Dr. Scott W. Atlas, physician and senior fellow at
Stanford University's Hoover Institution, writing in today's Wall Street
Journal...
With the unveiling of the Affordable Care Act's website,
the public experienced a painful reminder of the consequences of the
government's new authority over health care. While millions signed up for
insurance, millions of others abruptly lost their existing coverage and access
to their doctors because that coverage didn't fit new ObamaCare definitions.
The health-care law was generated by an administration
promoting government as the solution to inequality, yet the greatest irony of
ObamaCare is what will undoubtedly follow as a long-term, unintended consequence
of the law: a decidedly unequal, two-tiered health system.
One will be for the poor and middle class, and a separate
system will be for those with the money or power to circumvent ObamaCare.
With the Affordable Care Act, the government has
dramatically expanded its authority as final arbiter over health insurance and
consequently over access to medical care.
After the law's Medicaid expansion and with the
population aging into Medicare eligibility, the 107 million under Medicaid or
Medicare in 2013 will skyrocket to 135 million five years later, growing far
faster than the ranks of the privately insured.
Add to that centralization of power the Independent
Payment Advisory Board (IPAB), ObamaCare's group of political appointees tasked
with reducing payments to doctors and hospitals. Even Howard Dean, former
chairman of the Democratic National Committee, warned that "The IPAB is
essentially a health-care rationing body. By setting doctor reimbursement rates
for Medicare and determining which procedures and drugs will be covered and at
what price, the IPAB will be able to stop certain treatments its members do not
favor by simply setting rates to levels where no doctor or hospital will
perform them."
The hidden truth is just around the corner — those more
dependent on public insurance, mostly the poor and middle class, will have
limited access to medical care.
About one-third of primary-care physicians and one-fourth
of specialists have already completely closed their practices to Medicaid
patients.
Over 52% of physicians have already limited the access
that Medicare patients have to their practices, or are planning to, according
to a 2012 survey by Merritt Hawkins for the Physicians Foundation.
More doctors than ever already refuse Medicaid and
Medicare due to inadequate payments for care, and that trend will only
accelerate as government lowers reimbursements.
At the same time, ObamaCare is squeezing out the middle
class from affordable private insurance that correlates with far better disease
outcomes than government insurance. By bloating coverage requirements and
minimizing the consideration of risks fundamental to pricing insurance, the law
has already increased premiums by 20%-200% in more than 40 states, according to
a 2013 analysis by the Manhattan Institute's Avik Roy and others.
Less widely known is that inadequate reimbursement by
government insurance to doctors substantially increases private-insurance
prices. According to a December 2008 Milliman report presented by Will Fox and
John Pickering, a shortfall of more than $88 billion in payments from Medicaid
and Medicare beneficiaries added more than $1,500 extra a year in premiums and
$1,800 extra in total out-of-pocket costs to every family of four with private
insurance. With increasing enrollment into government insurance, private
premiums will undoubtedly rise even more.
* AND REMEMBER, FOLKS...
... the 107 million under Medicaid or Medicare in 2013
will skyrocket to 135 million five years later, growing far faster than the
ranks of the privately insured.
(*SHRUG*)
* MORE SUBSIDIES... HIGHER DEFICITS... MORE DEBT... FEWER
DOCTORS... HIGHER PREMIUMS...
(*SIGH*)
Even inside Medicare, two-tiered access will occur. Under
political pressure in advance of this fall's midterm elections, the
administration backed off from the ObamaCare plan to eliminate affordable
private drug-coverage options inside Medicare, options that all Medicare
beneficiaries enjoyed before the law. These substantial cuts will likely return
post-election, limiting those choices to more-affluent seniors.
Despite the government's assertion that the health-care
law increases insurance choices, the ObamaCare exchanges do the opposite for
those dependent on them and the government subsidies they offer. The average
number of plans offered in individual states has decreased from 117 in 2013 to
41 in the new exchanges; consumers in 16 states now suddenly have their choices
limited to three or fewer insurers.
* ONE... MORE... TIME...
The average number of plans offered in individual states
has decreased from 117 in 2013 to 41 in the new exchanges; consumers in 16
states now suddenly have their choices limited to three or fewer insurers.
ObamaCare is also eliminating access to many of the best
specialists and the hospitals for middle-income Americans. To meet the law's
requirements, major insurers are declining to participate in the exchanges, or
only offering plans that restrict choice of doctors and exclude many of America's
best hospitals. McKinsey reported a marked narrowing of hospital networks on
the ObamaCare exchanges: In 2013, 33% of individual insurance offerings
contained narrow or very narrow networks, but this year under the exchanges 68%
of options cover only those limited networks.
* ONE... MORE... TIME...
In 2013, 33% of individual insurance offerings contained
narrow or very narrow networks, but this year under the exchanges 68% of options
cover only those limited networks.
For cancer care, the overwhelming majority of America's
best hospitals in the National Comprehensive Cancer Network — including MD
Anderson Cancer Center of Houston, New York's Memorial Sloan-Kettering, Barnes
Hospital in St. Louis, and the Seattle Cancer Care Alliance uniting doctors
from Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Children's
— are not covered in most of their states' exchange plans.
AGAIN...
...are not covered in most of their states' exchange
plans.
Meanwhile, concierge practices are increasing rapidly, as
patients who can afford it, along with many top doctors, rush to avoid the
problems of an increasingly restrictive health system. The American Academy of
Private Physicians estimates that there are now about 4,400 concierge
physicians, 30% more than last year.
* WOW...
In a recent Merritt Hawkins survey, about 7% to 10% of
physicians planned to transition to concierge or cash-only practices in the
next one to three years.
(*SIGH*)
With doctors already spending 22% of their time on
nonclinical paperwork, they will find more government intrusion under ObamaCare
regulations taking even more time away from patient care.
* YEP...
As America doubles down on government authority over
health care, Europeans with the means to do so are increasingly circumventing
their own centralized systems. In Britain, even though they're already paying
for the National Health Service, six million Brits — two-thirds of citizens
earning more than $78,700 — now buy private health insurance. Meanwhile, more
than 50,000 travel out of the U.K. annually, spending more than $250 million,
to receive treatment more readily than they can at home.
(Even in Sweden, the mother of all welfare nations, half
a million Swedes now use private insurance, up from 100,000 a decade ago.)
Unless ObamaCare is drastically altered,
America's health care will also become even more divided, with rising
inequality. Just as in the U.K. and other countries where governments take an
outsize role in dictating health-care policy, only the lower and middle classes
in America will suffer the full consequences of ObamaCare.
