By Paul Goldfinger, MD, FACC
Our emphasis on Blogfinger regarding Obamacare has been to focus on how quality of healthcare will be affected. Since we haven’t yet seen how the new system will actually work on patients, we will discover some significant issues emerging later, and I am worried that we will not like the results as far as quality is concerned.
Recently the conversation has been mostly about insurance, but the health insurance issue has a profound connection to quality. Under Obamacare, everyone who acquires an ACA approved insurance policy will have healthcare subject to all the rules, regulations and stipulations of those policies.
Their quality of care will depend on what is allowed under their plans, and that will be enforced by the willingness of the payers to pay. So, for the system to work, most everyone needs to have an ACA approved policy. And those policies will be defined by thousands of rules and regulations which will change every aspect of healthcare and will, by necessity, be very bottom-line oriented.
As we inch along the road to the new system, we gradually learn more about it, but by the time we learn the latest news, such as the cancellation of millions of policies, it is already a fait accompli. In plain English, as we hear over and over, you can’t put the toothpaste back into the tube.
The latest aspect of the ACA that has emerged is the realization that there will be winners and losers. Some have used the R word, i.e. redistribution of wealth. No one can deny that, because the poorer and the sicker will be given expensive insurance for no cost or low cost. There will be stipends for those who make less than 400% above the poverty line. And to help raise the money for this program, there will be 1/2 trillion dollars more in taxes and higher cost premiums and deductibles for most of those who already have insurance. All this will become more obvious as the business community is forced into the program.
Wealth is usually described as having money and possessions, but that is not all that is being redistributed. The part I am focusing on is the way that healthcare, which 80% of Americans have “enjoyed” and which includes everything that makes quality care possible, will be compromised to some extent. And that is a sort of wealth redistribution as well.
Without a doubt we will have rationing in various forms, difficulty seeing the doctor of your choice, trouble getting care at the hospital of your choice, shortages of all sorts of medical providers, trouble getting physician appointments, inability to get tests done efficiently, deterioration of doctor-patient relationships, and compromise of the ability of your doctor to treat you the way he wants. Low fees will drive the best physicians to create boutique practices or become hospital employees or to leave medicine altogether.
Will there be good things to come out of all this? Yes there will, and many people will accept the “redistribution of wealth,” but did they really have to destroy the existing system to achieve those good things? Healthcare is about 20% of our economy. Was Obamacare the best way to fix our existing system? And will quality care decline as numbers insured get bigger?
What do you think?
Ken: Regarding your comment about “fixes,” I have no problem with fixing the new system, but we’ll see if meaningful fixes are encouraged by the Administration and/or actually permissible by law without Congressional approval.
I do believe this plan will move forward and will require fixing. Wait until the ACA shows its stripes in the trenches of healthcare. You will see how many fixes will be needed.
Use a little imagination; come up with a way to handle the shortage of medical professionals predicted. (Something short of a draft with mandatory service.) A “Manhattan project” to educate doctors, nurses, PNs, etc… maybe. After that, brain storm for fixes to any generally recognized deficiencies, simply complaining that unless overturned (the Repubs anthem) so there is nothing does not get us anywhere. I realize there are those who would prefer NOTHING…you can find lots of them in Washington.
Ken: Your own words are, “I have not seen an alternative put forth yet that addresses the healthcare disaster in this country.” I took that to mean an alternative to the ACA.
Fixing the ACA, without canceling it, is another matter altogether. I can’t imagine any fixes that would satisfy the supporters of the ACA, because the law cannot survive without mandates, rationing of care, dissing doctors, government control, canceling old policies in exchange for ACA policies, redistribution of wealth, etc.
Paul,
Waiting until failure before taking action to fix something (even a law) is not acceptable. Accepting that approach would be akin to not improving something that has not failed yet if one, e.g. a Repub, has a better plan.
Rather strange proposition.
Those looking for alternatives, the American Healthcare Reform Act seems the most promising. It includes the key provision of showing insurance to compete across state lines and small business to pool their risk and purchase as larger groups
A CBS News poll from three days ago found 69% of Americans are satisfied with their existing personal healthcare plan.
http://washington.cbslocal.com/2013/11/25/poll-69-percent-of-americans-satisfied-with-personal-health-care-plan/
What we are seeing is the whole system being blow up — either directly, or by second and third order effects that will play out over the next several years. If more than two-thirds of Americans are happy with what they have, and do not want to change, is it not a perversion of democracy that the desires and wants of a decided minority are pushed at the expense (both literal and figurative) of the majority? Is that the role of Government? A clear majority of Americans also do not want the ACA implemented. Again, the Government does not care and they are pushing ahead full steam.
What’s wrong with this picture?
Ken. The ACA is the law, so it is appropriately being analyzed and criticized. To fantasize about alternatives is a waste of time now unless the ACA is brought down by politics or by collapsing under its own weight.
If it does fail, then the Repubs must have a workable plan ready to go. You can be sure that alternatives can be found. Too bad they didn’t emerge before the ACA became law.
Of course speculation is acceptable on BF, so if anyone want to, go ahead. I will post your ideas.
—-Paul
If not the ACA, WHAT?
