Thursday, January 15, 2015

ObamaCare by Design: Rationing Healthcare

Late last year, all the negative talk about ObamaCare was limited to the comments of an M.I.T. economist, Jonathan Gruber, and how he and others used various tricks in designing ObamaCare in order to fool the stupid voters to buy into it.  Of course, in Congress, there had to be hearings in order to dig deeper into what he said.  But, no one asked a very simple question as to why an economist -- armed with his patented computer modeling -- became the chief architect of ObamaCare.

When you take a wide view of the various elements of the law, you can see that it is primarily designed to limit our access to healthcare and, as such, lower the overall costs.  That's why Gruber was needed.  Simply, healthcare economists like Gruber, and another economist who worked with the President, by the name of David Cutler, believe that we have the highest cost of healthcare in the world because we have too much easy access into the system and expensive procedures such as MRI scans.  Thus, in order to make the Affordable Care Act affordable, rationing techniques had to be imposed.

One of the biggest targets of ObamaCare and rationing are the so-called Cadillac Health Insurance plans. Cadillac plans are extremely expensive and originally offered to the wealthiest of Americans.  The plans, themselves, offer all kinds of high-level, break-the-bank coverage for things like private rooms and at-home nursing care.  ObamaCare tackles this supposed abuse of our healthcare system by imposing a 40% tax on any expensive healthcare insurance plan that is over $10,200 for an individual or $27,500 for a family with the economic assumption that Cadillac plans will be taxed out of existence.  Unfortunately, these plans are no longer just for the rich.  Many of those insured by them include people with high risk jobs, such as police and firemen as well as families with seriously ill members who need constant nursing; preferably at home.

Another way that ObamaCare rations is through a self-imposed process of creating health insurance   that has extremely high deductibles and high annual out-of-pocket caps in the exchanges.  This makes it very expensive for the insured to casually use the healthcare system. For example, the cheapest plans in the exchanges are the Bronze plans.  On average, they have an annual $5,181 deductible per individual or $10,545 per family that must be met first before the insurer shells out any of its own money.  After that, the insured pays 40% of any bills until an annual out-pocket cap of  $6,373 per individual and $12,749 per family is reached.  Only after that does the insurer have to pick up the full tab for further expenses.  For many low-income and lower middle class families, the prospect of shelling out $12,749 a year -- especially when someone is seriously ill over a period of two or more years -- is a frightening thought.  As a result, some may elect to wait too long before seeing a doctor.  A fact that could cost lives.  The designers of ObamaCare estimate that 93 million Americans will lose their insurance and be forced into the exchanges.

Then, there is the expansion of Medicaid.  Medicaid is a state-run and federally subsidized form of free healthcare insurance originally intended for the poor.  ObamaCare is expected to expand this coverage to 20 million lower income individuals.  Because the Medicaid programs pay doctors and hospitals so little, Medicaid patients have access limited to those providers that are able to accept lower cost repayments; usually large clinics that operate on a cattle-car basis with long wait times.  So, if you can force as many as 20 million insured out of their full-fare-paying and instant access insurance policies and push them into lower paying and longer waiting Medicaid, their costs will be lowered and their access will be limited.

Losing your doctor is, by design, an effort to force the more expensive physicians to change the way they operate their practices  As mentioned above, a total of 93 million are expected to lose their current insurance and move into the exchanges.  An additional 20 million are being moved onto Medicaid.  With both Medicaid and insurance policies in the exchanges, access to doctors is limited to a narrow network who will accept lower payment for their services. In doing so, this will leave many doctors with increasingly smaller patient bases and, as a result, unprofitable practices.  To survive, they will have to find ways to accept lower payments.  Many will consolidate their practices  in order to save on resources like nurses, receptionists, and supplies.  As a result, doctors, will not be able to spend much time with each patient, and we will see the use of lower cost Nurse Practitioners and Physician's Assistants increase.  Ultimately, your access to a doctor of your choice will be greatly reduced.

The Medical Device Tax (MDT), that is imposed under ObamaCare, is another rationing effort. The MDT is a 2.3% tax that will be applied to anything deemed to be a medical device.  And, the devices range from $3 million MRI machines to bedpans and dental drills. The designers of the tax argue that it is relatively small against an industry that has little competition and hefty profits.  Proponents of the tax argue that it is a small tax that is needed to help pay for the subsidies under ObamaCare.  However, that little tax is a $2.5 billion dollar annual hit against a $110 billion dollar a year industry.  An industry that economists blame for the rising cost of healthcare in this country.  Economists like Gruber know that hospitals, doctors, dentists, and veterinarians have only limited dollars to spend on medical devices and, they also know that insurance companies won't necessarily pay higher prices for them.  As a result, the tax is intended to cause medical providers to think twice about constantly buying newer, bigger, better, and, certainly, more expensive equipment.  It will be yet another reason for physician's to consolidate their practices in order to share these many devices thereby avoiding any costly idle time.

Lastly, for the elderly, there is the Independent Payment Advisory Board (IPAB).  Basically, the IPAB is tasked to control the rising cost of Medicare.  Called the Death Panel by some, the IPAB is intended to decide how increasingly scarce Medicare dollars are being spent.  To accomplish this, there will be rationing.  Once again we have economists at work on this one.  The Gruber's of the world understand that 32% of all Medicare expenses occur in the last two years of a patient's life.  Thus, if ObamaCare can control those last two years, it would mean massive savings.  So, expect the IPAB to make many decisions on how old is too old for certain expensive medical procedures like heart bypass surgery.  Instead, patients may wind up with the old remedy for heart pain: nitroglycerin tablets and limited physical exercise. Of course, the doctor will be off the hook because some bureaucratic panel will have made the no-surgery decision without any input from him.

All together, these things are designed to make healthcare worse; not better.  Which is what rationing is all about. And, quite frankly, people will die because of it.


Jonathan Gruber:

David Cutler:

Cadillac Insurance Plans:

Are You Driving a Cadillac?:

Bronze Plan Explained:

Obama Officials In 2010: 93 Million Americans Will Be Unable To Keep Their Health Plans Under Obamacare:

American Hospital Association: Medicare and Medicaid Financial Statistics:

Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates:

The Medical Device Industry in the United States:

Independent Payment Advisory Board:

IPAB Shifts Costs and May Negatively Affect Patient Access:

Care of Chronic Illness in Last Two Years of Life:

No comments: