American Elephants


Other Than That, ObamaCare is Doing Fine… by The Elephant's Child

When the Democrats started digging old plans out of dusty drawers, they decided, since they controlled both houses of Congress and the presidency, to go for government sponsored health care; they were absolutely sure that the American people were going to love it. Big mistake.

The cost of American health care had been climbing significantly, and Democrats were sure that they could significantly cut the costs of medicine by making the medical profession more efficient and insisting that they learn from the best practices of industry stars. Another mistake.

Democrats believed that the uninsured were a huge problem because people with no insurance were flooding emergency rooms and driving up costs. Turned out that most of those who used emergency rooms had insurance, they just couldn’t make appointments with their doctor for immediate help. Turned out that a large percentage of the uninsured did not have insurance because they could not afford it, but because they didn’t want to pay for insurance. They were healthy and unconcerned. Oops!

Democrats believed that if they added some nice benefits that people had never had before on their insurance like therapeutic massage, birth control and pediatric dentistry, the government insurance would be even more popular. They would just spread the costs of the new benefits across the board so the expense would not be noticed. They didn’t have an insurance actuary figure out the costs of including those benefits on a policy for 55 and 60 year-old folks who had no need for birth control or pediatric dentistry.

The CBO has issued a report that appears to show that ObamaCare will cost less and cover more people than expected. But their projections seldom turn out. There are just too many variables. The latest report says that ObamaCare will cost $104 billion less over the next 10 years than it thought just two months ago. The numbers rest on the CBO belief that premiums will be flat next year, but the industry has already warned of double-digit rate increases— a sharp rise that will drive costs up far beyond the CBO’s estimates.

Out of the blue, the Census Bureau has changed how it counts health insurance, just at the moment when ObamaCare is roiling the insurance markets. The effect will muddy comparisons between pre-ObamaCare and post-ObamaCare numbers. A lot of things we would like to know, like how many people gained or lost insurance under ObamaCare? Did government crowd out individual insurance? It will apparently take several years before we have answers to those questions.

The one thing that is increasing dramatically is unhappiness among physicians. Nine out of ten doctors discourage others from entering the profession. 300 doctors commit suicide every year. Depression among doctors is not new, but the level of unhappiness is on the rise. Being a doctor has become a miserable and humiliating undertaking, and many doctors feel that America has declared war on physicians and doctors and patients are the losers.

Many doctors just want out. More are running for Congress. Medical students opt for high-paying specialties so they can retire as soon as  possible. MBA plans for physicians are flourishing,  they promise doctors a way into management. The website called the Drop-Out-Club hooks doctors up with jobs at hedge funds and venture capital firms.

Some, including President Obama, seem to believe that doctors are paid way too much and if the government needs to save costs, they can just pay doctors less. This is the mindset that reduced Medicaid to such a point that those who go without health care may do better than Medicaid patients. Same goes for Medicare and the other government controlled health care systems.

More doctors refuse to accept health insurance. Some have gone into concierge medicine, where for an annual fee, the doctor is at your service for the year. The federal government is hoping to go after that escape from ObamaCare, and they are still intending to end Medicare Advantage plans.

Just processing insurance forms costs $58 for each patient encounter, according to Dr. Stephen Schimpff, an internist and CEO of the University of Maryland Medical Center.  Physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes, in which the doctor probably spends most of the time interacting with his computer.

Under ObamaCare the incentives are all wrong. The government adds ill-considered benefits to insurance policies in the hope of getting people signed up. This makes the insurance too costly for most people. The push from the government will be a constant effort to cut costs. Hospitals will push for doctors to see more patients in less time, so they can be adequately reimbursed. Doctors will be encouraged to pay less attention to the Hippocratic Oath and more effort to try to get adequately paid, or to get out of the profession—which will encourage the best and brightest to aim for other careers. Watch for a push for increased immigration of physicians from third world countries. Other than that…

 




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