People with pre-existing conditions will get coverage under Obama care, but they won't get treatment!

Under Obamacare patients with pre-existing conditions will get coverage (a government run plan), but the concern is whether the government plan will allow those same patients the treatment they would need. Sick people will be viewed as “a drain" on the finances of the system! That's just what happens under socialized healthcare!

By Ira Brodsky

Author, "The History & Future of Medical Technology"
People with serious medical conditions often achieve miraculous results in the U.S. thanks to a private health care system that gives them the freedom to track down and go to doctors with the right knowledge and experience. These people, who have the greatest and most urgent health care needs, will be stymied by Obamacare’s new layers of bureaucracy. Instead of swiftly obtaining the right diagnosis and treatment, they will lose precious time submitting forms and filing appeals.

As every physician knows, it’s important to arrive at a correct diagnosis as soon as possible because medical conditions are most treatable in their early stages.

A recent article in The Wall Street Journal illustrates the point. “Facing Lifesaving Heart Surgery, Twice” bemoans the plight of people who had heart surgery as children only to experience further heart problems as adults. Doctors were often baffled because their hearts had been reconfigured during childhood. In some cases, the best course of action proved to be going back to the pediatric hospitals and surgeons who performed the original operations. This is possible in a private health care system because patients are correctly viewed as customers. Under Obamacare — a system that perceives people with serious medical conditions as financial burdens to a government already deeply in hock — these patients are more likely to find themselves boxed in by rules designed to contain costs.

People with serious medical conditions quickly discover that there are three key components to effective medical care. The first is a timely and accurate diagnosis. Getting the right diagnosis may require not just a second opinion, but a third and a fourth. The second component is a complete list of treatment options. Multiple opinions and options require the free flow of information that only a competitive health care marketplace can deliver.

The final component is the freedom for patients to choose what they judge to be the best course of treatment. Patients and their families are best qualified to make these decisions because they are the ones most directly affected. Under Obamacare, it’s presumed that government officials are better qualified to make these decisions, and it’s a safe bet that they will be instructed to weigh each patient’s anticipated future contributions to society against the long-term costs of keeping that patient alive.

President Obama made it clear that this is exactly where we are headed when he said, “Maybe you are better off not having the surgery, but taking the painkiller.” He was doubtlessly thinking ahead to a time when the cost to government will take precedence over what’s best for the individual. Government-run health care is the most cold-hearted health care. For example, the U.K.’s National Health Service denies kidney dialysis to patients over the age of 55 just to save money.

Another way that Obamacare will hurt people with life-threatening medical conditions is by stifling innovation. Today, the U.S. has more CT scanners, PET scanners and MRI machines than any other country. And as the country that pioneered implantable cardio-defibrillators, the heart-lung machine and robotic surgery, the U.S. offers more and better treatment options. Thanks to our private health care system, entrepreneurs are free to develop powerful new solutions, and if government ever gets out of the way they will be free to drive down costs. In stark contrast, public health care systems start by constraining costs; most innovative solutions never get off the launching pad.

It’s understandable that people with life-threatening conditions are attracted to government programs such as Obamacare. Many of these people feel they have twice lost life’s lottery: first by having a medical condition they did not ask for, and second by being saddled with extraordinary health care expenses.

Unfortunately, Obamacare provides only false security. Subsidized or even free care is of no value if it doesn’t provide the right diagnosis and the right treatment at the right time. Nor does it help to encumber hospitals, doctors and patients with massive new regulations. The only way to reduce the cost of health care while maintaining or improving quality is to permit and encourage vigorous competition.

Give the patients who consume the most health care the freedom to shop for services and make their own buying decisions and they will help drive down prices for everyone else.

Ira Brodsky is the author of The History & Future of Medical Technology.

Surgeon’s Malpractice has doubled from 2009 to 2011, and OB/GYNs has quadrupled from 2005 to 2011!

