Your doctor’s future
Is this a description of your doctor’s future under ObamaCare?
Doctors will consolidate into larger practices to spread overhead costs, and they’ll cram more patients into tight schedules to make up in volume what’s lost in margin. Visits will be shortened and new appointments harder to secure…Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going “cash only.” If too many doctors take this route the government could step in—as in Canada, for example—to effectively outlaw private-only medical practice.
Please read the whole thing.
And then there’s the little matter of the missing money to pay for the proposed changes. Even if estimates indicate that it might solve some of the problems, Obama is reluctant to limit the tax deduction for employer-provided health insurance because he criticized John McCain for suggesting such a move during the campaign.
Neo,
More from the article you linked to;
Again, I do not think that Obama & the democrat’s so called reforms are really targeted at improving health care so mush as consolidating government control. I suspect that if this plan is implemented as described, forbidding doctors to opt out will soon follow. It will have to because most doctors will probably opt out. Maybe I’m wrong, but if I were a physician and was looking at the prospect described, I’d opt out.
Neo,
The entire Obama approach to this issue is, like virtually everything he advocates, wrong-headed and ultimately counter-productive.
For 19 years I have worked with and for a system which, while we still have a way to go, is generally acknowledged as the very acme of the field. We don’t accept anyone into our group who isn’t in the top 25% of her graduating medical school class (that’s just the first criterion). We do nothing but fiercely strive to be the highest quality, most affordable medical care system in the country. We have pioneered and are perfecting the electronic medical record. And on and on.
The way to improve medical care in this country is to create incentives for multi-specialty group practices, and perhaps other models as well, to compete with each other. The Obama plan fantasizes that a “public option” (actually designed to destroy other models over time) is the answer.
Well, they’ve certainly gotten off to a good start with their demonstration projects in the automobile industry.
Jamie Irons
Jamie,
When Germany reunified, one of the problems it faced was melding the two health systems. I don’t know exactly how the GDR system functioned, but I do know they had multi-specialty polyclinics that the people liked. They were replaced by the single practices common in West Germany. That decision surprised me because it involved lots of duplication in equipment etc. and less communication between doctors about individual patients. It also put older doctors in a bind because they were reluctant to invest in setting up a practice they would operate for only a few years.
All this is true and could happen; however if any vestiges of free markets are left, they will find ways to meet the changing needs in a cost effective way. Take for instance the concept of “Minute Clinics” at many CVSs. They are growing and treating the most common ills associated with going to a doctor’s office. These clinics refer patients they can’t handle to specialists. I haven’t gone to a GP doctor in years (thank God!) because I go to these fast and cost-effective little clinics. I have however gone to several specialists, specifically to get an ankle injury surgically repaired last September.
Bottom line is if we remain a capitalist society (and I realize that’s a BIG if) and we don’t let the government meddle too much, the marketplace can and will handle some of the above problems.
I was just watching Fox News & they featured an industry analyst during the discussion of Obama’s push for healthcare reform. The analyst stated that this is not about improving coverage, reducing costs, improving the quality of care and access. It’s a political reach for power and control of an industry that makes up 1/6 of our economy.
I think he’s exactly right, and it follows with the other grabs for power and control in the private sectors.
Where does it stop? DOES it stop?
Scary and creepy!
Webutante,
Obama’s goal of having a single payer plan is designed to eventually push out all private insurer competition. When the govt. controls all healthcare, they can then TELL drug companies what they are going to pay for medicines; they are going to TELL doctors what they will be paid for their services, and so on.
As I understand it, the way the federal govt. envisions their plan is to offer “insurance” for those who can’t pay (paid for by more taxpayer money….of course!!!), and providing rates which will ultimately cause business owners to realize it’s cheaper to let their employes sign onto the federal plan, even if they (the businesses) might be forced to pay a penalty to the govt. In this way, most of the employer-based insurance coverage will transfer to the govt. The remaining business will be too small to support private insurance cos., and they will be forced out of business.
