Why doctors are bailing out:
As the open enrollment period for 2014 approaches, premiums on individual plans in the Obamacare exchanges for California will double, and will increase 80 percent or more in Ohio. At the end of its first decade in force, the ACA will leave more than 30 million Americans without insurance – the driving issue behind health-care reform for at least the last twenty years.
The problem with all of the health-care industry reforms has been that precise goal: expanding insurance. The widespread use of comprehensive insurance policies insulates end users in the system from price signals, especially on routine care. That eliminates competition on price as insurers use their economic weight to pre-negotiate pricing on every kind of service and product under their coverage, from blood tests to setting broken bones. Providers locked into a specific schedule of reimbursements have no reason to innovate to either lower costs or increase value, and end up having to spend money and time dealing with insurance companies for delayed payments rather than focusing on the patients seeking treatment in their clinics.
Ironically, the multiplication of mandates and other regulations in the ACA on both private insurers and government-run programs like Medicare and Medicaid have more doctors opting out of the third-party-payer system altogether. Earlier this week, CNN Money reported on the migration to cash-only services among health-care providers, driven by poor reimbursements, increasing regulation, and high overhead.
ObamaCare has taken a terrible system and made it much worse.
We do cash all the time with Doctors. They get their money immediately and without hassle which improves their cash flow and results in much lower costs for us. I had one doctor here in the bay area do a procedure for $110.00 in Hayward. He is a senior staff physician at a large institution in Palo Alto and said that the same procedure there with insurance would be over $500.
Stupid Stupid STUPID.
Without that extra $390 the politicians wouldn’t have enough room for graft.
How would they get elected without graft? Silly voters.
But, but, we had to pass it to find out what was in it!
Americans buying plans on the individual market have to spend much more than they’ll ever pay directly to market-based physicians like Nunamaker
Until they get cancer. This is like arguing that a kitchen fire extinguisher is cheaper than fire insurance.
Buying insurance for big rare events is the only valid reason to buy health insurance. Routine and common care is less expensive for everybody than the existing plans. Well maybe not for the guy with ten kids but certainly for most people.
In this case you are right on the mark Jim however, insurance should not be used for wellness care. It should be for catastrophic events. Your house burnt down as opposed to ruining a pan.
Obamacare eliminates the ability to purchase just catastrophic insurance. I now have to buy a policy that covers everything including contraceptive (which is funny since I am an unmarried male with no daughters).
insurance should not be used for wellness care
Lots of people can’t afford wellness care out of pocket. How would you address that question?
Obamacare eliminates the ability to purchase just catastrophic insurance.
How many people had actual catastrophic insurance (with no annual or lifetime benefit limits) before Obamacare? Obamacare does offer catastrophic insurance to anyone under 30 (including people who would have been turned away before).
which is funny since I am an unmarried male with no daughters
And women have to buy policies that cover prostate cancer. It’s the nature of insurance to pool risks.
Really? Lots of people can’t afford an annual check up? I guess that depends on what you mean by “lots”.
Non-catastrophic health care is a lot more than an annual check up. At my last checkup the doctor ordered a $2,000 test, not because I have a catastrophic condition, but to get advanced warning in case I did. I have family members who take prescription drugs that cost $1,000/mo for non-catastrophic conditions.
It would be nice if all medical care fell easily into either the “so cheap that anyone can afford it out of pocket” or the “so expensive that only catastrophic insurance can cover it” bucket. But a lot of it is somewhere in between.
And that’s what happens when you’re not paying for healthcare: doctors charge $2,000 for a test and $1,000 for medication because they know you’ll agree because someone else is paying for it. Even the insurers love it, because they just pass on the cost to your employer.
I noticed here in Canada, for example, that glasses are much more expensive than they were in the UK. Most people can claim a few hundred dollars on employer-provided health insurance, so they can charge a few hundred dollars more than they do in the UK.
Yes, as with college and home prices, when you subsidize something, it results in price increases. Until the bubble pops.
because they know you’ll agree because someone else is paying for it
No, I paid for it (I have a $4k deductible). And if I hadn’t had any insurance they would have charged $5,700 (I asked); it was only $2k because my insurance company negotiated them down.
