American Elephants


Beyond Technology “Glitches.” by The Elephant's Child

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.



Obama Delivers an Infomercial In the Rose Garden by The Elephant's Child

Oh dear. President Obama’s spirited defense of ObamaCare today in the Rose Garden didn’t exactly go well.  He had a group of people behind him who supposedly had successfully become insured under ObamaCare, but they actually turned out to be people who intended to sign up really soon, rather than those who had completed the process.

The government won’t release the numbers of people who have succeeded in signing up until the numbers are big enough to actually look good. That’s not what anyone said, but the inevitable conclusion. The president was intent on putting a good face on the problems, but not his face. Not his fault, and he’s really disappointed with the problems.

But the problem has been that the website that’s supposed to make it easy to apply for and purchase the insurance is not working the way it should for everybody.  And there’s no sugarcoating it.  The website has been too slow, people have been getting stuck during the application process.  And I think it’s fair to say that nobody is more frustrated by that than I am — precisely because the product is good, I want the cash registers to work.  I want the checkout lines to be smooth.  So I want people to be able to get this great product.  And there’s no excuse for the problems, and these problems are getting fixed.

This is the usual Obama response. It is not his fault, he minimizes the problems, joins with you in disapproval — but  it’s a great product, will save you money, and preexisting conditions, affordable and preexisting conditions.

The commentary from across the media has been devastating. Maureen Dowd said “he assumed his favorite role of the shining knight hectoring the benighted: Sir Lecturealot.” James Taranto called it “Vaporcare” and said Obama delivers an infomercial when an accounting is due.” And the parodies and mockery are on the rise and growing. I loved this one.  Just click on the Apply button.

The administration would do much better to just admit that they have a giant fiasco, and tell the people what they are going to do about it. They should have taken the Republican offer of a year’s delay, but they didn’t recognize a good offer when it was presented to them.



You Can Keep Your Doctor, You Can Keep Your Insurance Policy… by The Elephant's Child


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