Just in case anyone has forgotten, the Associated Press and New York Times ran stories this weekend on how the new ObamaCare law distorts incentives and backfires in the effort to truly reform health-care costs. We’ll start with the AP, which looked into the novel innovation among doctors that creates de facto health insurance plans, based on the model used by law firms and retainers. That allows the wealthy to ensure access while locking out others, especially Medicare patients whose reimbursements don’t cover the costs of care:
Every year, thousands of people make a deal with their doctor: I’ll pay you a fixed annual fee, whether or not I need your services, and in return you’ll see me the day I call, remember who I am and what ails me, and give me your undivided attention.
But this arrangement potentially poses a big threat to Medicare and to the new world of medical care envisioned under President Barack Obama’s health overhaul.
The spread of “concierge medicine,” where doctors limit their practice to patients who pay a fee of about $1,500 a year, could drive a wedge among the insured. Eventually, people unable to afford the retainer might find themselves stuck on a lower tier, facing less time with doctors and longer waits.
Medicare recipients, who account for a big share of patients in doctors’ offices, are the most vulnerable. The program’s financial troubles are causing doctors to reassess their participation. But the impact could be broader because primary care doctors are in short supply and the health law will bring in more than 30 million newly insured patients.
Most doctors negotiate fees with larger insurers based on volume they expect to receive from being part of a network. If the government starts dictating terms between insurers and providers, as will have to happen with the state-run “exchanges” and the blizzard of coverage and cost mandates imposed in the individual-policy market, they will have much less negotiating room. The retainer structure allows them to guarantee a certain level of income, and patients with the means to guarantee access and timely care.
The AP is confused about Medicare and Medicaid in this piece; it’s the latter that adds 30 million enrollees, not the former. But the impact on provider access is the same, or even worse. That is a direct consequence of adding demand while artificially keeping prices low, a situation that guarantees shortages. Instead of increasing clinic care and improving health, the new law will paradoxically send more patients to emergency rooms instead, increasing actual costs.
The NYT gets the difference between Medicare and Medicaid correct in its article, and explains that the flood of new enrollees will likely mean less care and more problems:
Medicare is the only functional sector of the health care system today. The reform I wanted to see was Medicare for all. Instead I got the plan hatched by GOP Senators Grassley and Dole and first put into effect (in Massachussetts) by GOP Presidential candidate Romney.
I think that the GOP is going to be successful in killing ObamaCare. But then — finally — they’ll OWN the health care problem. And the health care demographics are just as cruelly ruthless for Republicans as for Democrats.
Anyway, the best health care plan of all is a healthy lifestyle. Eat wisely. Exercise. Don’t get overweight. Don’t smoke. Don’t drink too much. Buckle up. Keep your powder dry.
The best government “program” currently addressing the nation’s health care needs is Michelle Obama’s anti-childhood obesity program. You’d think that she could at least get some props for that. Like Bush richly deserved props for his anti-AIDS program for Africa.
But prevention programs are never sexy enough to merit any attention. There’s no real money in them, except cost savings, down the road. But cost savings down the road can’t compete with profits today.
– Larry Weisenthal/Huntington Beach, CA
@openid.aol.com/runnswim:
Wise words, but in Obamacare, even a healthy lifestyle doesn’t get you anywhere. You still are required to either purchase healthcare, or pay fines and penalties if you choose not to. Unless Obamacare is repealed, or struck down, we’ve lost the freedom to choose to participate in, or not participate in, healthcare commerce.
I don’t know much about the program itself, but the reason she doesn’t get props for it is because of her “do as I say, not as I do” attitude. While she dines richly, ofttimes on bad food as evidenced by the WH SB party, she lectures others on what they should be eating. Most of that may be an unfair charge to her, but when Obama’s admin habitually tells U.S. citizens one thing, and then they, themselves do another, she gets included in that group and it becomes another example of an ‘elitist’ attitude practiced by Obama and his people.
We are supposed to be a nation of freedoms and liberties. If one wants to indulge in certain commerce, and subsequently give the advantage of profits to another, it is not the place of the government to say they cannot as long as it doesn’t infringe on a third party’s rights. Unfortunately, some in our country have wandered into nanny-state territory, suggesting all manner of regulations and prohibitions intrusive and destructive to our personal liberties.
Have I got this straight? One of the main republican attacks on “Obamacare” has been that it would drastically cut funding for Medicare A and B from 2014 through 2033, correct? That’s how they stirred up anger about Health Care Reform among the nation’s senior voters.
So today republicans have begun rolling out the details of their own plan to take on deficits and debt. One of which is to replace Medicare with a voucher system. Seniors would be given vouchers having a certain dollar value, and then be sent off to find their own health insurance. What the vouchers don’t cover, they’ll pay for out-of-pocket.
Lots of luck with that.
The problem, of course, is what private insurance will likely cost most senior citizens. What would a for-profit insurance provider have to charge elderly people to cover costs and still turn a profit? Every one of these people will have a potentially very risky and very expensive pre-existing condition–namely, old age.
But hey! Let’s not worry about that! We’re broke, remember? Let’s focus on the fiscally responsible upside!
For example, top-end tax rates will be permanently reduced to a maximum of 25%.
@greg (#3): You are absolutely correct. The undisputed fact is that Medicare costs less (adjusted for age/disease, etc.) than strictly private sector medicine, while providing the absolute best quality (largest selection of providers and hospitals; absence of gatekeepers and pre-authorizations; unsurpassed outcomes; highest level of consumer satisfaction; fewest medical bankruptcies; no exclusions for pre-existing conditions; no lifetime caps on payouts, etc. etc etc.).
So you get rid of Medicare and what have you got? Greater cost; less quality; medical bankruptcies; uninsured seniors.
I’m a physician with a Blue Shield HSA policy, but I become Medicare eligible in just a little more than one year and I can’t wait to switch to the best health insurance plan available anywhere — Medicare.
– Larry Weisenthal/Huntington Beach, CA
Larry no “government” program is ever going to teach healthy eating habits. Even more so, when the Obamas fly in their own pizza chef from Chicago, feast on hot dogs and spare ribs, and never miss an ice cream photo op, (in between Obama’s cigarette smoking and Michelle’s own weight problem), how could anyone possibly take it/them seriously?
The reality is, if they would just go back to required PE classes, childhood obesity wouldn’t be the problem it is today. Even more so, all of the “politically correct” gay days and teach condom days could be used to teach (teach, not impose), good health and the consequences of eating badly. I personally would love to design a required nutrition class for kids in grade school, complete with medical professionals coming in to give lectures.
What kid is going to stop eating candy or drinking soda just because the soda machine got hauled away? On the other hand, if they were taught, age appropriately, the causes and consequences of type II diabetes and being overweight, it would make a HUGE impact.
BTW, to date Michelle Obama’s program has been a complete failure; no success stories for even the white house to embellish.
Republicans are laying out the first steps of a plot to eliminate Medicare. Somehow what Michelle Obama is up to seems like a lesser cause for concern.
Just reading over at Q&O, here’s a portion of Ryan’s Medicare proposal they had C&P’d for their discussion, don’t have time to look it up on Ryan’s site, hubby just came home and he’s really important:
http://www.qando.net/?p=10631
@Missy: Members of Congress are mostly not senior citizens and the cost of health care rises exponentially at retirement age. Also, despite the waste and fraud (which exists in all health care plans, only Medicare is much more transparent than private health care plans), Medicare somehow manages to provide the best care at the lowest cost and with the greatest degree of consumer satisfaction (exceeding the satisfaction ratings of the several health care plans available to the US Congress).
– Larry Weisenthal/Huntington Beach, CA