The great irony of health care reform

The great irony of health care reform is that really, nothing is new.  Everything, it seems, remains cloaked in secrecy.

Yes, there are things called exchanges now.  And millions upon millions of dollars will be spent on Internet, social media, TV, print, and radio advertising touting the law.  There will be counselors there to help people make an informed choice.

But there’s still a new complicated, unreadable law that promises much, but delivers, well, we’re still not really sure.  There have been so many promises, but no one knows (yet) what we’ve given up in return for the monstrous bureaucracy, new payments, and massive consolidation of doctors offices and hospital systems that this law has already created.

Sure, the least risky adult population under 26 can stay on insurance, but now millions of young people who make $20,000 per year will be signing up for something that costs one tenth of their salary annually ($163 per month x 12) and have no idea in the world what they’re getting (really) for their money.  They get well doctor visits, but what does insurance company B have over insurance company C, or company Z?  Why do people have to add a zip code on their websites — have some areas gotten political favors in exchange for lower costs when others don’t?

No one has a clue.

And that will total out of pocket costs really be in terms of co-pays and co-insurance kick in?  What happens when an insurance company refuses to pay for a service because it wasn’t the service they chose for people covered in their plans?

No one has a clue.

And how long will people have to wait for an appointment after January 1st, 2014 for their Medicaid care, in a system that already can’t pay its bills?  If my clinic’s any indication, today, this minute, it’s already a two and a half month wait for a routine follow-up appointment.

You see, there are only so many of us, and millions more patients on their way to Great Expectations now.  But as the new law has been taking shape, there has been downsizing, trimming of staff, more work for those who remain, and lots of doctors and nurses dropping out, moving on, or retiring early because they’ve been given sweet deals, or really had no choice.

Many are already frustrated, burned out, or getting to the point (sadly) that they really don’t care any more as more an more administrators are hired to tell health care workers how to work without doing the real work themselves.

So things will have to change under the weight of it all, and they will.

But for now, it’s all new, so enjoy.

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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  • buzzkillerjsmith

    The point of the ACA, rhetoric notwithstanding, was to expand health insurance. Not to make it cheaper, not to change health care delivery or to make medical care cheaper.

    The problem, as everyone at this blog knows, is that the HC system is a game of pick-up sticks. You can’t change one thing without changing a lot of things, often in ways that you can’t predict.

    Interesting times.

    • Deceased MD

      I really can’t entirely figure out what the goal was. Can you? HC for everyone as you said was the goal. But the name implies that it is suppose to be “affordable”. As far as HC for everyone–even that we don’t have yet. ( the whole medicaid debacle).

      • Gibbon1

        Whole goal of Obamacare was to eliminate the incentives the health care industry and insurance companies have to increase costs.

        You can see that over the last thirty years as costs have gone up well above inflation without the provisioning of better care in return. This is because there is has been no market for health care, only a collection of monopolies.

        Amusing anecdote since my GF with no dental insurance went to the dentist today. And they didn’t do x-rays because she can’t afford them. That got me to thinking, what is the cost of an x-ray really.

        Turns out the machine costs about 5k. A digital sensor about 8k. Total is 13k. Dentist charges $150 for a set of x-rays. Note you can rent compact car costing three times that much of $40/day easy. If you run the numbers and figure a two year payback, a dental x-ray capital cost should be about $6/ea. 15 minutes of labor (nurse) is about $30.

        So right there madness. There are simply no market forces at work here.

      • buzzkillerjsmith

        I think the ACA is a typical bill that winds up as a very messed-up stew, with a whole bunch of stuff added in by moneyed interests that must be bought off. I think the main plan with insurance expansion, but then they threw in the ACOs and meaningful use and who knows what else. The whole affordable thing is propaganda.

        It’s a mess.

        • Deceased MD

          Yes. Makes me proud to be an American. Not.
          It’s funny how the AMA at first I believe was against the ACA and then suddenly changed their tune. Although I wouldn’t swear to it. Just my recollection.

        • Deceased MD

          Hmm.. an ACA stew sounds lovely.
          2 lb of organic grass fed beef
          organic carrots, onions, potatoes
          throw in a touch of arsenic. season with cyanide and we’re ready to go.

  • Suzi Q 38

    I had a feeling this was not going to be good.

    My insurance rates will be increased to make up for the pre existing conditions. People will lose jobs and hours with benefits to being unemployed or less hours and NO benefits. Now this will be a new group on Obamacare.

    Health professionals may or may not be exempt from this. Hospitals and HMO’s are employers too, and they will figure out how to cut corners and do with less personnel.

    The need for NP’s will increase, as GP’s want out or can not meet the patients demand for medical care.

    This is no longer interesting to me.
    This is sad.

  • Anthony D

    In the end, it isn’t the insurance company
    paying more, it isn’t the employer paying more it’s YOU the taxpayer
    paying more.

  • dontdoitagain

    How can a government program make health care less expensive when they ADD more layers of people to the health care industry? The government spent 640 million dollars on their stupid computer program that doesn’t work. 16,500 new IRS agents and who knows how many new government jobs have been or are being added. All of which have to be paid for by health care insurance premiums and the fines fees and penalties incurred by a hapless population that can’t afford the skyrocketing insurance and out of pocket expenses.
    Plus Ms. Nancy (Pelosi) claims that the government can pay down its debts with this law. How does that work? Health care is already astronomically expensive, completely out of whack with reality and she proposes that the government can pay down trillions of dollars of debt on the back of the ACA? I may not be the smartest, most educated person on here, but I don’t see how this is possible.

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