Doctor's malpractice insurance cost rise has little impact in Pittsburgh region so far Sunday, November 11, 2001 By Christopher Snowbeck, Post-Gazette Staff Writer Pennsylvania doctors predicted in January that escalating malpractice insurance premiums would force many physicians to flee the state, but that hasn't occurred in the Pittsburgh area. To be sure, defections are increasingly common in the Philadelphia area. Last month, a group of 18 orthopedic surgeons said they would stop performing surgery, though they continue to practice in Delaware County, rather than pay malpractice premiums of $130,000 per doctor, up from $65,000 two years ago. But such announcements are practically nonexistent in the west, where work force numbers suggest the region isn't suffering from a lack of doctors. For example, while the birth rate has declined in Western Pennsylvania in the past 15 years, the number of doctors specializing in obstetrics and gynecology has boomed, according to the state's Medical Professional Liability Catastrophic Loss Fund, or CAT Fund. Whereas 388 ob-gyns were practicing in Western Pennsylvania in 1987, the number had grown to 513 by last year, an increase of roughly 30 percent. "The statistics that are in hand at this time do not reflect a mass migration," said John Reed, director of the CAT Fund, which defines Western Pennsylvania as a 27-county area. "That does not, however, answer the question about whether physicians will leave in the future. At this point, we're fortunate that most physicians are still here." Like other doctors, Dr. Jeff Baum, president-elect of the Pennsylvania Orthopedic Society and a surgeon at UPMC St. Margaret, says excessive jury awards are to blame for the fast-rising malpractice insurance premiums, and the solution is tort reform. Among other things, that means passing laws to cap the amount of money juries can award for the pain and suffering of injured patients in medical malpractice cases. But John Gismondi, a trial lawyer in Pittsburgh, countered that problems in the malpractice insurance market stemmed not from large jury awards but from the insurance companies' stock market investments and previously underpriced policies. Doctors should focus on preventing errors, Gismondi said, rather than asking the Legislature to curtail the rights of plaintiffs. Despite the higher premiums at his office, Dr. Frank DiCenzo, an obstetrician in Sewickley, is sticking around, but he predicts other doctors will leave or, in the case of his specialty, will stop delivering babies. Six years ago, DiCenzo's practice paid $78,000 for malpractice insurance covering five ob-gyn specialists and a gynecologist who didn't deliver babies. Some doctors have come and gone since then, but by last year, the tab for the same mix of doctors was almost $286,000. Barb Condit, the practice's business manager, expects next year's premiums to exceed $300,000. The increase in malpractice premiums has been coupled with stagnant reimbursement rates, which leaves reimbursement for specialists in Western Pennsylvania well below the national average, according to DiCenzo. "At the current reimbursement level, we are receiving about $40 to $60 per hour for each hour of direct patient care," DiCenzo said. "This is the equivalent of what a lawn mower repairman, plumber, car mechanic or painter gets reimbursed for his or her services." Further complicating the fiscal picture is the rising cost of technology that doctors must buy to improve their practices, said Dr. Helen F. Krause, an ear, nose and throat surgeon at UPMC Passavant. But physicians' arguments about reimbursements, compensation and the impact on the physician work force don't always fit with national studies on the subject. Physician reimbursement here, for example, might not be what it once was, but it's not necessarily out of line with national averages, according to a recent study by the Pennsylvania Medical Society. The study found that Pittsburgh physicians rank 17th among the 25 largest metropolitan areas in HMO reimbursements, a rank commensurate with the cost of living and size of the area. The study did find problems with physician reimbursements in Pennsylvania, but, as with malpractice premiums, the worst of it is in Philadelphia, where physician pay ranked dead last. "HMO payments to doctors in Philadelphia are some of the worst payments in the United States," said Dennis Olmstead, chief economist with the Pennsylvania Medical Society. "But I couldn't sit here today and tell you that physician payments in Pittsburgh are 20 percent lower than they are in Ohio or New York." At least two national reports published this year suggest that some doctors have been enjoying pay increases. Medical Group Management Association reported this year that median compensation for specialists increased 6 percent to $256,494 between 1999 and 2000. Orthopedic surgeons saw their median compensation increase by more than 5 percent to $335,646. Pay for ear, nose and throat surgeons declined less than 1 percent to $235,415, but ob-gyns' median income increased about 2 percent to $236,353. A survey released last month from Merritt, Hawkins & Associates in Dallas found that practices looking to hire specialists were paying more, too. And there's a question as to whether the flight of doctors would dangerously deplete the overall supply of physicians here. It's hard to get a precise picture of the local physician work force, but 1993 and 1995 numbers from the Dartmouth Atlas of Healthcare show that Pittsburgh had about as many doctors as the national average in the three specialties being hardest hit by the premium crunch: orthopedics, neurosurgery and obstetrics. More recent CAT Fund figures show a decrease in the number of neurosurgeons in Western Pennsylvania since the mid-1990s. Whereas there were 80 neurosurgeons in 1995, the number fell to 72 by 2000. But the number of ob-gyns increased from 455 to 513 over that same period, and the number of orthopedic surgeons grew even more dramatically, from 278 to 354. Orthopedic surgeon Baum said part of the reason for the increase in physicians in his profession was that doctors are more specialized in the procedures they perform. What's more, the research community has grown, he said, meaning that not all of the new doctors are providing care to patients. Baum acknowledged that the increasing ratio of physicians to patients could be a factor in why doctors can't afford higher premiums, as more providers compete for the same number of patients. But the MGMA salary figures are higher than what many orthopedic surgeons here make, he said, and rising malpractice premiums are being eclipsed as a problem by insurance companies that have stopped offering policies here. "I just heard today that [for] 60 percent of the orthopedic surgeons in the Greensburg area, their insurance carrier would not renew their insurance," Baum said. "Have droves of orthopedists left the western part of the state yet? No, they haven't. But I don't know what's going to happen come the new year."

