ObamaCare is the gift that just keeps on taking. Anyhow, I hate to say “I told you so…”, but I’m not the only one that said it.
[…] the New York Times reports that the controversial health care reform act has accelerated the destruction of small medical practices at the expense of large firms. And if the Times is right, these are part of some fundamental changesin the American health care system that no Supreme Court decision can undo:
From Colorado to Maryland, hospitals are scrambling to buy hospitals. Doctors are leaving small private practices. Large insurance companies are becoming more dominant as smaller ones disappear because they cannot stay competitive. States are simplifying decades of Medicaid rules and planning new ways for poor and rich alike to buy policies more easily. […]
Other changes influenced by the legislation may leave some patients and doctors lost in the new land of giants. As medicine moves from a cottage industry to one dominated by large organizations, some patients with insurance will probably find their choices more limited. But their care may be better coordinated, as hospitals, doctors and even insurers join to streamline services.
“The system is transforming itself,” said Charles N. Kahn III, president of the Federation of American Hospitals. “But the success of these changes depends a lot on whether there is sufficient funding.”
Is this what the social engineers who redesigned the American health care system really wanted to do? Is big better in health care, and is bigger still better still?
If the Times is right, so far the principal effect of the plan has been to accelerate the decline of family doctors and small medical practices in favor of larger, bureaucratic health care providers along the lines of HMOs.
Even if ObamaCare survives Supreme Court scrutiny next spring, its trials will be far from over. That’s because the law has a major glitch that threatens its basic functioning. It’s so problematic, in fact, that the Obama administration is now brazenly trying to rewrite the law without involving Congress.
The Patient Protection and Affordable Care Act offers “premium assistance”—tax credits and subsidies—to households purchasing coverage through new health-insurance exchanges. This assistance was designed to hide a portion of the law’s cost to individuals by reducing the premium hikes that individuals will face after ObamaCare goes into effect in 2014. (If consumers face the law’s full cost, support for repeal will grow.)
The law encourages states to create health-insurance exchanges, but it permits Washington to create them if states decline. So far, only 17 states have passed legislation to create an exchange.
This is where the glitch comes in: ObamaCare authorizes premium assistance in state-run exchanges (Section 1311) but not federal ones (Section 1321). In other words, states that refuse to create an exchange can block much of ObamaCare’s spending and practically force Congress to reopen the law for revisions.
My Kate just finished a month of grueling reading/studying/testing for three huge exams in medical school. She has no life, outside her medical school studies and classes. She called me just after 10:00 this morning, actually lazily giggling, because she had slept in (no classes today) … She was gazing at her engagement ring (recently acquired) and said that part of her life seems as if it is somebody else’s (planning a small wedding for June 2012 after her first set of boards … she and her fiancé at a different medical schools hours away from each other). She told me she was going to spend the day cleaning her small apartment, prepping a mountain of laundry for a weekend trip home, playing with her fat cat, and running to the store for overdo supplies … after relaxing at lunch at her favorite fast food eatery. Thank God for free LDs on our cell phones. She doesn’t have the time or mental energy to worry about exactly what the medical world in this country will be when she graduates from medical school … But I do, as I am sure many other parents who know how much their kids have invested in their long and hard years of study, work and sacrifice are worrying …