As for those Minute Clinics , you may be happy and satisfied to depend on these, but I don’t think the larger part of the population would be comfortable doing so. Who staffs them? Are there doctors or primarily Physician’s Associates (which are nurses with some advanced training, and authorized to prescribe many medications)? Do you pay for your visits there out of pocket? Or do you have insurance that covers any charges, as well as medications prescribed. I would think one would have to carry some insurance because such Minute Clinics surely are unable to handle catastrophic illnesses (like cancer), required surgeries, sophisticated testing beyond X-ray and perhaps basic blood analysis.
If this is the case, these clinics don’t eliminate the need for insurance anyway. If the government owned all medical care business, it could open such clinics and have sole control over the level of employee expertise, rationing of procedures and medicines and so forth.
I find it absolutely frightening and foresee a drastic drop in the level of healthcare. Also, without a free market and competition, what is the incentive for researchers and pharmaceutical companies to invest huge dollars in research and development to continually provide better and more cutting edge care? Does one think the government would take up this segment of the medical industry?
Finally, the bureaucracy required to operate a govt. medical system is mindboggling — probably doubling the existing size of government, at least. If you think it’s difficult to resolve contested claims with your HMO or insurers now, forget about it with the federal govt. bureaucracy. (Think about how hard it is to deal with the IRS if you have problems! The medical system would essentually dwarf the IRS in scope and size.)
Jamie I,
As someone who seems to know more about this than I do, I hope you’re correct regarding your comment about multi-specialty group practices, and other models which you alluded to.
If they were actually functioning AND the government was completely out of the medical business, I would hope we see costs dropping substantially. Enough so that insurance could once again be affordable and would actually cover your entire treatment.
Especially for more advanced treatments like chemo and radiation, etc.
The reason I say that is that I have seen individuals use their entire lifetime of policy amount (1 to 2 million) used up in cancer treatments before being done with the treatments. At that point they have to use medicade (or medicare, I’m not sure) but the only way to qualify is to not have sufficient assets, at least enough to be disqualified over. At that point couples have had to divorce and put all of the assets in the other persons name so that they qualify. Or play some other such shell game. Else they’re just out of luck.
Go back to LBJ and look at the estimates of the cost of Medicare over time, look at the explosion of costs in Medicaid, peruse the gigantic costs being incurred as a result of the “Prescriptions for Seniors” legislation, consider the fact that both Medicare and Social Security will be dead broke and without funds long before what was anticipated only a short time ago, and then tell me that the trillions of dollars that will be spent on ObamaCare can actually be sustained by our country. Health care in the future is likely to consist of witch doctor chants and the burial of toads at a crossroads during a full moon.
About the only thing I can see standing in the way of nationalized health care is a full-scale economic meltdown and bankruptcy of the U.S. government. And that may well be on the way.
Trouble is, the consequences of that will be even worse than national health care.
The quality of care will decline. Rationing will happen. Innovation will slow and even be arrested. And it will bankrupt the country.
I’ve studied this problem ad nauseam. I have had so many discussions with physicians and investors that I’ve lost count. All think this is going to be a disaster.
And I agree that this is about the Marxists grabbing for more power and control over the economy and society. If it really was about just covering the uninsured, which the Democrats/Marxists say are about 40 million people, then the answer is to expand and more robustly fund Medicaid. But these people lie, and lie, and lie, and lie… But I guess only former Leftists like me can understand just how profligately the Marxist lie. They asked me to be a liar, and I refused.
Terrifying. My boss has no idea and lives under the delusion that the cash only/private payer option would still be available for the ‘rich’. Nothing I say explaining the creeping control socialism would create can convince people like her. I imagine an entire country full of such unthinking sheep and it’s too tragic to consider.
They lie and lie, and when not lying, dissemble. The verminous press keeps echoing the “40 million uninsured AMERICANS”. Americans, never “US citizens”, so included are the 12 mill plus illegals. Another 10 mill or so are the opt-outs who refuse to pay their share of employer-provided insurance becuse they’re young and well, and the millions who at any time are between jobs and thus temporarily without.
So do the math: the US healthcare system will be convulsively dismembered to “help” maybe 10 million US citizens truly without insurance and too well off for Medicaid. That is 3% of the population, for Pete’s sake. “Reform” is either insanity or a Marxist powergrab .
