Posted on 05/25/2013 7:55:06 AM PDT by Kaslin
I believe we are moving toward two different health systems. Which tier do you think you will be in?
In one system, patients will be able to see doctors promptly. They will talk to physicians by phone and email. They will have no difficulty scheduling needed surgery. If they have to go into a hospital, a "hospitalist" (who reports to them and not to the hospital administration) will be there to make sure their interests are looked after. They may even have an independent agency that reviews their medical records, goes with them when they meet with specialists and gives them advice on every aspect of their care.
In the other system, waiting times will grow for almost everything ? to get appointments with physicians, to get tests, to obtain elective surgery, etc. Patients may find that they don't have access to the best doctors or the best hospitals. They may find that the facility where they are treated does not have the latest technology. In terms of waiting times and bureaucratic hassles, health care for these patients may come to resemble the Canadian system. It may become even worse than the Canadian system.
The evolution toward a two-tiered system was already under way before Barack Obama became president. But ironically, the Affordable Care Act (Obamacare) is accelerating the pace of change. It is doing so in four ways.
First, Obamacare is supposed to insure 32 million additional people by this time next year. If the economic studies are correct, these newly insured will try to consume twice as much medical care as they have been. In addition, most of the rest of us will be forced to have more generous coverage than we previously had. There will be a long list of preventive services that all plans will be required to cover ? with no deductible and no copayment ? and commercial insurance will be required to cover a great many services previously avoided (including, everyone must know by now, contraception). These two changes alone will boost the demand for care considerably.
On the supply side, there is really no provision under Obamacare to create more doctors. In fact, the supply of doctor services is likely to decrease because of two more features of health reform. Doctors, who are already weary from third-party interference in the practice of medicine, will step up their retirement dates as they contemplate the prospects of even more bureaucracy. Also, hospitals are acquiring doctors as employees at a rapid rate. Indeed, more than half of all doctors are now working for hospitals. When doctors quit their private practices and start working for hospitals, they reduce the number of hours they work. (Forty hour work weeks and golf on the weekends replaces 50 and 60 hour work weeks.) Since they have a guaranteed income, they also become less productive.
These four changes add up to one big problem: we are about to see a huge increase in the demand for care and a major decrease in the supply. In any other market, that would cause prices to soar. But government plans to control costs (even more so than in the past) by vigorously suppressing provider fees and the private insurers are likely to resist fee increases as well. That means we are going to have a rationing problem. Just as in Canada or Britain, we are going to experience rationing by waiting.
Consider how much waiting there already is in the U.S. health care system. On the average, patients must wait three weeks to see a new doctor. In Boston, where we are told they have universal coverage, the average wait time is two months to see a new family doctor. Amazingly, one in five patients who enters a hospital emergency room leaves without ever seeing a doctor ? presumably because they get tired of waiting.
All this is about to get worse. Waiting times are going to be especially lengthy for anyone in a health insurance plan that pays providers below-market fees. The elderly and the disabled on Medicare, low income families on Medicaid, and (if the Massachusetts precedent is followed) people who acquire health insurance in the new health insurance exchanges will find they are financially less desirable to providers than other patients. That means they will be pushed to the end of the waiting lines.
Those who can afford to will find a way to get to the head of the line. For a little less than $2,000 a year, for example, seniors on Medicare can contract with a concierge doctor. These doctors promise prompt access to care and usually talk with their patients by telephone and email. They serve as an advocate for their patients, in much the same way as an attorney is an advocate for his client.
But every time a doctor becomes a concierge doctor, he (or she) leaves an old practice serving about 2,500 patients and takes only about 500 patients into the concierge practice. (More attention means fewer patients.) That means about 2,000 patients now must find a new physician.
Because the two tiers of health care will compete with each other for resources, the growth of the first tier will make rationing by waiting even more pronounced in the second tier. As a result, waiting times in the second tier could easily exceed those in Canada.
I also believe all this is going to happen much more rapidly than anybody suspects.
For a few years I was a volunteer working with indigent people, many with various disabilities. I noticed when many of these people were enrolled in Medicaid they would go to the doctor frequently. They would go to the doctor if they caught a cold. In two different cases I remember clients called ambulances because of perceived “heart palpitations.” In neither case could the EM doctor find any problems after doing a range of tests.
If you advertise “FREE” kittens or puppies the people who show up at your door are mostly those too dysfunctional or poor to take care of a pet.
