I've been hearing people claim that, without Obamacare, there will be medical scarcity. The truth is that Obamacare artificially creates medical scarcity. Granted, the current way Medicaid and Medicare are run already artificially creates a certain level of medical scarcity. Obamacare just makes it worse.
The new phrase to learn is "Pay for Performance". This is something that has been implemented privately already within some hospitals and publicly with some state-run programs. This is how it works: When the P4P group reimburses the doctor, they look at his rating. The rating is used as a modifier to decide how much he is reimbursed. This rating may be created in many different ways, but Obamacare has a specific means in mind.
Obamacare, I must add, reserves this wonderful new measure for Medicare and Medicaid.
Medicare and Medicaid are already notorious for under-compensating the doctors. If a Medicare patient goes to the doctor with a bad cough and is charged, say, $150 for the visit, Medicare will pay the doctor, on average, about $50-70. If our private insurance companies did that, then the doctor would charge us the other $80-100. However, in Medicare and Medicaid, the doctor is not permitted to make any effort towards regaining his lost income. Now, most doctors do not work with a profit margin of 60% of their intake. Therefore, all Medicaid and Medicare patients provide a loss.
This is, by the way, why doctor's offices will only take a certain number of Medicare or Medicaid patients. This is why it's hard for them to find doctors. Each doctor can only afford to take so much of a loss before he risks bankruptcy. Only a small percentage of his patients can come from Medicare or Medicaid.
Now P4P will create a rating for each doctor that is based nearly entirely on his cost effectiveness. What does this mean? Suppose a 95-year-old woman needs a knee replacement to remain mobile. She has two choices: Have the operation and stay on her feet, or consign herself to a wheelchair for the rest of her life. Usually, she would make that decision depending on affordability versus usefulness, and she would make it based on her own beliefs and ideals. If she is a sedentary woman, she may find the wheelchair to be an easier path, but if she is an active runner, she might think that it is worth any cost to give her that ability back again.
In Obamacare, however, if she has that operation and then dies of pneumonia 18 months later, her operation is deemed to have not been cost-effective and her doctor's score goes down.
That score is used along with a multiplier to decide how much the doctor gets paid by Medicare or Medicaid patients. If he refuses to do the operation for her, he keeps a Grade A rating and may receive something like $100, or maybe even $120, for the $150 office visits. If he does it, however, his rating drops and his reimbursement does as well, for every Medicare or Medicaid patient he takes.
Why on earth would anybody set up something like that? The problem is that liberals do not understand why the doctor makes the medical decisions that he makes. See, there really is a mild problem with doctors over-prescribing and over-treating certain situations. For instance, a patient with bronchitis is likely to be able to clear it up with his own immune system inside of a week or two. However, the doctor is likely now to prescribe antibiotics whether he needs them or not. Why?
The current system of malpractice suits allows anyone who can convince a judge that he has been wronged by his doctor to sue, not only for damages, but for 'pain and suffering' as well. Suppose that doctor does not give out the antibiotics, and tells the patient to return within a week or if certain systems develop. Suppose that patient doesn't see the doctor in a week and gets worse and worse, until he has to come in and receive an emergency course of antibiotics for, say, $800 all told. Now he can sue that doctor for $800 in costs and $10K, or maybe $100K, or any arbitrary number, for pain and suffering.
The Republican answer to this problem was a proposal to cap pain and suffering malpractice payments and to set up a special court system allowing people with medical knowledge to judge whether or not the doctor did the wrong thing. That's because the Republicans understood that the reason why doctors over-treat is because of fear of lawsuit.
Obama told us a bunch of stories about pediatricians removing tonsils from children and physicians amputating the feet of diabetics in order to make more money. That's right, Obama and those who created Obamacare firmly believe that the only reason why doctors over-treat (and perform regular acts of malpractice) is to line their own pockets. Naturally, they believe that the best way to rein in these evil doctors is to pay them less for over-treating their patients.
That leaves doctors in a catch 22. They will have a choice with Medicaid and Medicare patients between risking higher bills by being sued for perceived under-treatment or risking lower payments from the government for perceived over-treatment. Since so many doctors are still small business owners working under private practices, the best and safest answer is clear: Stop taking Medicare and Medicaid patients at all.
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