It is important to note that when people in Europe or Canada want medical care that is not readily available to them in their system because of rationing or waiting times, they have the option of coming to the U.S. if they are willing to pay. If we lose our present system for socialized medicine, there will be nowhere to run.
It’s interesting that you folks are concerned about the spiraling cost of health care under an Obama plan when as I noted in the other topic, we ALREADY have spiraling costs under the current system, which is the only system in the industrialized world without some sort of government universal health care plan. The Obama plan is far more market-oriented than any plan already implemented in most Western countries. It’s really hard to imagine how we could do worse than we do today in terms of cost — where we spend twice that of Japan or France yet by most measures their health care is very similar to ours in terms of statistics like survival rates for cancer, etc.
Unless you think we Americans are fundamentally unable to match the French or Japanese models without continuing to spend gargantuan amounts on health care, I think these are proofs of concept that some government intervention in health care neither destroys freedom of choice nor reduces the quality of care by any significant amount.
In terms of private insurance, as I noted before, Canada’s system allows private insurance to supplement the government program (unlike in some countries), and so if you want more access you can get it if you pay for it. The same is true of Obama’s plan.
Hong Says:
May 13th, 2009 at 10:25 pm
No, I think your boss may have a point. The super-rich and the politically-connected have no intention of living under the same rules they establish for the “masses”.
One of the worst effects of socialized medicine is that the field will be less attractive to the best and brightest. Imagine fewer of the go-to doctors for specific diseases, less research by brilliant minds. Only more freedom in the market for health care will improve access and maintain quality.
I want to weigh in here, because I have been practicing medicine for 27 years as a family practice physician. When I started, the HMO concept was brand new, and as an idealistic young doctor I was all for it because I believed (naively) that I could help patients make cost effective choices, provide good advice about preventive care and do a lot of the same things that specialists could do for less money. Well, we all know what happened. Consumers revolted and soon I had tire tracks on my chest from all the patients who did not want me as their gate keeper. Lately there has been a resurgence of the same idea: it’s called the medical home, and in this iteration, patients join or are assigned to a medical “home” and care decisions are made in an unspecified manner than will somehow enhance health and cut costs. To me it looks like a Trojan horse and I am disappointed that my professional Academy has endorsed it. I forsee the same sorts of battles between doctors and patients that happened under the HMO idea.
Americans like the idea of doing something, not waiting in queues to see specialists. I don’t know if that is right or wrong, but I see it as a cultural phenomenon that sets us apart from other nations. It’s going to make a single payer plan very problematic in my opinion, because the only way to reduce costs is to limit access and reduce technology. The pie in the sky ideas of applying preventive health care principles to a population that neglects common sense self-care (smoking, lack of exercise, obesity) are just that. Do the health care planners think that doctors have not already tried to advance these things? Unfortunately, it is human nature to live in denial, and I don’t see that changing any time soon. Just the other day, a 58 year old man walked into my urgent care clinic in the middle of a serious heart attack. We got him off to the hospital by ambulance and he is doing OK. He had cardiac risk factors up the yinyang AND he had health insurance, OK? He had been told at sometime in the past by a physician to address the factors, but he did nothing about it until he had the heart attack. This is not an isolated case; it happens all the time. Yes, we will improve health by supplying payment service (this is the real meaning of the term “health insurance”) to all people. But it will drive costs UP unless there is serious rationing, just as is done in other countries. Do not believe it when the doctors working on government or industry panels claim that if we just provide basic preventive advice, costs will drop. Ditto for the electronic medical record. The EMR will be cool and fun to work with. But don’t expect your doctor to look you in the eye ever again if he/she is using one, unless they happen to be a 40 word/minute typist. (Disclaimer: I am a hunt-and-peck typist). EMRs will allow the government/health insurance companies to audit every visit and start disallowing payment for things they feel are “inapproriate care.” Doctors will love working for nothing. Guess what happens next? They will refuse, somehow, to start treating those conditions.
A word on Minute Clinics, mentioned by another poster. They are not the solution. They are already losing money for their corporate hosts (in Minnesota, anyway). At best they skim off about five of the most easily treatable conditions in health care from clinics that are more stressed from providing care for chronic conditions and could use some easy to treat problems in order to make up some of the deficit. I work in urgent care now precisely because I was tired of being a nag about people’s non-compliance with their treatment. With the advent of “quality initiatives” I was more and more focused on getting the numbers right so I would have a good report card, and less about the well being of my patients. That was wrong. Now I have a chance to manage/cure things that my patients agree are wrong with them and all of us are happier. I have lost some of the continuity experience, but I regained my sanity and sense of medical ethics.
Mitsu, you really can’t think critically at all, can you? Over in the other thread, you were presented with the logical absurdity of all of the arguments you have repeated here. Instead of even trying to defend them, you just moved the same illogical arguments, entirely unsupported by facts, over to a new thread and started over.
Read what some of the other posters have written here, such as Dan, Jamie Irons, and Tom — people who work within our medical system and actually understand how it works. Think about what they’ve written. Explain with supporting evidence why they are wrong. THEN you will be making an argument worth reading. Until then, as a preventative health care measure, I’m going to have to skip your posts on this topic.
Mitsu,
You appear to support Obama’s plan just because of your political position. You clearly have not even looked at, let alone read up on socialized medicine and how it is not working in other countries! The queues for tests and procedures are so onerous in Canada, that only a month ago, the equivalent of thier Chief Justice of the Supreme Court chastised the system while noting that people are just sitting waiting to die because the system cannot get to them in time. There apparently is no “triage” built into the system: i.e. determining care by most urgent need. It’s wait your turn in line!
Further, it is inevitable that there wil be rationing, that the formularies of permissable medications will be stripped down to the less costly generic forms of medicines — even when, in reality, not all generics are equal, and frequently do not work exactly as the original drugs. I happen to require several medicines that I cannot use in generic form as they are ineffective. But the enormous bureacracy that will result from federally funded one-payer system will determine the viability of medicines, tests, treatments, even equipment!
As I said above, and as someone else also noted, driving costs down on drugs because of the clout of being the only option will just cause the pharmaceutical companies to discontinue, or at best, severely limit research and development, as will happen in all areas of medical technology. And as a number of others have noted, there will be less incentive for the best and the brightest to go into medicine when they are essentially forced to treat people as per federal govt. edicts.
Back to the enormous bureacracy that will be required to run such a system — those who make decisions will be so far remove from patients and doctors that it will REDUCE effective medical care.
Finally, one must realize, when defending this policy as driving down costs, no one has taken into account the tens of thousands (if not hundreds of thousands) of civil servants it will require to administrate a federal system, and the costs of salaries, offices, equipment and supplies, etc. This will considerably offset a great deal of the “savings” proponents of national healthcare use to sell the idea.
And Mitsu, if we are the “the only system in the industrialized world without some sort of government universal health care plan,” that is NOT a reason to change over — especially when we see that it does NOT work effectively in other countries, and those who can afford to, escape to receive medical care here! That says a great deal about the level and availability of healthcare that now exists here.
And you might want to take a look at what Tom says above (10:38 PM) regarding the administrations use of nos. of uninsured as another reason to get their way. It is a fact that many of those are illegal aliens; many are young people first getting out into the world, and thinking health insurance is not a priority right now when iPods and iPhones, hip cars and plasma TVs are much more attractive.
What we need is to maintain free choice w/ a better informed population re: insurance and the various alternative kinds that are available. Better we should have medical educational reform to enlighten people re: their choices and the alternatives and consequences of not having some kind of insurance. And Dan is exactly right when he says labels the notion of preventive care as a means to a successful end of rising costs. People need to take personal responsibility for their health, and if they don’t, it is not the role of the govt. to come in and punish them! Is the “nanny state” going to begin telling us what we can eat and not eat under the premise of preventive care? And the fact is, that preventive care can help to some extent, it cannot prevent many severe illnesses and diseases that are passed genetically (would the “nanny state” then stipulate who can, and who cannot have children?), or via unknown sources such as most cancers, Parkinson’s, Alzheimer’s, among many others I know nothing about.
Socialized medicine is about power and control and bigger government. It will not result in improved and less expensive health care — quite the opposite results will be achieved.
Instead of parroting your political leaders, you might want to consider the merits and disadvantages of the alternatives, and why this country has not implemented socialized medicine to date. There is very good reason!