What does this:
Lots of people can’t afford wellness care out of pocket. How would you address that question?
Have to do with this:
Until they get cancer.
George already addressed your question:
Obamacare eliminates the ability to purchase just catastrophic insurance.
You get catastrophic insurance (a fire extinguisher) for cancer. You get a health plan for wellness. These are two different things, yet Obamacare tries to make them the same thing, making wellness plans unaffordably high, and the cancer treatment inadequately funded.
Have to do with this:
There are two problems: 1) some people can’t afford even non-catastrophic care, and 2) some people (most everyone) can’t afford catastrophic care.
You can address these problems separately, or together. The Obamacare approach is for everyone to have comprehensive insurance, addressing both problems. You advocate catastrophic insurance for problem 2), so I was asking what you suggested for problem 1).
You get catastrophic insurance (a fire extinguisher) for cancer. You get a health plan for wellness. These are two different things, yet Obamacare tries to make them the same thing,
If you need both, why not combine them?
making wellness plans unaffordably high, and the cancer treatment inadequately funded.
They are more expensive than mere wellness plans because they’re also catastrophic plans (with no limits). And what makes you say that cancer treatment is inadequately funded? Unlike past catastrophic plans, Obamacare plans don’t top out at $200K, or even $1m.
If you need both, why not combine them?
Because, as we’ve seen, it makes a Charlie Foxtrot of the health industry.
If you’re worried about poor people, give them health stamps, like they get food stamps. A much simpler, market-based solution.
give them health stamps, like they get food stamps
Per-person food requirements are fairly predictable. No so health care needs.
If you need both, why not combine them?
Ah, the Marxist answer, “need”. Who determines need? Millions of Americans will never get cancer, why do they “need” insurance for cancer? Why should they subsidize others “need” for insurance at a lower cost?
Lots of people can’t afford wellness care out of pocket. How would you address that question?
Jim, I suppose my problem with this is that I don’t agree. Instead, I would address the problem by having them pay for their own wellness care.
As to the fire extinguisher analogy, I see getting insurance for a preexisting health problem is like buying fire insurance after the fact to cover a fire that just happened. It breaks the whole idea of insurance.
I see that I’m echoing what people are already saying in reply to your post. You could have already answered your question by just thinking about it.
I would address the problem by having them pay for their own wellness care.
The question is what to do when they can’t afford their own wellness care. The Obamacare answer is: give them comprehensive insurance. What’s your answer?
I see getting insurance for a preexisting health problem is like buying fire insurance after the fact to cover a fire that just happened. It breaks the whole idea of insurance.
Yes, that’s why there’s a mandate: the idea is for everyone to get insurance before the fire.
The Obamacare answer is: give them comprehensive insurance. What’s your answer?
Ok, I’ll just focus on options that perform better than Obamacare will.
1) Do nothing. This might not do as much for the poor as you’d like, but it has the considerable virtue of not harming society.
2) A lightweight program that does health care tasks with demonstrated high value for the cost, such as immunizations or prenatal care.
the considerable virtue of not harming society
Having the poor go without healthcare doesn’t harm society?
program that does health care tasks with demonstrated high value
Such a program would include the very things (e.g. contraception, blood pressure monitoring) that lead people to complain about Obamacare.
Having the poor go without healthcare doesn’t harm society?
I’d have to say that this hypothetical case would not harm society. But as it turns out the poor don’t have to go without healthcare now or in the past.
In contrast, Obamacare pretty much destroys insurance and drives up the cost of health care. That’s what I’d call “harm to society”.
Such a program would include the very things (e.g. contraception, blood pressure monitoring) that lead people to complain about Obamacare.
Not at all. I said “high value” not whatever fad of the moment you happen to claim to care about. And it’s worth noting that those two things you mention would be very cheap to provide even if we were to grant your point. Obamacare is not about that at all.
Lots of people can’t afford…
So let’s be clear, we are talking about an economic question. Second, we are talking about insurance, which the government is wiping out with their program. Eliminating competition does the exact opposite of lowering costs.
