Thursday, July 5, 2012

The Coming Crisis in the Availability of Medical Care

It’s the care, stupid.

What good is health insurance if you can’t find a doctor?

If doctors are transmogrified into glorified cogs in a bureaucratic machine, then your relationship with your doctor, the old human-to-human thing, will necessarily be eroded.

So says Daniel Henninger this morning in the Wall Street Journal. Surely, he is right.

Obama was smart to focus the health care debate on insurance claims. When Obama promised that you would be able to keep your doctor, he may have been lying or he may not have known any better. Reality was never his strong suit.

At the least, it was a clever rhetorical ploy. It blinded almost everyone to the question of whether or not Obamacare would have any real effect on the quality and availability of care.

Obama did not, Henninger explains, ask the doctors whether, under Obamacare, they would be able to continue to provide the same medical care.

If the new medical regime rewards doctors for “volume,” he adds, that means that they will have a lesser incentive to spend time with an individual patient or to work on a specific case.

And what makes you think that the medical profession will continue to attract the best and the brightest young people.

A few years ago I was chatting with a heart surgeon friend. He was explaining that, given the average age of a heart surgery patient, his specialty had been taken over by Medicare.

If the surgeon believes that two surgeons are necessary to perform a bypass and Medicare will only pay for one, the second surgeon's place will be taken by a nurse.

The standard of care will necessarily deteriorate.

He added that when he did his residency around four decades ago there were around 600 applicants for 120 heart surgery residencies. Today there are 60 applicants for the same 120 slots.

Does this increase or decrease your confidence in young heart surgeons?

Imagine the same system applied to all medical specialties. 

Nowadays fewer physicians are willing to treat Medicare patients. Fewer still are willing to treat Medicaid patients.

The administration argued that the Affordable Care Act was going to ensure that poor people would have access to medical care without having to go to emergency rooms.

But, that assumes that physicians will be willing to accept Medicaid reimbursement rates. Or better, whether they will be able to afford to take them.

Since the ACA does nothing to reign in malpractice insurance premiums, physicians often do not have a choice about whether to see certain groups of patients or even to continue to practice medicine.

Obama’s sacred promise: you can keep your doctor if you want, was either ignorant or a lie. It was typical for a president who does not keep his word and feels no shame when he doesn’t.

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