Thursday, November 22, 2012

The High Price of Nickel-and-Diming Doctors

The High Price of Nickel-and-Diming Doctors

By  on November 21, 2012
 / Bloomberg Business Week

The above article describes the difficult decisions that more and more physicians are forced to make to abandon private practice and take a salaried position with a hospital - and how this affects your health care, and the cost of care in general:

"Dr. Thomas Lewandowski, a Wisconsin cardiologist, had a tough choice to make in 2010 after the federal government yet again reduced the payments he received for treating Medicare patients: He could fire half his staff to keep his practice open, or sell it to a local hospital. He sold, becoming one of more than 6,000 employees at ThedaCare, which runs five hospitals and numerous clinics in the northeastern part of the state. Lewandowski is among thousands of once-independent doctors who are joining with hospital chains to stay afloat, a trend that threatens to raise the price of health care even as the federal government strains to keep a lid on costs."

Read the whole thing here.

The above article does a nice job explaining the tremendous short-term health care cost -inflating consequence and other adverse consequences of driving former private practice physicians into hospital employee status. With it, the delivery of all health care services is forced into the setting of expensive high-overhead, high-tech, glossy, magnificent glass - and steel corporate settings. By that standard, ObamaCare would seem not to make sense and to produce the opposite effect of its promise of making health care "affordable". 

Of course, it does- but n reality, ObamaCare is not about affordability or health care- it's about control. 

First step: Raise administrative costs and hassles and drop reimbursements to force all previously private, independent  physicians into salaried employee status- where they seek refuge for a stable salary from the government onslaught. Benefit: they are now under the control of  a couple hundred giant hospital corporations - the new "Accountable Care Organizations" (and thus hospital administrators),  which can then be much more easily controlled by the federal government.

Next step: Bundled lump sum payments  from Medicare / Medicaid - and federally organized state-wide insurance monopoly exchanges- to  hospitals and their employed, salaried doctors- now run as  "Accountable Care Organizations"-  to force employed doctors to ration out medical services to patients under financial or administrative pressure or threat - from hospitals- under threat or risk of their own financial self- sacrifice or self-destruction or professional self-destruction/ job loss by their powerful ACO employer.

Next step: Structure all private and employer-provided health insurance in such a way that insurance premiums will be driven progressively higher, and simultaneously institute much less expensive  fines. 
This provides a double incentive for individuals and employers to forgo buying - or just dump-  their own private coverage and for  businesses to stop providing employee health coverage and dump their employees into the federally -run, state-labelled insurance monopoly exchanges.

As premiums rise, the private insurers which were jumping up and down with delight when ObamaCare was passed thinking they were now guaranteed massive profits by all the people and businesses now *forced* to buy their products- will progressively fail financially and dump their newly uninsured onto the government exchanges and directed onto the government Medicaid roles. Presto: single payer government run health care. One payer- the US government- sets all the rules and the payments.

Next step: Let the blood-letting and cost cutting begin. Across the board cuts to all hospitals/ ACO's  and their employed doctors while simultaneously and progressively squeezing more and more work for them for less pay like blood like a stone- far worse than the current situation. 

Next step: Meltdown across the system- Physicians and nurses will resign from the employed status under slave labor conditions in beautiful glass and steel hospital structures (don't worry - the physical plant  will rapidly deteriorate as number of support staff get cut) , with diminishing numbers of demoralized, overworked, underpaid medical staff with lower and lower staff to patient ratios, higher stress and ever expanding hours and responsibilities with prison-like working conditions. Mass exodus- back into fee for service system or out of medicine entirely for self-preservation. 

All of this , of course, will be happening simultaneously over the next several years- rather than in discrete steps - and all is brought to you by your federal government- who "cares' about your health care....

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