It’s not just lots of people. ALL people have to settle for less health care than they might like. This is a basic law of economics which is built into its very definition… a choice of alternatives.
I notice a lot of poor people smoke. They have that right, but it is a choice. That cigarette money would more than pay for a health care insurance policy.
What if they’re just poor with no habits they could give up? Are they poor and sick or poor and healthy? That brings us to the question of what is insurance.
If they’re sick, it’s not insurance. The concept of insurance is that you start with a pool of healthy people and cover the costs when a small fraction of those get sick.
The cost of catastrophic insurance is kept down because the fraction from the pool of healthy people that eventually require it is even smaller.
But all people will eventually require hospitalization. While not true, the insurance industry already has that covered. It’s basically an annuity which you pay for during the time you are healthy to cover the cost of that eventuality.
But poor people…
Yeah, it sucks to be poor as I can personally attest. That’s why the best policy is to keep government overhead out of it. So us poor have a chance to become not so poor over time by making the right choices.
Politicians always demagogue that they can fix problems contrary to the laws of nature. They can not.
“Until they get cancer. This is like arguing that a kitchen fire extinguisher is cheaper than fire insurance.”
Wait a minute, Jim. Doesn’t ObamaCare include a “shall issue” requirement that prevents health insurance companies from denying coverage due to ANY pre-existing conditions? If that’s true, then your example above is invalid, right? Any young healthy adult could pay the relatively small “tax” for not purchasing health insurance, for decades, then sign-up for a platinum-level health insurance policy the same day he/she is diagnosed with cancer, right?
Who needs a fire extinsguisher when you can demand a fire truck when the time comes? Sounds great in theory, but only works until the firemen catch a clue and decide it’s not worth it. Thus exactly what is happening as Rand described.
Any young healthy adult could pay the relatively small “tax” for not purchasing health insurance, for decades, then sign-up for a platinum-level health insurance policy the same day he/she is diagnosed with cancer, right?
Yes, you can game the system that way. It’s been possible to do that in MA under Romneycare, and it turned out that very few people did so. We’ll see how it works out nationwide.
Funny that you bring up cancer because Obamacare cuts back on who can get cancer screenings. Those young people don’t fit the demo so they wont be getting any advanced warning. The doctor patient relationship should not merely be a function of statistics where we take choices away from people on the margins.
I think back on all the people I know and have known in life who had cancer early in life and how under the new system they would not receive the care they deserve and it makes me sad.
Obamacare cuts back on who can get cancer screenings
Could you explain what you mean by this? Obamacare makes recommended cancer screenings (e.g. mammograms, pap smears, colonoscopies) available without any out-of-pocket cost, which is expected to increase the number of people getting those screenings.
Are you talking about screenings that aren’t generally recommended (e.g. a colonoscopy for a 30 year old without risk factors)? You will still be able to get those, but they might not be covered, just as they weren’t necessarily covered pre-Obamacare.
The HHS secretary moved the age upward for some cancer screenings. Many in the medical community were shocked. It is a case of an unelected government worker making medical decisions that should be between a patient and the doctor.
When the government says you can not have a proceedure good luck getting your doctor to provide it.
And free isn’t free. People will be paying higher premiums for services they could already get under the old system. If paying a deductible was too great a burden, then paying even more each month in premiums doesn’t solve the problem of high medical care costs.
The HHS secretary moved the age upward for some cancer screenings.
Do you have a link to the specifics, or know which screenings?
When the government says you can not have a proceedure good luck getting your doctor to provide it.
Really? If you’re willing to pay, I don’t think you’ll have any trouble finding a doctor to do a screening, regardless of medical guidelines. There are companies whose whole business model is doing un-recommended screenings of dubious utility (e.g. full-body cancer scans) for cash.
I did a search for “Sebelius cancer screening” and found this.
