Monday, April 4, 2011

Hype Vs. Reality

A few recent stories highlight the gulf between pro-ObamaCare hype and reality.

1) The 4/1/2011 New York Times reports that "Cuts Leave Patients With Medicaid Cards, but No Specialist to See".

Many of these patients are learning the hard way that "coverage" does not equal actual medical care. From the NYT article:
"Having a Medicaid card in no way assures access to care," said Dr. James B. Aiken, an emergency physician in New Orleans...

"My Medicaid card is useless for me right now," [patient Nicole] Dardeau said over lunch. "It's a useless piece of plastic. I can't find an orthopedic surgeon or a pain management doctor who will accept Medicaid."
Expanding Medicaid was one key element of ObamaCare's promise to improve "access" or "coverage". However, many states are setting Medicaid reimbursement rates so low that doctors cannot afford to see these patients. The big question will be whether cash-strapped states like Louisiana will respond by compelling physicians to accept Medicaid patients at the state rates (i.e, price controls).

Something similar has already been proposed in Massachusetts, namely compelling physicians to accept certain state-sanctioned insurance plans as a condition of retaining their MA medical license. Fortunately, that law did not pass -- but it may inspire similar proposals elsewhere.

2) In contrast, the 4/2/2011 Associated Press reports, "High-end medical option prompts Medicare worries".

More patients who can afford it are seeking "concierge physicians" who will actually take the time to listen to their problems, answer their questions, and provide individualized high-quality health care -- rather than the cookbook-style medicine being demanded by ObamaCare with its government practice guidelines.

Many middle-class patients are finding the $1500-$1800/year retainer fees to be affordable. But this trend is also arousing a backlash by the statists who want to limit people's ability to opt out of any government-run system. This is no different from the socialists in East Germany wishing to limit the ordinary citizens from seeing how much better life was in West Germany. Hence, we can expect increasing rhetorical and political attacks against the idea of concierge medicine, arguing that (as many already do) that it creates a "two-tiered" system, or that it's "inegalitarian".

3) Finally, physician-blogger Kevin Pho notes, "Electronic medical records and pay for performance don't improve care". These are major initiatives of ObamaCare. Men like Medicare chief Donald Berwick argue that electronic medical records (EMRs) and "pay for performance" (P4P) will improving health outcomes.

Evidence is mounting that this is false. What they will do is allow the government to more closely control how doctors practice medicine. These mechanisms facilitate future rationing by creating the mechanisms for tracking what tests and treatments doctors prescribe -- and punishing those who fail to adhere to the government practice guidelines.

Americans wouldn't tolerate a government that required them to log all their meals with a central database, and punished them for eating foods the government didn't approve of. They shouldn't tolerate the government doing the same to their doctors.