2014 and 2015 Medicaid reimbursement increase then huge decrease in 2016 and following years!

Obamacare raises Medicaid reimbursement in 2014 and 2015! Oh…but wait…in 2016 the reimbursement rates will drop to below 2012 rates. It’s called the bait and hook! The Government will use the bait of high reimbursement to hook you into accepting more Medicaid patients. Then the Feds will pass legislation that will not allow you to drop those new patients. Financial ruin ensues!

Side Effects: Obamacare and a Physician Shortage Mean Reduced Access to Care Under Medicaid

H/T Kathryn Nix – Writing in Heritage Foundation

A main goal of Obamacare was to expand health care coverage in the United States, which it tries to achieve largely by adding 18 million more individuals to Medicaid. But health coverage does not always equate to access to care, which is already apparent in the Medicaid program. In light of an increasing physician shortage across the nation, the changes made by Obamacare will make it even harder for Medicaid beneficiaries to receive primary care.

Medicaid patients already face an uphill battle trying to find physicians, since the program pays providers significantly less than private insurers and even Medicare. In many cases, reimbursement does not even cover the cost of providing services. Meanwhile, the Association of American Medical Colleges predicts a shortage of 45,000 primary care physicians and 46,000 surgeons and medical specialists within the next 10 years. As the population ages, demand for health care providers will rise.

A recent study by the Center for Studying Health System Change (CSHSC) looked at the effects of the large influx of new Medicaid patients on access to primary care physicians (PCPs). It concluded, “Medicaid PCP supply will likely increase the most in states that already have the largest PCP supply relative to the Medicaid population, while shortages of PCPs for Medicaid enrollees are likely to grow even worse in states that already have low Medicaid PCP supply.”

In an attempt to address Medicaid beneficiaries’ difficulty in finding care, Obamacare increases federal Medicaid reimbursement rates for primary care to match those of Medicare for two years. But this temporary fix will not solve the long-term problem.

Moreover, the CSHSC found that “states that currently have the fewest number of PCPs relative to the population—primarily in the South and Mountain West—already have Medicaid reimbursement rates close to or exceeding Medicare rates and, therefore, will see relatively little impact from the increased Medicaid reimbursement rates.”

Jessica Marcy writes for Kaiser Health News that these states “could struggle to provide medical services to the surge of new patients expected to enroll in Medicaid under the health overhaul and federal incentives may not provide much help.” CSHSC’s Alwyn Cassil drives home the point: “If you thought the increased Medicaid reimbursement was going to get a lot more docs to jump in and be willing to take on new Medicaid patients, it’s not going to work that way.”

Rather than expand a broken system, Congress should have acknowledged that the program is not structurally sound. It already places an untenable financial burden on states and does not pay providers enough, resulting in low-quality care for those who depend on it. Unfortunately, Obamacare does not provide a permanent solution to these serious problems, instead exacerbating them.

This post was co-authored by Meera Yogesh. Yogesh is currently a member of the Young Leaders Program at The Heritage Foundation.

The Truth: States expand Medicaid by paying Physicians less! New York, Rhode Island, New Jersey, California, D.C., Maine, Florida, Illinois, Minnesota, and Michigan have the lowest Medicaid reimbursement

H/T

Avik Roy, Contributor

The Apothecary is a blog about health-care and entitlement reform.

How Do Blue States Expand Medicaid? By Paying Doctors Less 

New York, Rhode Island, New Jersey, California, D.C., Maine, Florida, Illinois, Minnesota, and Michigan have the lowest Medicaid reimbursement.New York has the worst Medicaid primary care reimbursement rates in the nation.

The biggest health-policy debate in America right now is whether or not states should opt in to Obamacare’s dramatic expansion of Medicaid, our government-run health care program for the poor. Governors from both parties are concerned that the costs of the expansion will be higher than projected, and that the federal government will back out of its funding commitments. But if you want to see the future of Medicaid, all you have to do is look at the blue states where progressives hold sway, where governments have expanded Medicaid by paying doctors less.

Medicaid suffers from the developed world’s worst health outcomes. The main reason is that the program pays doctors and hospitals so little that many doctors lose money treating Medicaid patients. As a result, many doctors don’t take Medicaid, and people on Medicaid die sooner from cancers that could have been adequately treated at an earlier stage.