It seems you heard the story completely wrong. It was the U.S. Preventive Services Task Force — outside experts — who reviewed the research and dropped their previous recommendation for routine mammograms for women 40-49. Instead, they wrote that “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account”. That isn’t the government saying you can’t have a procedure, it’s doctors and scientists saying that you should make an individual decision with your doctor.
But even that bit of scientific advice upset lots of people, so Sebelius rushed out later the same week to say:
I think Sebelius should have stood by the experts — science is science. But your characterization of her actions appears to be 100% false.
Sebelius was using poor science to justify her actions and when called out on it was forced to back track. People were outraged that the government would implement a policy like that. But why is the government gwtting involved at all?
We need the government out of health care. They should stick to persecuting political dissidents with IRS audits and visits from the FBI not telling my doctor what to do.
Sebelius was using poor science to justify her actions and when called out on it was forced to back track
Where do you get that? There wasn’t any problem with the Preventive Services Task Force’s science, and Sebelius hadn’t taken any action?
But why is the government gwtting involved at all?
Because it’s useful to have experts look at the research and make recommendations. Is that really controversial?
Sure, pay thousands in health insurance premiums to avoid paying $75 cash for an office visit out of pocket. That makes a lot of sense.
People have this absurd notion that just about any type of medical expense should be covered by insurance. How much would your car insurance cost if it covered fill-ups, paint jobs, new tires, etc.?
Real medical insurance would cover serious expenses like hospitalization. Routine expenses should be out of pocket, preferably with a health savings account. We can address those with chronic medical conditions without having the government make a massive clusterf**k of the health insurance industry.
People have this absurd notion that just about any type of medical expense should be covered by insurance
Absurd or not, that is a common sentiment. That’s one reason to expect that more people will get comprehensive coverage once Obamacare makes it more affordable, as happened in MA.
We can address those with chronic medical conditions without having the government make a massive clusterf**k of the health insurance industry.
Our health insurance system was already a mess pre-Obamacare, and getting worse, with tens of millions lacking any sort of coverage, and millions more with coverage so poor that bad luck meant bankruptcy, going without care, or both. Obamacare isn’t anyone’s idea of the best possible solution, but after decades of failed efforts it’s the only one that’s gotten enough political support to actually be enacted.
Obamacare wont be making anything more affordable. Not for individuals and not for the government.
Obamacare isn’t the best possible solution? That is not how it was sold. And if it doesn’t solve the problems it was created to address, why bother with the horrible new tax on the people?
Obamacare looks like the worst possible solution, unless you are a part of big pharma, a health insurance provider, or other Obama donors in the medical field.
Obamacare wont be making anything more affordable.
If you are on the low end of the income scale, or have a pre-existing condition, Obamacare will make insurance affordable where before it was either unaffordable or completely unavailable.
That is not how it was sold.
It was sold as a balanced compromise. The insurers got new customers but they had to stop turning away people with pre-existing conditions. The hospitals got more insured patients, but they lost some Medicare funds and had to improve the quality of care or face penalties. Device manufacturers got better-insured customers, but their products are taxed. Consumers got guaranteed access to better coverage, but have to pay even while they’re young and healthy. Everyone has a reason to be happy, and everyone has a reason to complain.
Obamacare doesn’t make insurance more affordable for people with pre existing conditions. It does mandate that they have to get insurance.
Poor people may get subsidies but that does not make health care affordable. It just transfers wealth but instead of poor people getting it, it goes to Obama cronies in the health insurance industry. Ask a poor person if they want a policy that costs $20k a year or if they want $20k a year.
There are any number of things that could have been done to actually lower the costs of health care but Obama chose not to go that route.
And Obamacare was never sold as a balanced compromise. It was sold as reducing the cost of health care, leaving existing policies alone, and increasing coverage. What we get is higher health care costs, higher taxes, and existing policies changed or outlawed. There may be increased coverage but some reports estimate 30 million people wont have coverage.
And at what cost? We now have the government between the patient and the doctor and the government having access to more confidential information that is none of its business.
Can you tell your doctor something in confidence or do we need to worry that they will report you to the government in order for them to get paid?
Obamacare doesn’t make insurance more affordable for people with pre existing conditions. It does mandate that they have to get insurance.
