And So I Go: Yesterday, Today and Tomorrow

Obamacare reminder: What’s in it?

Posted on: January 24, 2011

These two are older posts  I think may need to be rerun now that it is possible  the Senate may just have to do a do-over under the Republicans and  and  6 Senators coming up for re-election in 2012.

Depend On The Government For Your Health Care? Good Luck…What Obamacare really offers us:

The government sold health care reform with 5 basic talking points:

1.  You won’t be able to be kicked off of your insurance when you really need it

  • Turns out that the insurance companies CAN kick you off if they pay a fine. It is not hard to imagine that an insurance company will figure out pretty quickly that it would be cheaper to pay the fine than to pay for coverage of a long term chronic illness.

2.  You won’t be denied medical care for pre-existing conditions.

  • If the insurance company deems that you have lied on the application you will be denied coverage.
  • Sick children are no longer considered to have pre-existing conditions, but what about women who are pregnant?

3.  You can keep the doctor you have if you are already covered.

  • With the cuts in Medicare reimbursements that have already happened (no more consultation fees) and the looming 21% cut at the end of October. Many more physicians than the current 30% are looking to opt out of Medicare.  When the commercial insurance reimbursement rates drop (as they invariably will since they pay at a percentage of Medicare) there will be more doctors looking to leave commercial insurance as well.

4.  Health care reform will lead to increased access

  • There is no way that there will be an increase in access when you take into account; 1) the physician shortage, 2) Those physicians who will leave medicine after the passage of this monstrosity (a recent poll of physicians states that 35% would leave the profession), and 3) those who will stop taking insurance all together because they are simply fed up.
  • Expanding Medicaid to those who are currently uninsured is not going to help since most doctors are not taking Medicaid now.  Currently access to specialists is pretty poor, it will decline further.

5.  Health care reform will cover 30 million more uninsured people

  • The bill will cover approximately 7 million more people over the next nine years and leave over 100 million people under insured.

6.  The health care reform bill will decrease the deficit

  • The CBO numbers do not take into account the “doctor fix” and the government takeover of student loans was added to pad the numbers.
  • If you do real world accounting by adding in the “doctor fix” (over 230 million dollars) you actually wipe out the cost savings and you increase the deficit (anywhere from 400-700 million dollars.)
  • It is likely that the estimated costs will likely be much higher. How can anyone really know what is going to happen in the next 10 years. To say that these numbers are optimistic is being kind.
  • The Health care reform bill has done absolutely NOTHING that would really lower the cost of health care.

The pharmaceutical companies got three major cost raising concessions

– the government cannot go out of the country to shop for cheaper drugs

– the patent for biologics was extended to 12 years from 7 thereby locking out cheaper generic drugs. (For example a patient can continue to pay over $1000 a month for a drug like Embrel instead of getting some relief.

– patients will not be able to buy cheaper over the counter medications with their health savings account only more expensive prescription medication.

The health insurance companies may whine about their profit margin, but they get millions more people to add to their roles. Most of those people will only see a doctor 1-2 times a year for routine things, but will pay 14% higher premiums for the privilege.

The hospitals which account for the biggest piece of the Healthcare pie (31%) got a pass. Surgeons have had to deal with bundling of charges for over a decade. What about applying that to hospitals? That would have certainly lowered the cost. Since bankruptcy caused by medical costs are largely due to the hospital charges.

– There has been no legislation to change their habit of itemized billing where they stand to make a profit on everything from the single pill of Tylenol to the box of Kleenex in your hospital room.

I got a call from a fellow physician today who talked about picking up stakes and doing medical work overseas. I have a feeling I am going to get a lot more of those types of calls from fellow physicians in private practice. There are only so many physicians that the hospitals can employ and only so many more patients a physician can see.

It seems that the ultimate goal of this exercise is to eventually make all physicians government employees under a single payer system. As it stands the system created by health care reform is a give away to the pharmaceutical industry and the health insurance industry (you just need to look at the rise in their stocks today). It certainly can be seen as the first step on a slippery slope towards single payer. The powers that be are banking on physicians going along like lemmings, but I have no doubt that if we don’t they will institute some sort of draconian policy to make us do it like they have in Massachusetts (medical licensure is tied to taking the state insurance plan). If that happens, good luck finding a physician who will want to deal with this.

And this is how my alter ego BB-Maxine feels about the whole thing:


Now, let me get this straight … we’re trying to pass a health care plan written by a committee  whose chairman says he doesn’t understand it, passed by a Congress that hasn’t read it but exempts themselves from it, to be signed by a president who also is exempt from it and hasn’t read it and who smokes, with funding administered by a treasury chief who didn’t pay his taxes, all to be overseen by a surgeon general who is obese, and financed by a country that’s broke.

What the hell could possibly go wrong?

i
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