Let’s Avoid More Unintended Consequences

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There are many people who believe that many of the changes that the health care system has been making over the past decade are having an important unintended consequence – creating a two-tiered health care system. As the “customer service†aspects of medical service delivery serving lower and middle class people declines due to reimbursement constraints, physicians are expanding concierge medicine, in which people pay directly for more individualized and responsive health care. While many people will point to ObamaCare as the cause, this trend was already in place, just now moving at a quicker pace.

About one third of primary care physicians and one-fourth of specialists have already completely closed their practices to Medicaid, notes Scott Atlas, a physician and senior fellow at Stanford University’s Hoover Institution (Wall Street Journal, May 1, 2014 Opinion). Over 52% of physicians have already limited the access that Medicare patients have to their practices or are planning to do so (survey by Merritt Hawkins for the Physicians Foundation, 2012). More doctors than ever refuse Medicaid and Medicare due to inadequate payments for care.

As the government, under ObamaCare, constitutes to lower reimbursements, this will get worse. While the Affordable Health Care Act was supposed to increase health insurance costs, the opposite has happened. The average number of plans dropped from 117 in 2013 to 41 in the new exchanges; consumers in 16 states now have their choices limited to 3-4 insurers.  McKinsey reported a narrowing of hospital networks on the new exchanges: in 2013, 33% of individual insurance offerings contained narrow or very narrow networks; the new ObamaCare exchanges report that 68% cover only those limited networks.

Simultaneously, the American Academy of Physicians report there now are 4400 concierge physicians, 30% more than a year ago. Another 7-10% already reported that they expect to make that move. With doctors already spending 22% of their time on non-clinical paperwork, increased government intrusion will take even more time away, and encourage more physicians to change their practice arrangements to avoid it.

Our health care experts and government officials have a choice: continue to fight over ObamaCare with no alternatives being offered or look-forward by developing alternative scenarios that will assure all people quality and timely health care that’s affordable.  What solutions would you suggest?  Share them with us!

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