Before: they either can’t get it, or have to pay sky-high premiums. After: they can definitely get it, at the same price offered to everyone else.
Poor people may get subsidies but that does not make health care affordable
It makes it affordable for them.
It was sold as reducing the cost of health care, leaving existing policies alone, and increasing coverage.
It has reduced cost growth, it left most policies almost entirely alone*, and it will greatly increase coverage.
*They had to add dependents up to age 26, get rid of annual and lifetime caps, and offer no-copay coverage preventative services.
some reports estimate 30 million people wont have coverage
That’s much better than the current 50 million.
We now have the government between the patient and the doctor
No, we don’t.
the government having access to more confidential information
No, we don’t.
Can you tell your doctor something in confidence
Yes.
they will report you to the government in order for them to get paid?
What are you talking about? Obamacare for the non-poor is private insurance, it isn’t the government paying the doctor. Medicare, which we’ve had for almost 50 years, is the government paying the doctor.
Just because it’s a common sentiment, it doesn’t mean it’s a rational one. “If a million people say a stupid thing, it is still a stupid thing.”
Recent estimates are a cost of $20,000 a year for a family of four for health insurance. That’s an absurd amount. Pay for actual insurance (hospitalization and catestrophic coverage) and set up a HSA to pay for routine things like office visits and prescription drugs. Cash payments from the HSA to doctors will save a lot of money because the doctors get paid immediately and don’t have to waste so much of their resources on fighting the insurance companies or the government for their payment.
it’s the only one that’s gotten enough political support to actually be enacted.
If didn’t get enough political support to get enacted — it was enacted via bribes and legislative legerdemain, and it continues to not have political support.
it was enacted via bribes and legislative legerdemain
It was enacted in the same way as any other major piece of legislation. Senators representing over 60% of the country voted for it. A majority of the House voted for it. A President who won the popular vote by 7% promising to reform healthcare signed it.
What other health reform effort has come even close to that sort of support?
Guys, give up. As long as there’s anybody anywhere who can’t afford anything, even if it’s because they spend $350/month on phone and TV, Jim will say that only FedGov can make up the difference.
It would be nice if there weren’t any poor people, but there are. If you think they should do without health care, just say so.
Nobody says that “poor” people have to do without health care. But why shouldn’t they pay for that health care just like everyone else?
But why shouldn’t they pay for that health care just like everyone else?
If they’re poor, and they need non-trivial health care, then by definition they can’t pay. The question is what to do in that case: should the rest of us pay, or should they do without?
Obamacare also mandates trivial care. Obamacare is all about providing trivial things at great cost and trivial care is what most people will access.
If they’re poor, and they need non-trivial health care, then by definition they can’t pay.
I looked at the definition of “poor”. It just means characterized by a lack of wealth or degree of poverty. Nowhere in there do I see “poor” defined as “being unable to afford medical care”. Now that might be a bit too subtle or obtuse for you to grasp, but there’s no reason a poor person can’t afford so-called “wellness care” any more than they can afford food. My take is that in a sane medical market, the poor would be able to afford medical care.
Instead, the problem appears to me to be artificial government interventions that have radically driven up the cost of medical care. Obamacare falls solidly in that category with a variety of idiotic measures that drive cost up. Medical care has been turned into an engine for diverting wealth and implementing poorly thought out policy rather than a tool for improving peoples’ lives.
I think going to a “sucks to be you” policy of buying only the health care that you can afford would be greatly preferable to the current state of things.
I think going to a “sucks to be you” policy of buying only the health care that you can afford would be greatly preferable to the current state of things.
The current state of things includes such a “sucks to be you” policy for 50 million uninsured Americans. It isn’t working so well.
The current state of things includes such a “sucks to be you” policy for 50 million uninsured Americans. It isn’t working so well.
“Uninsured” means “self-insured”. And the current state of things includes Obamacare as well. It’ll get worse to that alone.
There once was a lot of people who could not afford health insurance so we mandated them to have it. Problem solved. So why not just outlaw poor people? Mandate everyone not be poor or they pay a tax.
