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?