Given that Medicaid is jointly run by the states and the federal government, I thought it would be a useful exercise to look at how much Medicaid pays doctors on a state-by-state basis. The best data we have comes from a 2009 Urban Institute study by Stephen Zuckerman, Aimee Williams, and Karen Stockley, showing how state Medicaid fees vary from state to state, relative to Medicare’s fees. Medicare, in turn, pays doctors approximately 80 percent of what private insurers pay. I combined these data, and then created a map that illustrates the distribution of reimbursement rates, which you can click to enlarge.

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What’s notable is that, of the ten Medicaid states (including D.C.) that pay doctors the least, relative to private insurers, nine are reliably blue: New York (29 percent), Rhode Island (29%), New Jersey (32%), California (38%), D.C. (38%), Maine (42%), Florida (44%), Illinois (46%), Minnesota (46%), and Michigan (47%).

By contrast, of the ten states that pay doctors the most, nine usually vote red: Alaska (113%), Wyoming (94%), Idaho (82%), North Dakota (81%), Delaware (80%), Oklahoma (80%), New Mexico (79%), Arizona (78%), Montana (77%), and North Carolina (76%). Tennessee doesn’t use a fee-for-service formula for its Medicaid programs, so its fees couldn’t be compared to those of the other states.

The point of this analysis isn’t partisan. Some blue states, like Delaware, pay doctors reasonably well, and some red states, like Texas, don’t. But there is a rough correlation of states with extensive Medicaid programs to those with poor physician reimbursement.

Due to the way in which the federal government provides matching funds for state Medicaid programs, states have an incentive to game the system by increasing Medicaid spending. For every dollar that a state spends on Medicaid, the federal government spends an additional $1.33. Fiscally irresponsible governors love that they can take political credit for expanding Medicaid, knowing that taxpayers in other states are picking up the majority of the tab.

But because Medicaid spending grows at a much faster rate than other types of spending, drunken Medicaid expansions result in a fiscal hangover. Today, in a recessionary environment, states are facing expanded Medicaid rolls, with less tax revenue to fund them. On top of that, Obamacare bars states from rolling back their Medicaid eligibility criteria—a provision that may face legal challenges, in the aftermath of the recent Supreme Court ruling. Even before Obamacare, the mandarins at the U.S. Department of Health and Human Services would routinely block states from reducing their Medicaid populations.

So, if states need to reduce Medicaid spending, but can’t make less people eligible for Medicaid, what do they do? Pay doctors less. “As in previous years, provider rate restrictions were the most commonly reported cost containment strategy,” concludes an extensive Kaiser review of state-based changes to Medicaid in 2012. “A total of 39 states restricted provider rates in [fiscal year] 2011, and 46 states reported plans to do so in FY 2012.” Note that the Medicaid rates I supplied above are from 2008, and therefore four years out of date.

Obamacare includes a temporary, two-year bump in Medicaid fees for primary care, expiring in 2014. Progressives hope that this bump will become permanent, in the way that the Medicare “docfix” has. But our $1.4 trillion budget deficit makes that outcome unlikely. States that go forward with Obamacare’s Medicaid expansion are almost certain to compensate for it by reducing their provider payments. Don’t say you weren’t warned.

Are doctors in California, for example, less likely to accept Medicaid patients since they’ll get paid less?

Surprisingly, the academic literature suggests that’s not the case. There’s surprisingly little connection between how much a state pays its Medicaid doctors and the rate at which they accept new patients. The Center for Studying Health Care Change looked for such a connection in a 2009. It found that 42 percent of primary care doctors were willing to accept new Medicaid patients, fewer than would take on new private patients.

But when they looked for variation by state, the researchers had trouble finding anything significant. “On average, there is no variation in Medicaid acceptance rates among PCPs [primary care providers] depending on the overall level of PCP supply in the state,” the study concludes. “This is unexpected given that low-PCP states have substantially higher Medicaid reimbursement for primary care on average compared to high-PCP states.”

Factors other than reimbursement rates seemed to be better predictors of a physicians’ willingness to accept Medicaid. Doctors who work for a fixed salary — and therefore are a bit insulated from reimbursement rates — tend to have significantly more Medicaid patients than those who work on a fee-for-service basis.

But the HSC study she cites relates to the supply of primary care physicians, not what they’re paid. A different HSC study, by Chapin White, states clearly that “Increasing Medicaid fees is…clearly related to a reduction in…access problems.”

Furthermore, Sarah notes that doctors on a fixed salary, who are insulated from low reimbursement rates, see more Medicaid patients. This reinforces the notion that the low reimbursement rates are a barrier, not the opposite.