Obamacare not only requires that poor people have health insurance, it pays for it (as long as your state allows it).
it pays for it (as long as your state allows it).
But only as long as someone can provide enough tax revenue to cover those costs. When they no longer can, then it doesn’t matter what Obamacare “pays” for.
As I see it, economically, the fundamental economic flaw of Obamacare is that it will make the situation much worse. It stimulates and subsidizes demand greatly without providing any means to increase the supply of medical care. That naturally results in higher medical care costs.
My take is that will result in a destructive feedback loop where more subsidies and more regulation will be attempted (because of the large numbers of stubbornly uninsured people that will result) resulting in yet higher health care costs and no improvement (or even a considerable worsening) of the numbers of uninsured.
Persons under age 18 should have free health care, paid for by taxpayer funds if necessary.
Able-bodied adults should get no taxpayer-funded health benefits whatsoever.
And I say this as an adult with no health insurance whatsoever.
For a while we had a dental insurance policy that covered two annual checkups and teeth cleaning and cavities. It didn’t cover root canals or catastrophic dental work.
I commented about this to a number of people, I was told that if people didn’t have their regular visits covered they wouldn’t go, which would be more expensive to society in the long run. I was a bit skeptical but I heard the same story from everyone I mentioned this to.
Daver, here in Canada the only things not covered under health care are dentistry and optometry. For some reason nobody is clamouring for them either.
We have vision insurance from work as well. It covers an annual eye exam and about a third of a pair of glasses. Awfully nice of the people without glasses at my work to help pay for mine.
Anyway, yet another fake insurance insurance.
Have you noticed how the base expense is what insurance will cover and the next tier up is what people can afford out of pocket? If insurance didn’t have such a distortion on the market, eye glasses would be much cheaper.
There will be a rise in service providers with an optomitrist/chiropracter business model where the service is free with insurance or a small out of pocket deductible. The survival rates for cancer wont go down but our population will have the most frequently monitored blood pressure and the most supple lower back muscles in the world.
I am sure there is some Democrat group already planning to drive around distributing plan b pills and cashing those obamacare checks.
I’ll let you all in on the dirty little secret of socialized medicine: nobody *has* to be a doctor. And you can’t force anyone to be a good doctor.
You can import doctors, which I expect we’ll end up doing. I’m not sure India has enough to supply both Europe and the US.
After all, even in Egypt, the Pharaohs
Had to import
Hebrew braceros
What do you mean you can’t force people to be doctors? Haven’t you been paying attention to what has been going on?
I said you can’t force anyone to be a good doctor.
There are lots of people who want to be doctors, and who would be good doctors, but who aren’t because the medical profession tightly controls the number of medical school and residency slots in order to keep wages high. We don’t need to force anyone to become a doctor — in fact there’s a surplus of untapped demand.
My father recalled that when Medicare was being debated, shortly after he got out of medical school, he knew a lot of older doctors who were sure that it would destroy the practice of medicine, and everything that made medicine an attractive career. Now it’s almost fifty years later, and again there are worries that mandatory health insurance will keep people from wanting to be doctors. I suspect that these fears, too, will turn out to be overblown.
Oh, its all a plot by evil doctor colleges. That makes total sense. Let’s encourage medical schools to lower their admissions standards…
It will be interesting to see greedy doctors be blamed for Obamacare’s failures.
Blame insurance companies. Blame doctors. Blame people who think we pay enough in taxes already. But never blame the politician that created the mess.
Jim pushed the “Need = Right” fallacy again. But then where would State-shtuppers be without it?
The current state of things includes such a “sucks to be you” policy for 50 million uninsured Americans.
Before the current state, most people were happy with their insurance. It was the few that were irresponsible that complained. Most uninsured are the young and healthy. It’s called freedom.
If people are already sick… IT IS NOT INSURANCE. That situation is and should be dealt with differently. Charity has been the traditional method, but the government would like to screw that up as well. Driving doctors and hospitals out of business doesn’t help either.
Poverty is an issue. So why is Obama working so hard to create more of it?