Posted on 12/14/2013 5:56:58 AM PST by Kaslin
At this point we have no idea how many people will become newly insured under ObamaCare. For the first year out, the number of people with insurance may actually go down! But the administration's goal is to insure an additional 30 million people and eventually a lot of those people will acquire health plans. When they do, the economic studies predict that they will try to double their use of the health care system.
Adding to this increased demand will be new mandated benefits. The administration never seems to tire of reminding seniors that they are entitled to a free annual checkup. Then there are new benefits for women, including free contraceptives. And all of us will be entitled to a long list of preventive services — with no deductible or copayment.
But the health care system can't possibly deliver on all these promises. The original ObamaCare bill actually had a line item for increased doctor training. But this provision was zeroed out before passage, probably to keep down the cost of health reform. The result will be increased rationing by waiting.
Take preventive care. The health reform law says that health insurance must cover the tests and procedures recommended by the U.S. Preventive Services Task Force. What would that involve? In the American Journal of Public Health, scholars at Duke University calculated that arranging for and counseling patients about all those screenings would require 1,773 hours of the average primary care physician's time each year, or 7.4 hours per working day.
And all of this time is time spent searching for problems and talking about the search. If the screenings turn up a real problem, there will have to be more testing and more counseling. Bottom line: To meet the promise of free preventive care nationwide, every family doctor in America would have to work full-time delivering it, leaving no time for all the other things they need to do.
When demand exceeds supply in a normal market, the price rises until it reaches a market-clearing level. But in this country, as in other developed nations, Americans do not primarily pay for care with their own money. They pay with time.
How long does it take you on the phone to make an appointment to see a doctor? How many days do you have to wait before she can see you? How long does it take to get to the doctor's office? Once there, how long do you have to wait before being seen? These are all non-price barriers to care, and there is substantial evidence that they are more important in deterring care than the fee the doctor charges, even for low-income patients.
For example, the average wait to see a new family doctor in this country is just under three weeks. But in Boston, with ObamaCare-type reform, the wait is about two months.
When people cannot find a primary care physician who will see them in a reasonable length of time, all too often they go to hospital emergency rooms. Yet one study found up to 20% of the patients who enter an emergency room leave without ever seeing a doctor, because they get tired of waiting. Be prepared for that situation to get worse.
When demand exceeds supply, doctors have a great deal of flexibility about who they see and when they see them. Not surprisingly, they tend to see those patients first who pay the highest fees. A New York Times survey of dermatologists in 2008, for example, found an extensive two-tiered system. For patients in need of services covered by Medicare, the typical wait to see a doctor was two or three weeks, and the appointments were made by answering machine.
However, for Botox and other treatments not covered by Medicare (and for which patients pay the market price out of pocket), appointments to see those same doctors were often available on the same day, and they were made by live receptionists.
As physicians increasingly have to allocate their time, patients in plans that pay below-market prices will likely wait longest. Those patients will be the elderly and the disabled on Medicare, low-income families on Medicaid, and (if the Massachusetts model is followed) people with subsidized insurance acquired in ObamaCare's newly created health insurance exchanges.
Their wait will only become longer as more and more Americans turn to concierge medicine for their care. Although the model differs from region to region and doctor to doctor, concierge medicine basically means that patients pay doctors to be their agents, rather than the agents of third-party payers such as insurance companies or government bureaucracies.
For a fee of roughly $1,500 to $2,000, for example, a Medicare patient can form a new relationship with a doctor. This usually includes same day or next-day appointments. It also usually means that patients can talk with their physicians by telephone and email. The physician helps the patient obtain tests, make appointments with specialists and in other ways negotiate an increasingly bureaucratic health care system.
Here is the problem. A typical primary care physician has about 2,500 patients (according to a 2009 study by the Centers for Disease Control and Prevention), but when he opens a concierge practice, he'll typically take about 500 patients with him (according to MDVIP, the largest organization of concierge doctors). That's about all he can handle, given the extra time and attention those patients are going to expect. But the 2,000 patients left behind now must find another physician. So in general, as concierge care grows, the strain on the rest of the system will become greater.
I predict that in the next several years concierge medicine will grow rapidly, and every senior who can afford one will have a concierge doctor. A lot of non-seniors will as well. We will quickly evolve into a two-tiered health care system, with those who can afford it getting more care and better care.
In the meantime, the most vulnerable populations may have less access to care than they had before ObamaCare became law.
Members of Congress and the political elites will be going to the Mayo Clinic while us peons will be standing in line at swamped hospital emergency rooms and government clinics.
The Unseen Hand of the Market” can become a mailed fist when the Taker Class perverts the market sufficiently with socialist laws, rules, regulations.
The new 'health care' will be a bonanza for 'doctors' who graduated at the bottom of their classes in Caribbean 'medical schools. I knew a doctor (many years ago) - (total quack) who got his medical degree in Italy. When I asked him if he spoke Italian he said 'no' but that his parents paid a small fortune for his medical degree... It's similar in some of the Caribbean island 'medical schools'. So yeah, Obamacare's got incentives from hell. The horrors will keep coming until everyone's been touched.
