I wonder how that would change, though, if they fail to pass the annual "doc fix" and let reimbursement rates drop by 32% (as they would if a "doc fix" is not put in place by January).
Getting rid of the "doc fix" was one of the premises that were used to make the numbers work out for Obamacare.
Failing to renew the doc fix would not have a big effect at first, because the providers just would not believe that it wouldn’t come back, and retroactively to boot, just like salaries for government workers after the “shutdown.”
If it persisted, the effects would be very modest. The reality is that beyond absolute fixed costs, the customer’s ability to pay determines the price of any good or service, and health care is no different. You’d see harsh cuts to variable costs — salaries of practitioners, jobs of administrative staff, vacuuming of hallways, wattage of lights, etc. A few very marginal facilities that were barely staying ahead of fixed costs now would close. Older doctors with healthy investment portfolios (whose ability to retire sets a high fixed “opportunity cost”) would quit, but 35 year old doctors with $500,000 mortgages and $250,000 in school loans aren’t going anywhere.
The reality is that Eastern Europe and India can send us ten well-trained physicians overjoyed to work for $100k a year and a green card for every one American doctor who’d quit if he could no longer clear $250k from his practice, and the infrastructure of American health care facilities is simply vastly more expensive than they need to be, which the medical tourism industry testifies to eloquently.