I have not seen an alternative put forth yet that addresses the healthcare disaster in this country. Neither Congress nor Blogfinger’s commenters seem to have a solution other than you better take of yourself and make sure you do not get sick, hit by a bus, catch a disease, etc,,,etc…
Our country unfortunately has already fundamentally changed after 9-11 and continues to do so. Mandates, excessive regulations, lies, loss of liberties, etc. have become common government practices for quite some time now.
Indeed and agreed the ACA is flawed. However the unanswered question remains : How else can healthcare for all Americans be achieved ??
Frank S.”Government intervention”can come in all shapes and sizes. We see it involved in private enterprise all the time. It could be helpful in fixing our dysfunctional current health system, but the “intervention” we are seeing before us now is a takeover where mandates, excessive regulations, coercion, lies, redistribution of wealth, and loss of liberties are tools that go beyond healthcare.
It is an effort to fundamentally change our country, and that degree of “government intervention” is excessive, and the truth of it all was never revealed when the ACA was passed.
I do not like government intervention. I did not like government intervention with bank bailout(which only helped big corporations), with homeland security(which hasn’t stopped terroism and just made people insecure/paranoid), with going to war where we are not even wanted, with giving aid to foreign countries where we are hated, etc., etc.
However when it comes to providing basic proper healthcare to all Americans I feel this is a national and moral imperative. Thus although flawed I support the government intervention in providing healthcare to all. How else can universal healthcare be achieved in our lifetime ?
While the “immigrant ” settlers who had not contributed to prepare for the coming 2nd winter were cast out (never to be seen again) of the Plymouth Rock Settlement fort by Capt. Standish, he allowed to remain: the infirmed, women, children, and those too old to survive on their own. That is the AMERICAN way.
Frank S. The purpose of this piece is to describe the redistribution of wealth that will occur as part of the design of the ACA and the resultant threat to quality care. Nowhere in my article is there any suggestion that anyone be denied healthcare. As I have said before, we should have universal healthcare in this country. But I believe that goal could be accomplished in ways other than a government takeover.
Ultimately, this will only serve to INCREASE the gap between those who have and those who don’t. As more private practices stop accepting Medicare and other lower-end insurance plans, only those with excellent insurance or money will be able to afford the best specialists. Those who don’t, will be relegated to average providers or less than the best care. This may include less access to cutting edge treatments and procedures that can only be performed by highly skilled physicians and surgeons.
Places like the Hospital for Special Surgery will become out of reach for many who can’t afford to pay for those excellent doctors. The term “elective procedure” will be eliminated from our medical lexicon, unless you are willing to pay for it yourself.
AT this point, a single payer system would probably work slightly better, as much as I loath the idea.
First : Happy ThanksGiving day to all. Be grateful for what you have and please try to understand and see that not all are so blessed.
Paul : We are all brothers & sisters and need to help one another. Yes this will cost $$ and yes this will mean more people entering into the health care system. What is the alternative ? To keep ignoring/denying these people healthcare ?
Grounded In Reality : You characterize. Just because one is poor does not mean they are unwise,unproductive, and irresponsible. Many folks work 2 even 3 jobs just to make ends meet. Many folks after the recession/this bad economy lost company provided insurance and now earn half what they used to and can not afford insurance. Yes some may have made bad choices or have had bad luck(you never did ?). Thus they should be condemned to no health care ? “fall back on family & friends” ? What if they do not have family or friends? What if their family or friends can’t afford to help them ? Again then should they be condemned to no health care ??
Happy Thanksgiving . Be grateful and kind and giving in heart & mind.
Grounded in Reality, I agree!
You couldn’t have said it better or clearer!
We folks with insurance are already paying for those without it. Emergency room care for indigent people is eventually paid for by higher insurance premiums when hospitals increase their rates and, subsequently, insurance companies raise our premiums. The ACA will hopefully allow people to see their doctors for preventative care and/or office visits and prevent unnecessary emergency room visits.
A rapidly growing flaw with our society is that too many people want things they did not earn. It is not immoral to believe that folks should be responsible for themselves. If they make bad choices, or have bad luck, then they should fall back on family and friends — not on the folks who made the wise choices and are responsibly taking care of themselves.
The health care “takers” is a whole new set of folks that responsible people have to subsidize. When will the craziness end? Correct me if I am wrong, but I believe that about 47% of wage earners do not pay income taxes, although they might pay other taxes, and that there are >100 million people who get lifestyle subsidies from the government other than social security and Medicare. Just how much subsidizing should the productive and responsible members of society be expected to do?
I see the “redistribution of wealth” concept in providing health care as the major difference between those who consider health care as a basic right for all and those who don’t.
Frank: You miss my point. I did not characterize that 20% in any way. It simply is the percent of people in our society who do not have healthcare coverage.
I believe that our society should provide for that 20%, but providing for those people will not be free, and the rest of the population will have to pay, not only in money, but in deterioration of their own care. That is what I see happening, and that is my point.
You imply that 20% is not significant. 20% is 2 out of every 10 people ! No one should go without healthcare. Especially in America where there is a disgustingly unfair amount of wealth.
The new system might not/will not be perfect. However for those excluded from current system it will be a vast improvement. It may make the difference between being healthy or not – maybe even living or dying.
Basic proper healthcare belongs to all people regardless of their “wealth” or lack thereof. To think otherwise is immoral, self-centered, and greedy. Perhaps doctors might make less money. However they make 3x to 10x times the average American’s income to begin with.
Well now let the replies fly.