ON the lighter brighter side, all those folks who graduate based on affirmative action or 'special help' will now be able to have large practices and be PAID the exact same as a doctor how knows what he's doing.
This is NOT a dog whistle - I'm talking about blacks and women who get advantages getting into medical school - and staying there... when they're not qualified.
The government will just mandate that all doctors must accept all patients, regardless of whether they are on Medicare, Medicaid, or Obamacare private insurance. This is where we are headed—a single payer system. The public will be begging for it after a few years of Obamacare.
The issue is that the average doctor is so busy that he has his whole schedule filled by existing patients for at least three weeks out. His staff knows how to plan the schedule for the existing patients, but a new patient takes longer than those who have been in before since the doctor has to take her history, review previous work and tests, if any, and figure out what her problems are. So it could be months before there’s a spot in the schedule big enough to accommodate an unusually long appointment.
Massachusetts Medical Society: Wait times for doctors is too long
"Take two aspirin and call me in two months." That's what prospective new patients looking for a first appointment with a family physician are hearing in Hampden and Hampshire counties, according to an annual survey from the Massachusetts Medical Society. The average wait time for a new patient appointment with a family physician in Hampden County is 58 days, up from 48 in the 2012 survey, according to a study released Monday.
In neighboring Hampshire County, the wait for a first appointment with a family physician is 56 days, down from 96 days a year ago. In Franklin County, the wait time fell by nearly half from 205 days to 106, but is still longer than three months and the longest wait time in the state.
By comparison, the statewide average is 39 days. Suffolk County, which includes Boston and its suburbs, has the shortest wait time at 16 days.
You probably qualify for Medicaid.
I refuse to believe both stats are real - three weeks to see a doctor?
The “Progressives” have long crowed about the glorious Canadian model for Health Care Reform.
Go research the waiting time for an MRI in Canada and get back to us.
But that’s Canada.
The left is trying to turn our Healthcare System into what Canada has.
That's because of the low payouts from Medicare. Be thankful you're not on Medicaid where the payouts are even lower.
I recently asked my GP if he saw Medicaid patients. His response, "I haven't seen a Medicaid patient in years."
The going to the emergency room claim was a little suspect too....I think that only works for the very rich and very poor. Going without is the more likely alternative.
The last time I went to the emergency room — caught a really bad cold during Christmas...cost me $125 and the insurance wouldn’t pay because it wasn’t an emergency.
I don’t know. It is taking longer and longer for us to get an appointment with our family doctor now. In fact, we usually have to see the nurse practioner for most things. I don’t mind, in a way, because that is usually fine. But what if we really needed to see our doctor? Government involvement in health care has been messing things up for decades, and it’s getting worse.
I’m sure most can get in to see a doctor much faster. But from what I’ve see, if a doctor has openings, there’s a reason for it.
And it’s good to see Kerry and Pelosi can get their Botox treatments as needed.
They really seem to think that:
HEALTH INSURANCE = HEALTH CARE
Of course, that's lunacy. Health insurance is simply a payment/risk-sharing system for delivering health care services. It isn't health care itself.
Health care is hospitals, doctors, nurses, armies of their support staff, plus ambulances, MRI machines, pharmaceuticals, medical equipment manufactures, and on and on.
You can, for example, issue rationing cards to the poor to buy rice, but if there isn't any rice, the rationing cards are worthless. Rationing cards don't equal rice. Health insurance doesn't equal health care.
I've tried to pin down liberals over the past few years with the question: "how many doctors and nurses does Obamacare train? How many hospitals does it build, equip and staff?"
Blank stares. Just blank stares. Like deer caught in the headlights.
So, I'd say, "basically what Obamacare does is promises 40 million more people access to the current system of trained medical staff and physical infrastructure, but does nothing to increase the number of doctors, hospitals, drug and equipment makers, and so on?"
More blank stares.
Then I'd say "so you're increasing demand but not increasing supply. Yet Obama is promising lower prices and no rationing, including death panels. But we know from Econ 101 that if demand increases and supply stays the same, then prices have to go up. So, how does that work exactly?"
Liberals usually respond with some emotional outburst, like "you conservatives don't give a damn about what happens to the 40 million uninsured" or something. They never address the question. They seem incapable of understanding a simple fact that health insurance for all does not mean access to healthcare for all, in any meaningful sense.
I used to think it was because they were all morons, but that's only true for the bottom 80% of Rats. The top 20% know exactly what they're doing and why. It's all about getting power and keeping power. That's it. They don't care about whether anybody actually has access to adequate health care. They just want to run people's lives.
Democrats are evil.
Anti-kulak?
Yes.
Doctors=kulaks.
See my tagline.
You’re wrong about women being at an advantage getting into medical school. Women who apply, on average, have strong applications, good grades, good test scores. Admissions committees work hard to make sure they get a gender balance.
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