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Monday, November 14, 2011

Obamacare

Obamacare gives me a sick feeling to my stomach. It fails in all of its objectives: it will not provide better quality care, it will not make health care more accessible, nor will it provide health insurance at less cost. The root of that is that Obamacare was crafted by lawyers, not doctors. There is no tort reform, so doctors will continue to practice defensive medicine to avoid, as much as possible, getting their butts sued off from doing the best they can. There are a few rare exceptions I've heard of where the doctor really did need his medical license suspended- and did-but for the most part doctors do the best they can and only practice defensively because that is how they avoid paying millions in lawsuits. It is truly a bad time to go into medicine.

There hidden costs to Obamacare that largely ignored but are already being implemented. This has to do with Medicare. Starting in 2012, Medicare will reimburse a hospital for a patient in one lump sum, determined by the reason for admittance, or diagnosis. Thus, the ER (emergency physicians), the floor to which the patient is admitted (hospitalists or internal medicine), any blood work (pathology), other imaging tests (radiology), and any other doctors involved in that patient's care, will have to split the money. And it is NOT much money, not enough to cover costs. Regardless of length of stay in the hospital, regardless of any other health conditions treated or considered in the patient's treatment. One sum. Hospitals are quaking in their boots, with good reason.
Doctor's salaries which are tied to hospitals are about shrink from about $150k-$200k to about $100k a year (what a pediatrian or family practice often makes at the current time), unless they work more- and most of these doctors are already working far longer hours than the average American. When you consider how much time and effort and debt a doctor has to put in to finish his training (often about 30 years old before a real job is possible), they are really getting a bum deal. Less time and ability to save for retirement, get out of medical school debt, less time for families, etc. The only winners in terms of jobs will be hospital administrators, who have the uncoveted duty to divvy up the money such that all doctors won't quit and move to another country or retire early. Which is certainly happening in Great Number. As I write.

Now let's consider how this affects the patients. Fewer doctors: bad for patients. Less money for procedures and treatments: the less the doctor will want to spend quality time with patients, preferring to treat more patients to be adequately reimbursed. As doctors continue to practice defensive medicine in the absence of tort reform, patients will continue to be paying for care they don't necessarily need. As far as the government option is concerned, I can vouch from personal experience that the quality of care available for people NOT paying for care is NOT equal to the care available to the ones who do.

Next let's look briefly at the implications for private health insurance companies. The pricey demands of Obamacare upon both insurance companies and employers using private insurance companies are ridiculous. Basically, Obamacare insists that people must be issued the same top-grade coverage including non-essential things like abortions and sex-changes, rather than allowing them to choose the kind of medical coverage that makes the most sense for them which might well be less expensive. In the case of employers, offering insurance for employees under Obamacare is so costly that many are hiring independent contractors, specifically to avoid paying for employees' health insurance. Obamacare is even costing jobs, at a time that employment in this country is struggling.

This looks like a lose-lose-lose to me. And fewer jobs in every case: fewer doctors, fewer employers hiring because of Obamacare, insurance companies going bankrupt leaving thousands more without jobs...

So why did it pass - against the will of the American people? Why did Pelosi/Reid/Obama ram this down our throats one unfortunate Christmas Eve? I believe I know the answer: government control. They know full well that the implementation of Obamacare is bad for private health insurance and doctors and patients, but that soon the government option will be the only one left. They don't care about the quality or availability of care to individuals, either, because if they really did, Obamacare would never have passed. Repeal now! Or overturn it! Or both!

As an aside: I could say the same thing about the auto bailout, Wall Street bailout, takeover of student loans, etc. We're headed towards socialism. Why wouldn't we want to copy Europe? Maybe because it's ridiculously in debt and going down the tubes and the people have far fewer economic freedoms?!

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