Posted on 01/07/2012 5:34:10 AM PST by Kaslin
Are you having difficulty finding a doctor who will see you? If you are, brace yourself. Things are about to get a whole lot worse.
Right now, the biggest problems are in Massachusetts. If you live in Boston and are trying to see a new family doctor, get prepared to wait more than two months before you ever get a foot in the door. For the state as a whole, the average wait to see a new family doctor is one month. More than half of all family doctors and more than half of all internists are not accepting new patients at all.
What if you live in another state? Just wait two more years. In Massachusetts people are lined up waiting to see doctors because of the health reform championed by the former governor (RomneyCare). And as Barack Obama has said on more than one occasion, RomneyCare is the model for ObamaCare.
Why? In both the Massachusetts health plan and the new health care law the mistake is the same: insuring the uninsured, but doing nothing to enable the medical community to deliver more care. Massachusetts succeeded in cutting the number of uninsured in half — a worthy accomplishment. But the state did nothing to expand the number of doctors, nurses or paramedical personnel. The result: a major increase in the demand for care, but no change in supply.
I learned what this means in human terms a while back from a Boston cab driver. She was on MassHealth (Medicaid) and her biggest problem, she told me, was getting care. "I went down a list of 20 doctors before I found one who would see me," she said. "Twenty doctors?" I responded incredulously. "Were you going through the Yellow Pages?" "No," she said, "I was going down the list MassHealth gave me."
In Massachusetts, this is what the advocates of health reform call "universal coverage."
Bad as all this is, it is actually rather mild compared to what is about to happen in other states. In Massachusetts, less than 10 percent of the population was uninsured before the reform set in. In Texas, by contrast, one in every four people is currently uninsured. Insure half of those and the demand for Texas doctors is going to soar.
Estimates are that ObamaCare will succeed in insuring 32 million otherwise uninsured people. If economic studies are correct, once these folks are insured, they will try to double their consumption of health care. On top of that, ObamaCare does something that Massachusetts did not do. It will force the vast majority of people who already have insurance to switch to more generous coverage. For example, everyone will have to be covered for a long list of preventive care and diagnostic screenings, with no copay and no deductible. Once people have this extra coverage, they will be inclined to take advantage of it.
Get prepared, then, for a huge increase in the demand for care. The result will be growing waiting lines — at the doctors’ offices, at hospital emergency rooms, at the health clinics, etc.
In the early stages of Massachusetts' health reform, Governor Romney told me what he expected to happen. Instead of uninsured patients going to hospital emergency rooms to get expensive care in inappropriate settings (all paid for by the rest of us), he said, insured patients will be getting less expensive care in the offices of primary care doctors.
Ah, but the best laid plans …. Turns out that more people are currently seeking care in hospital emergency rooms and at publicly funded community health centers than there were before the reform! As one academic study concluded, in Massachusetts you have the same people seeking the same care at the same places you had before. Health reform has mainly meant shuffling money around from one bureaucracy to another.
When health care is rationed by waiting, who gets care and who doesn’t? Here is the real surprise. Just as ObamaCare intends to do, Massachusetts set up health insurance exchanges where the uninsured could obtain insurance, in most cases with generous government subsidies. Yet the newly insured are the patients having the greatest difficulty obtaining access to care. According to one report:
• Only 56 percent of family doctors accept patients enrolled in Commonwealth Care (subsidized insurance sold in the "exchange").
• Only 44 percent accept patients in Commonwealth Choice (unsubsidized insurance sold in the "exchange").
• The fraction of internists who accept Commonwealth Care and Commonwealth Choice is 43 percent and 35 percent, respectively.
In Massachusetts this is called "access to care."
“to continue receiving enhanced taxpayer-funded government medical insurance that is better than that the rest of us are forced onto.”