Nothing, if the cost reflects the service, and isn't a huge payment for five other people who don't pay through government mandated cost-shifting.
“governmental intervention” is the great cost increaser and inhibitor for any business.
We are in the midst of refing our mortgage. We have been with the same bank for 20 years. We have a checking acct, two saving accts, a line of credit, a debit card, safety deposit box and other stuff with them.
Our credit ratings are over 800, and the bank gets direct deposits from our IRAS, SS, my pension and other income generating sources. So the bank knows exactly how much per month net income we have each month and will have.
We have lived in the same home since the 1970’s and the Zillow appraisal shows our home and neighbors’s homes to be valued above the great Pelosi/Reid/Barney lite in the loafers housing crash.
In spite of our documented stability and great credit rating, since, we are considered evil white people by the current administration, we have to have a ton of stuff besides the obvious hard data above for our approval.
The lady in charge of our loan process, said the cause is the raft of people they had to hire to meet fed/state regulations working out of some isolated office, who make everything a hassle. She said 8 years ago, we would have been approved in a couple of days with a drive by appraisal.
Welcome to Europe.... Public vs Private.
Not sure. But I am certain in which one members of Congress and the Executive Branch will be.
When that happens, it is time to start shooting the “other tier”.
Its already started... see “concierge” medical services. Every day more doctors are signing up to be included in these programs.
I’ll predict there will be American clinics that treat only Canadians, and Canadian clinics that treat only Americans. The airlines will be the big beneficiaries of Obamacare.
That will be the time to assure that IRS clerks leaving work have "accidents".
Why would the government want to keep you from doing something that would reduce the load on the medical system and cost them nothing?
Power, that’s why.
It seems the biggest complaint about socialized medicine is that it’s not socialized enough. Nothing’s free. Buy the best coverage you can afford. Can’t afford better? Work harder to earn more to buy better.
I have little sympathy for someone sitting around complaining that the government isn’t providing enough of anything, including healthcare.
They want the money, the government believes that ALL money belongs to them, and they want it. In their opinion the money you pay to a foreign doctor or hospital is not YOURS, it is theirs and you ARE costing them, and they can reduce the load on the system by simply denying you care, (remember those Death Panels?).
Other option--access to medical care is destroyed: for everyone, and rich people too.
Two tiers would require a infrastructure of hospitals that are for profit, because there are too many regulations for our not-for-profit and nonprofit hospitals to embrace the "rich tier."
How many do we have already, profitable for-profit hospitals? Not many. I can't even think of any off hand.
And this fictional for-profit hospital which caters to the wealthy cannot have an emergency room. Think about it. ERs must take all comers by law, but the the law creates no ERs. So the for profits cannot be in the ER business or they would cease to make enough profit to run the rest of the hospital.
So, the wealthy do not have their own ER. If Bill Gates wrecks his car in a town that has a for-profit hospital, he still has to go to the hospital that caters to the poor. Then, once stabilized, he can be transferred to his sort of place.
The wealthy like to travel, and it would behoove them to stay away from places that do not have a hospital waiting for them.
Hospitals are very much like the Space Shuttle. This is a useful analogy. They are both highly complicated, expensive repositories of technology and highly trained personnel.
Once you shut down the Space Shuttle, even Bill Gates with all his money will never ride in one.
I do not think this two-tier system is as inevitable as everyone assumes. You just need to know a little about the ecosystems of hospitals.
I would make a guess by 2025....that we are paying five to eight times the current amount for health care. There will be unregistered doctors who roam the countryside....working out of hotel rooms, and just doing examinations for cash. Most nurses will have gone to private medical units, and if you want a decent nurse at some hospital...figure a $70 a day charge. Your local dope dealer will be selling you drugs...cheaper than the local pharmacy can.
Welcome to the future of Obamacare. And all of those bureaucrats who forced this on Americans will claim to “know nothing about it.” Or they will use the excuse that it isn't being funded enough: code for we need to raise taxes to astronomical levels. Only thing, money isn't and won't be the problem. Total mismanagement and corruption will be norm just like with Social Security, Medicare and Medicaid. And since there isn't and won't be any accountability it will be a mess.
And our nation's socialist-entitlement and single-payer preK-12 **schoools**!
Every argument used to defend single-payer and socialist-entitlement K-12 schooling will be used to defend single-payer and socialist-entitlement Obamacare.
Yup. Until they run out of other peoples money. Then what?
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