending on inventions that have not yet been invented, but already taxed, seems an exercise in futility.

I’m not sure that “wait times” for an appointment with a specialist are a truly useful statistic. Depends on whether you’re visiting the cardiologist because you keep having chest pains, because you’re embarking on an important job and your company wants you to have a complete going over, or because your blood pressure is too high. The wait time to see an internal medicine physician in 2013 was 50 days — but it makes a big difference if it’s just a routine checkup or a serious concern. If the latter, do they squeeze you in shortly, or is it still 50 days?

I wouldn’t bet too much on technology. ObamaCare’s new medical device tax has had terrible effects on device makers. The White House and HHS have little understanding of business, and no understanding that slapping a big tax on all medical devices can devastate an industry, and deter would-be inventors.

The more I read about ObamaCare and its problems, the clearer it becomes that those who devised this mess had no understanding at all of the business of medicine, the business of insurance, and the businesses of its supporting entities. They wanted to give people free medical care. They believed that doctors were all rich and charged too much when they should be giving care as a public service. They believed that insurance companies cheated their customers and hospitals charged too much (look at those charges for ordinary aspirin), and they do not and did not understand the complexity of all the people of a nation and their health needs.

They regarded it as a political game in which they could get more votes for their party if they gave people “free” health care. They had no idea how to pay for it, but doctors and hospitals didn’t need to get so much money, and old people cost way too much when they hadn’t very much longer to live and weren’t worth spending money on.

The people who are making the decisions about what will be covered and what will not are people who have made a lifetime of politics and have never participated in the private sector. It has always been politics and the next election, and winning. Washington D.C. is largely unaffected by the recession or unemployment, and truly loses touch with the people who depended on them to represent them faithfully.

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