The Doctor Won't See You Now

The six words eagerly anticipated in the waiting room are: “The doctor will see you now.” Under Obamacare, that waiting is now suspenseful with no certainty that the words will be heard.

Obamacare was conceived to increase the numbers of people in our nation who had health insurance. It was not conceived to increase the number of people who had health care.

The argument was made during the debate in 2009 that no one in America goes without health care. In 1986 Congress passed the Emergency Medical Treatment and Active Labor Act which mandated that any hospital that accepted Medicare or Medicaid payments could not turn anyone away from their emergency room regardless of diagnosis, citizenship or ability to pay. Since virtually every hospital accepts Medicare payments, all are included.

Many Americans choose not to insure themselves precisely because of that law. They know that they will be cared for and, indeed, they are.

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The Left spends a great deal of time whining about the underserved not knowing what services are available to them. They should show up at an emergency room some evening and watch the action. The underserved know exactly what is available and they avail themselves of it.

A new women’s health clinic opened in a small boutique hospital in a northern suburb of Atlanta 20 years ago. It was opened with virtually no publicity. From the first night it opened it was overrun with uninsured women in labor arriving in cabs to have their babies in this brand new facility. They knew all about it. That hospital didn’t survive.

A chicken processing facility in Athens, Georgia provided health insurance to all employees, but a majority chose not to participate because they didn’t want to pay their share of the premium. The plant manager told me that two of her employees, who did choose to participate in the insurance program, delivered babies in the past year, but told the emergency room that they lacked insurance. They didn’t want to pay the deductible.

We are confronted with an age-old problem in a free society. A lot of folks who want the benefits don’t want to pay for them. A door was opened in 1986 that enabled them to take advantage of the system and they, unsurprisingly, strolled through it.

With so many people taking advantage of the system politicians decided that it was time to mandate health insurance coverage. The quickest way to do that would be to repeal that 1986 law that gave everyone an escape clause from insurance coverage. That was suggested and ignored.

A decision was made that government could, by an act of Congress, fix the problem by providing that everyone must be insured. Of course, adding 45 million users to routine healthcare without adding any new doctors or nurses would create a system in which people might have insurance, but would be unable to be cared for. That point was also made and ignored.

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Well, we have arrived at exactly that point only two years into the new era.

In 2010 the Mayo clinic decided to not see Medicare patients in one of its Arizona clinics. The reason is not complicated. In 2008, the Mayo Clinic lost $840 million caring for Medicare patients. It is not difficult to see where this is headed.

Medicare consistently pays 20 percent less than traditional insurance coverage and Obamacare promised to make an additional $714 billion in cuts

Medicaid reimbursements are declining also. Medicaid pays doctors about 59 percent of what Medicare pays them—which is why doctors increasingly refuse to take new Medicaid patients. The Centers for Medicare and Medicaid Services (CMS) reported that 9,500 doctors who had previously accepted Medicaid patients refused to do so in 2012.

A 2013 survey from Deloitte Center for Health Solutions found that 62 percent of physicians will retire earlier than planned in the next one to three years.

The Obamacare law required Medicaid programs to reimburse doctors at the same rate as Medicare for 2013 and 2014. Those rates are scheduled for a huge reduction in 2015 and we can expect more doctors to opt out.

Covered California plans are setting fee schedules in line with that of California's Medicaid Program which means Obamacare exchange plans are cutting provider reimbursement by up to 40 percent. Over 70 percent of California’s doctors are not participating in these plans.

While there is no formal “rationing” of care taking place yet, there is informal rationing by insurance companies by reducing the numbers of doctors in their networks and creating longer wait times. One study shows that where a commercial plan might have 40 cardiologists per 100,000 people, a typical Obamacare plan would average only 15 cardiologists.

When Obamacare was passed there had not been a net increase in the number of nurses in years. More than half of that workforce is close to retirement. Additionally, an entire cohort of nursing instructors is preparing to retire.

So we have come full circle. A health care system that was dedicated to health care has become a system dedicated to health insurance. That was a political decision taken to satisfy a political constituency. In so doing a condition was created that is not conducive to attracting and keeping the single most important part of any health system, the caregivers. When you reduce a person’s ability to care for people and reduce their pay for doing it they will leave.

The doctor won’t see you now.

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