Saturday, June 30, 2012

The Real Obamacare

(The following was written by a friend of mine whom has just finished his residency and is about to take his first job as a doctor. He's given me permission to share it, enjoy)
The Real Obamacare

The reason that medicine costs so much is because many individuals do not pay for it. The uninsured and under-insured visit the ER because they will not get denied an ER doctor evaluation when they do not wish to pay for an office consultation. Lawyers have made it where if a non-emergency is not seen in the ER, then the doctor suffers in court, therefore extensive, expensive workups are ordered that the patient never intends to pay. Medicaid patients do not pay a dime for any medical service or medication, and many go to the ER whenever convenient and get a full workup free of charge that you and I as taxpayers pay for. Ever realize that you and I are paying for someone on Medicaid to get free Tylenol from the pharmacy?

The problem with the insurance companies is not that they are big, greedy monopolies, but they have been subject to so many forced legal requirements and increased costs from hospitals (the hospitals have to raise the price for everyone to balance out the people who don't pay any of their bill or don't even have an address to bill, ie. illegal alien, etc.) and thus have no other choice but to drop certain people or coverages or increase premiums; it is just business. Insurance companies are not increasing in number due to so many of these legal precedents and ramifications, so healthy competition is at a minimum, and vastly meddled with by the federal government. So the problem with our current healthcare system has been caused by the federal government. And the solution? To expand
the current failing system. That is Obamacare. The Affordable Care Act may sound pretty to the individual, but in reality it is designed to destroy private insurance.

The ACA cuts reimbursements to facilities and clinicians taking care of Medicare patients, so more doctors cannot afford to accept Medicare, or at least they must accept fewer patients. It penalizes doctors for not using electronic medical records (and to the exact intricate specifics they dictate, all of which are insanely expensive by the way), so older doctors are being forced to shut their doors rather than now lose Medicare money and go bankrupt or buy a $10,000 electronic medical record when they plan to practice for less than 5 more years. It expands Medicaid to cover an additional 15-30 million people, but it does nothing to further compensate clinicians for seeing these people. A private physician who sees only Medicaid patients goes bankrupt, because Medicaid pays 30 cents to the dollar; it costs more to see the patient than you get paid. So more Medicaid holders have less doctors and access; this does not fix the problem. And they go to the ER instead. Might as well take a free ambulance ride to the ER while they're at it so they don't have to pay for gas. And you and I pay for it.

So how about the government-issued insurance plans set to come out in 2014? They're designed to be cheaper, so more people can afford them. Sounds sweet. Problem is, people look at the cheaper thing and often not what it covers (or which providers will accept it, which may not be many, making it akin to Medicaid) and will cancel their private insurance. Now more people than ever are on a government insurance policy that doctors cannot afford to accept, because it does not (granted may not) pay enough to sustain a practice. Even less access to care. This does not fix the problem of getting people their health care access that they need.

The government is also about the least efficient manager of goods and services; they do not save money nor prevent waste; quite the opposite. From experience the VA system is about the biggest example of waste there is. The government also is very picky about who gets what and when (trust me on this; I have battled many a time to get my Medicare and Medicaid patients what they need when the government says no). So we get less patient-centered care and more dictation on what the government says is what's best for the patient instead of the doctor, and the patient gets fewer choices and options. And the ACA fails to address anything at all about the absolute biggest medical expense of all: nursing homes. The law does nothing to keep people out of nursing homes, but will not pay for a nurse to make a nice, quick, easy, inexpensive visit to someone with home health and prevent further health decline. Medicare and social security are set to go bankrupt before any of us younger folk get of age, by the way.

I'm sorry to say the Supreme Court ruling this week forcing insurance or taxation will not get insurance for everyone; the tax imposed is still significantly less than insurance premiums (private or proposed public insurance), so a very large number of people will still opt out, and small business owners, already under so much legal taxation, will (if not forced out of business) most likely resort to paying the tax instead of providing medical insurance to their employees.

The solution is not to expand a failing system the government helped to create; it is to get the government back out so we can have our own private insurance competition again.

A side note: the majority of doctors in this country are against Obamacare and are not members of the AMA.
(So there you have it, a doctor's perspective on Obamacare and the problems with the medical industry)

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