There is an article in the New Atlantis Times that Matt Drudge linked to the other day. Dr. J. didn’t pick this up before Matt because he doesn’t get the daily New Atlantis Times, and because he was winging his way to Atlanta to conspire with Big Pharma. He would share with you the details of the conspiracy but then it wouldn’t a conspiracy now would it?
BlueCross&BlueShield of Tennessee, who happens to be the good doctor’s insurer, funded a study how Obamacare would affect access to healthcare state wide. Their analysis suggests that in 2014, 700,000 Tennesseans will become insured, many of whom are younger men eligible for Medicaid, and the rest will be able to purchase subsidized policies through state run exchanges.
This is, of course, if the Supreme Court doesn’t strike down Obamacare (John, Antonin, Clarence, Sam, and especially you Tony, you will find the law wholly unconstitutional (Jedi fingers waving towards DC)).
There are consequences of this influx of insured patients on to the insurance rolls. First, utilization will go up. When one has a low co-pay (or no copay in the case of women receiving womens’ health services in the post Sibelius era), they are more likely to use a service that they otherwise might not. Preventative services may be good medicine, but they’re not necessarily cost effective. As a consequence costs will go up for individuals paying for their premiums.
Second, the wait for said services will be longer because more people will be demanding services from a fixed number of physicians. As physicians are paid less than the cost of doing business caring for Medicare and Medicaid patients, they will be less than enthusiastic to take these patients into their already crowded clinics. Many private practice physicians are struggling to keep open and they are selling their practices to hospitals (who are relative winners with Obamacare) where there is safety and cost effectiveness in numbers due to lower per provider overhead.
Even at New Atlantis Ivory Tower Medical Center, one of the primary care groups has its own urgent care clinic so if you don’t feel good you see the doc of the day rather than your doctor. You only see your doctor for scheduled visits. Remember, you can keep your doctor, you just might not get to see him for every sore throat or tummyache. Fortunately the other primary care groups do not operate on this model. But make no mistake, as hospitals buy up private practice groups the scarcity of clinic visits will likely result in your urgent be managed in this model. In the interim when you feel unwell, you may be forced to go to Walgreen’s doc in the box.
Now Dr. Coulter, president of the BCBS think tank sums it up thus: “It will be a little longer line but everybody will be in line.” Well Kum-bay-fucking-ya, lets all hold hands, sing, dance and sacrifice unicorn glitter to the rainbow gods! What he’s not saying is the line will be longer, in part, because folks who may not need to go to the doctor are going to be gumming up the works. So if you have a pressing need, getting in with your generalist will take longer and then your referral to your specialist will take longer, as primary care providers that are pressed to see more people in less time tend to refer to specialists with less impunity, increasing costs to insurers and thus your premium. Do you detect a pattern here? Thought so, gentle reader.
Take solace in the fact that Dr. Coulter feels that the state exchanges will do a less shitty job than federal government run healthcare. He says, “I have a lot more confidence in their ability to run things than I do the federal government.” He clearly forgets about TennCare collapsing under the weight if it’s own promises as it ran out of other people’s money. And if he does take that into account, you WILL be waiting longer for your care.
Healthcare expert and film auteur Michael Moore profers that it’s patriotic for Americans to wait longer for the delivery of their healthcare because it we will all be in line together. He suggests that it’s only non-life-threatening issues that you will wait for and magically there will be no waits for urgent care despite the fact there more patients in the system without an increase in operating room slots will mean no additional wait time. Right? Wrong!
In Sweden, there was a study of ~5500 patients who were stratified as imperative (2 weeks), urgent (12 weeks), and routine (6 months). The median waiting time was 55 days. 55% of patients were operated on within their allotted time, meaning 45% were not. The folks operated on within their window had a mortality of 6.2% while the unlucky 45% had a mortality of 8.0%. This translates to an excess of 44 patients who deaths potentially could be explained by going to the OR later than they should have. Now, when they correct for age, gender, anginal symptoms and operative risk, in other words the determinants of something bad happening to them, all is well and good. The thing is, they’re wrong. The authors cannot make that statistical adjustment in this scenario. In this scenario, patients were placed into 3 categories. 45% of the patients in each category couldn’t be operated on in the timeframe desired, and their death rate was higher. The statistical adjustment demonstrated that they put people in the wrong places in line, and they can use that information, perhaps, to reshuffle the lines in the future.
Dr. J. could pull more studies for you if you’d like, but you get the idea.
Mr. Moore, longer waits won’t be patriotic, they will be lethal, and better yet, you, the politically connected and medically connected will not have as long to wait because doctors are always willing to work in a colleague, a friend, a patient a colleague is sufficiently concerned about because of their acuity, or someone of import in as an overbook. Dr. J. does it all the time. It will continue in the future, but we can only do so much.
So how do we fix this? Simple. Repeal Obamacare. Leave medicaid for the truly needy and phase out medicare in a manner that empowers citizens to ensure themselves into their golden years (it can be done). Implement incentives for individuals to insure themselves. Allow folks to roll over HSA money. Put people, rather than the government, in charge of controlling costs. Decrease, rather than increase, the regulations that are increasing costs in healthcare. With the increased costs of healthcare, private practice is going the way of the dodo. Doctors’ salaries are going down, as well, so insufficient numbers of people are going into the field. It’s all basic macro- and micro-economics. It’s all fixable by doing the opposite of what Washington is doing.
*SomeTime After Tomorrow