Filed under: Democrat Corruption, Domestic Policy, Economy, Health Care, Liberalism, Politics, Progressivism | Tags: An Unworkable Law, Deeper Into ObamaCare, Problems Begin To Surface
There’s a good bit of economics that is covered by plain common sense, but even that the Progressive mind does not seem to grasp. The idea that you can take the American system of medical care and add a giant governmental bureaucracy on top of it and then promise the American people that “your medical care will cost $2,500 less per family,” suggests both an unfamiliarity with Economics 101 but also lifelong math-avoidance.
The complications are not just websites that do not work. It is clear that they are not just “glitches” that can be ironed out over a weekend or three. There are deep problems in the basic code, according to some experts. Well, time and money and tech experts will someday get it up and running. But that’s just the beginning of the problems.
Nobody knows quite how ObamaCare will affect hospitals. If more people without insurance sign up, hospitals may get paid for charity care that they now provide for free to uninsured patients.
Insurance is presumed to rectify the overuse of emergency room care, but the association of emergency room doctors has said that the majority of emergency room use is not the uninsured, but people with perfectly good insurance. Which makes sense. People don’t need emergency treatment on a regular 9-5 schedule, and your doctor’s next available appointment may be in two weeks.
The proponents of ObamaCare envision a transition where hospitals are rewarded more for the quality of care than for the volume of patients they treat. This sounds really noble, but I do not understand how this works. The idea, as I understand it, is to collect data on all patients and all treatment, and then they will determine statistically what are the “best practices.” and everybody will be required to do the best practices. They expect technology to solve many of their problems. There is a lack of understanding that medicine is not a one-size-fits-all discipline.
Hospitals must live in two worlds — one where they can still earn money per procedure and pay their expenses, and another that sees the treatment of patients in a more “holistic” way, with successful outcomes the most important measure of a hospital’s performance. So a hospital that treats young people and makes them healthier gets more brownie points if they can shuffle off the old sick people to a another facility? I suspect that “holistic” is a clue, and can be filed with other nice words like diversity, and multiculturalism. President Obama has always included “making people healthier” in his lectures on the Affordable Care Act.
Nobody knows what is happening with doctors. Several physicians of my acquaintance have departed for other venues. One went to Africa to fill needs there, One went to Montana, One bought a big motor home, and outfitted it as an office and intends to accept no insurance. Several have started concierge practices.
We have a current shortage of doctors. Many have said they will retire early, or do something else. Doctors are some of our best and brightest, with high dedication and would be able to do pretty much whatever they want. The Association of American Medical Colleges predicts a shortage across all specialties of 130,000 by 2025. Graduating medical students choose specialties where they are apt to be paid enough to pay off the cost of their education. Today nearly 20% of Americans lack access to primary care, and the demand for care by the newly insured is sure to increase.
The availability of doctors who will accept Medicaid patients is decreasing as reimbursement to doctors is increasingly inadequate. Ditto Medicare. With a huge baby boom cohort beginning to retire, ObamaCare mandates $716 billion payment reductions from 2013 to 2022 as across the board cuts.
The Medicare Trustees project that the lower payment rates will cause 15% of hospitals and skilled nursing facilities to become unprofitable by 2019 and 40% by 2050. Payments to Medicare Advantage plans will be cut by $156 billion by 2022. The Independent Payment Advisory Board can reduce physician payment rates as a method of reducing the cost of Medicare. 9,539 physicians have already stopped accepting Medicare patients. The House has passed bipartisan legislation to repeal IPAB.
I suggested above that it might take two weeks to get a doctor’s appointment, but the experience of people in Britain and Canada suggests that eleven or twelve weeks might be more the norm, and a trustee of one of the NHS hospitals recently died after her much-needed operation was postponed four times.