As far as I can tell, only 2 of the plaintiffs-one a former CongressCritter from Texas-Dick Armey- are former Federal employees trying to keep their taxpayer subsidized Cadillac-Care...the other two appear desirous of not having to forfeit that which they’ve been coerced into paying for through a lifetime’s work-although I suspect that one of them-a founder of E-Trade-could probably pay cash for his care, or purchase without difficulty whatever policy he might choose.
The moral, right thing to do, is to grant people the choice, without robbing them of their SS.
Government, in the absence of being seen as a moral, just entity, ultimately maintains itself only via the barrel of a gun.
“..why alot of doctors are going the “concierge” route. Yes? No?”
perhaps this process will define an economic price-point for services free from regulatory manipulation
Romney has got a pass on this so far and it is obviously because the other candidates' "handlers" have either done a rotten job of research OR believe voters are so stupid they will tune out the moment a candidate starts citing such data. Their job is to prioritize the data, condense it, and turn it into soundbites. One wonders what those people are doing for their paychecks.
I predict that eventually the government under nobamadon’tcare will force doctors to only see nobamadon’tcare patients by making it a precondition of getting their licenses renewed. Stay healthy or die! At that point, who in their right mind would want to be a doctor?
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Why do we want to exchange a medical system where not everyone has medical insurance, but everyone gets medical care, for a system where everyone has medical insurance but not everyone gets medical care?”
The short answer is, we don’t. This struggle has nothing at all to do with the financing or provision of medical care. That is a smokescreen.
This struggle is about overthrowing the system of government of the United States and replacing it with something else (fundamental transformation).
“Free” healthcare + punishing greedy doctors is just the candy.
My former employer (I'm retired) insures my family through United Health Care. My co pay for Emergency Room use is a flat $50. My insurance has always paid zilch for office calls, urgent care clinics charge a doctor's office call in addition to usage of the facility itself, for which my insurer has a co pay and deductible that has to be met.
It's much cheaper for me to use an emergency room than an urgent care place. I wonder how many other insured people are in a similar situation?
I haven't used an emergency room unless it's an emergency but my insurance, as it is, certainly gives incentive to do so.
I see, the problem is that medical care has gotten really expensive, so expensive that if you don't have insurance you can't even get it. So the solution is to make sure everyone has insurance, even "conservative" commentators agree on that. The discussion of root causes of cost explosion are simply not to be considered.
See my number 47, it's exactly opposite of yours. An urgent care visit costs me nearer $300 opposed to E.R. of a flat $50.
I know it doesn't make sense but that's the way it is.
I’m on Medicaid and if my experience is typical, this article doesn’t even begin to convey the problems. I’ve had doctors bill Medicaid after talking to me for ten minutes and never putting a hand on me — no exam whatsoever, and most questions not about my condition either. Usually they don’t let you know what they’re billing, but I ask and sometimes get to see the paperwork. I’ve had to borrow vehicles and funds to go far from home to specialists who then assign a PA to interview me and then make another referral to another office far from reach. (They absolutely refused to do this interview over the phone — the rules don’t let them get paid that way.) A therapist once spent half an hour demonstrating leg lifts and then handed me a brochure — cost to the taxpayers over $200. Again, IF this is typical, govt health care should be illegal. I believe it’s a racket with more corruption than a city sewer, and when it comes to mooching, the indigent patients are pikers — the real moochers are the health care workers.
Also, there are indeed very few available doctors who accept Medicaid, outside the metro areas. Appointments are generally two or three months’ wait for a specialist, and it’s ALWAYS a specialist; the local GP doesn’t want to be responsible, or maybe he’s incompetent. Mine asks the standard questions every time, and wants me in there every month, way more than one needs to see him. He does not do basic exam: he’s never looked down my throat, or into my eyes or my ears. Checked BP once in all the years I’ve been seeing him. Orders the same blood work every time — it never changes — and I have to borrow a vehicle to travel to the hospital for that. It’s totally unnecessary, a waste of money, time and energy, and if I don’t do it I’ll be dropped and categorized as uncooperative (which seems to be the worst possible diagnosis for the indigent patient — or subject — or “unit”).
