By Paul Goldfinger, MD, FACC Editor@Blogfinger
As many of you know, my main concern regarding Obamacare relates to how it will affect quality of care. But all we hear is about insurance and economics. But even with that, we can begin to see the effects on quality, because some people will be left naked on Jan 1 when they no longer have coverage. Obviously, if you don’t have health insurance, the quality of your care will be reduced. But I am certain, as you know, that quality will be negatively impacted in many ways and I recently reported on the situation with practice guidelines potentially interfering with the doctor-patient relationship.
However, on Jan 1, as people actually seek care under the ACA, I suspect we will hear many horror stories having to do with the deterioration of quality care. In today’s Wall Street Journal we find an opinion piece by Marc Siegel, MD, and Professor of Medicine at the NYU School of Medicine. Dr. Siegel says he has awakened “to the harsh realities of our medical future.” His piece rambles a bit, but you can see from his observations that you don’t need a weatherman to tell you which way the wind is blowing. Here is Dr. Siegel’s “The Death of the Bedside Manner” *Wall Street Journal, Dec. 27, 2013.
BOB DYLAN:
The United States will not end up with a two-tier health care system. It already has a multi-tier health care system with more than two tiers. Incentives in Obamacare don’t improve on this, they make it even worse. I’ve mentioned that there are actually provisions in the ACA bill that allow for “direct primary care”/”concierge medicine” practices. (Some of the amazing parts of a 906 page bill that nobody could be bothered to read, never mind understand!)
In the U.S. there are fewer physicians per person than in most other OECD (Organization for Economic Cooperation and Development) countries. In 2010, the U.S. had 2.4 practicing physicians per 1,000 people. The OECD average was 3.1 practicing physicians per 1,000 people. In my opinion, Obamacare does nothing to increase the U.S. physician supply.
I’m curious as to how controlling the price of health care without increasing the supply of health care can possibly make U.S. health care better and more available.
Some types of medical care may be very costly. Hemodialysis for kidney failure might be one example. In 1972, Congress passed legislation authorizing the End Stage Renal Disease Program (ESRD) under Medicare.
If a primary goal of Obamacare really WAS to allow expensive medical care to be provided to Americans without bankrupting them, or to compensate hospitals for care to uninsured patients without bankrupting THEM, there were ways to do it without loading the U.S. health care system into a giant unguided missile.
Jesse: I am pleased that you decided to challenge Dr. Siegel’s article in the WSJ, but you took a swipe at me as well. I posted Dr. Siegel’s article to illustrate that we are on the verge of finally finding out about how Obamacare will affect the quality of medical care under the new system. It is inevitable that this aspect of the ACA will kick in soon, as the fuss over the website and insurance issues begin to subside. As far as Dr. Siegel’s opinions, my views about those specifics were not discussed in this posting.
You call me “relentless,” but how about sticking to the issues. I am a physician who takes the sworn oath of Hippocrates seriously, and patient care is the bottom line. On Blogfinger, I will continue addressing quality concerns under the ACA, and hopefully you will participate in the debate.
I call it “Obamacare” because I saw the President on TV saying, “I embrace that name.”
I would not want to disrespect him. –Paul
It seems that Dr. Siegel was not at all familiar with the work done by his office assistant early on. So it was a bit of a shock for him to begin to see how all of those aspects of his medical practice interact.
Insurance companies regularly disallowed certain services, kicked people off their plans and did not cover certain drugs or denied people access because of a pre-existing conditions. Those are the folks who are now learning that their old plans were pretty much useless with incredibly high co-pays. Dr. Siegel admits that many of these issues pre-dated the Affordable Health Plan, but that was not going to get in the way of his broadside against the ACA. He goes on to build his very negative assessment, mostly directed at concerns about service and income flow. I am sure that he would have joined the AMA resistance, back when Medicare was first proposed.
Paul. I love Blogfinger. I love your selection of photos, and your musical tastes happen to be in line with mine, but I must respectfully suggest that you have been relentless about the ACA even before the roll out and all of the problems with the web site.
The insurance companies, the GOP all were quite happy with shaping and re-shaping “Obamacare” as you call it, and doctors were silent on the matter of single payer option or the abuses connected with pre-existing conditions as well as the constant hassles that ordinary folks have had over the years with their insurance companies. It is well known that there are many doctors and some office assistants that spend hours during the course of a week needing to do battle with insurance companies to justify treatment to those old insurance plans.
Finally, what Dr. Siegel recommends is a kind of a two tiered system. Clinics for those who cannot afford the most expensive plans and recruiting teams of doctors to serve those folks. Kind of a “doctors without borders” for the US.
Medical care should not bankrupt Americans. The system that we have had in place was great for those who could afford it, and onerous for those who could not. But I am afraid that some doctors never saw those folks, because their office assistants stopped them at the door.
Jesse M. Vazquez