The system is, IMO, rotten and should be dismantled completely and then outlawed.
Obamacare would, I believe, bring experiences like mine within the reach of everyone, regardless of ability to pay.
This article provides some interesting anecdotal evidence of the increase in demand under RomneyCare and soon ObamaCare. Obamacare promises free or highly subsidized care for a large list of required services. With little or no constraints from payment, individuals will take advantage of these new free goods and services.
The article indicates that the supply of health care is essentially fixed leading to increased waiting. Supply will decrease under Obamacare at least the supply available through Obamacare because of price controls. Obamacare will impose price controls on drugs and services. Price controls on services will be imposed indirectly using insurance companies as middlemen to deliver the bitter medicine to providers.
In the long run, we will have an explosion in demand and sharp retraction in official supply. In the short run, Obamacare may seem to work well as providers, insurers, and drug companies cope. In the long run, coping will breakdown leading to reductions in supply. However, Obamacare will be difficult to stop once it is implemented. The illusion of free health care is powerful even if health care is plagued by shortages.
The Democrats will not readily accept a two-tier system with wealthy individuals paying for services outside of Obamacare. If shortages become too severe in Obamacare, Democrats will attack the private system forcing the wealthy to endure the same misery. The private system will need to move out of the reach of Democrats perhaps to medical care ships, Mexican/Canadian border clinics, and Indian reservations (my favorite idea). I am not sure if Canada will permit clinics to serve paying US customers.
If the SC does not stop Obamacare, the only hope is a Republican president in 2012. If Obamacare is fully implemented in 2014+, it will be difficult to repeal in any way.
Let’s see.....if I was a good liberal/Democrat/progressive, and my biggest concern was that there are/will-be too many people on this planet, what would I do to kill off people?......hmmmmmm.....abortion of course.....destroy the medical care in my country?......sure......that would help kill off those little people who are always on the beach when I want to walk there in solitude......and we’d claim universal coverage so the dummies would vote for us......great.....kill ‘em off and get votes!
I'd think twice about taking that cruise! The Community Organizer might commission his own fleet.
Remember, sometimes "IT'S A COOKBOOK!"
Obamacare means everyone will be on the dole, as far as health care goes. And you will be treated like folks on the dole.
And the bug guys are takin note. My regular doc is at Advocate Medical Family Practice, a big dog locally. Their local office is now touting open hours on Saturdays and Sundays for walkins with no appointment required! Comopetition is a good thing, and the only thing that can save our healthcare system.
Yes, cash on the barrelhead is preferred by doctors. They’ll see you and see you fast. Nurses have told me they will discount deeply for cash.
While we’re on the subject, here’s one among my personal horror stories: in the course of a regular exam at a family clinic some years ago, I asked a doctor about a painful little bump on my back. The doctor wouldn’t touch it, wanted to order a biopsy. I asked how much that would cost and the answer turned out to be nearly a thousand dollars. Another doctor passing by, overheard this, came in and popped out the boil with his thumb, and slapped a bandaid on it. (The first doctor literally could not — or would not! — tell a pimple from a malignancy, despite the diplomas all over the wall.) Second doctor’s fee: “No charge.”
It would be nice if the Emergency room could send the non emergency cases there. But that would make too much sense.
If Obamacare actually goes into effect which I seriously doubt my doctor is going to switch to a fee based practice. We are just going to keep going to him and pay the fee. We call and get in the same day.
Maybe the free clinics should be set up next to the ERs, so the patients can be easily redirected when appropriate.
NO. Time does not change the charge. Test and how complicated your care is determines the charge. The charge has nothing to do with what is actually payed. Unless you are uninsured. Why is this the case. There is price controls or look at it as wage control on payments. Health care Providers do not work as a business in a free marktet. What they get payed is capped not matter how much it costs the business to provide the service.
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