Medicare is in deep trouble because it is a single payer health care system that seeks to cut costs by, among other ways, restricting physician and facility compensation. As a consequence, we are seeing the ongoing collapse of the system as doctors restrict their patient load and cease providing optimal care. From the story:
Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you’re a senior covered by Medicare, the wait is eight weeks. How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he’ll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District’s Foxhall Internists group who recently announced they will no longer be accepting Medicare patients. “It’s not easy. But you realize you either do this or you don’t stay in business,” she said.
Doctors across the country describe similar decisions, complaining that they’ve been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress. And that’s not even taking into account a long-postponed rate-setting method that is on track to slash Medicare’s payment rates to doctors by 23 percent Dec. 1. Known as the Sustainable Growth Rate and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy’s overall growth rate. But after the SGR formula led to a 4.8 percent cut in doctors’ pay rates in 2002, Congress has chosen to put off the ever steeper cuts called for by the formula ever since.
The same thing is happening in Medicaid.
True, Obamacare isn’t single payer, but it intends to so hobble the private sector that we have no other place to go.
Solving this mess will require dynamic action. First, increase competition in the system, including by price. Obamacare seeks to limit it. Second, decentralize control to allow creativity and dynamism in the marketplace. Obamacare stifles it. Third, we all need to pay for part of our own health care, perhaps means tested, and provide vouchers for people so they can buy private coverage. Obamacare tries to give the proverbial free lunch, of which there is no such thing. Fourth, we have to triage government generally–that is wipe out/consolidate whole sectors of federal bureaucracy that have less urgent functions. Fifth, we need to cut regulations that stifle grown and the production of wealth.
Some of these areas are beyond SHS’s scope. But the unfolding Medicare/Medicaid debacle shows we are currently heading in exactly the wrong health care direction.
November 26th, 2010 | 11:43 am
[...] This post was mentioned on Twitter by Vince Humphreys and J. Robert Howell, Wesley J. Smith. Wesley J. Smith said: Obamacare: Medicare’s Travails and the Loss of Optimal Care » Secondhand Smoke | A First Things Blog http://bit.ly/fVE0oq [...]
November 26th, 2010 | 4:21 pm
“True, Obamacare isn’t single payer” [gee, good of you to admit it] “but it intends to so hobble the private sector that we have no other place to go.”
It “intends”? Now how, exactly, do you know what it “intends”? The answer is, you don’t know any such thing
Your claim is nonsensical, since you know perfectly well that the reforms put in place under “ObamCare” to correct well-documented abuses by private insurers, are long overdue, and that the industry will adapt to them. Really, Wesley, sometimes I think the RNC writes your columns for you.
November 27th, 2010 | 4:13 am
These are all common sense suggestions – thanks for making some reality-based, solid proposals instead of pie-in-the-sky wishful playing with numbers. The system is the problem: messing around “at the margins” isn’t going to make it viable for the long term. Rethinking our whole approach is necessary. Or we could just bury our heads in the sand, like the EU countries did for so long, lying to each other, the markets, the rest of the world… until their socialist systems threaten to topple – a fate any system must eventually suffer which relies on OPM – Other People’s Money – to survive. Everything looks great until you run out of OPM.
November 27th, 2010 | 10:27 am
as HW noted, just more RNC Pablum…
“First, increase competition in the system, including by price.
Second, decentralize control to allow creativity and dynamism in the marketplace.
Third, we all need to pay for part of our own health care, perhaps means tested, and provide vouchers for people so they can buy private coverage.
Fourth, we have to triage government generally–that is wipe out/consolidate whole sectors of federal bureaucracy that have less urgent functions.
Fifth, we need to cut regulations that stifle grown and the production of wealth.”
The only thing you forgot was to cut taxes on the wealthy.
The unfettered marketplace is not up to the task of equitably delivering healthcare. If one considers healthcare to be an important national issue, like defense and immigration, then government intervention is required. If one considers it a consumer issue, like buying televisions or dog food, than the market will distribute the resource by supply and demand.
By nature, insurance corporations prefer not to insure the elderly and the ill at a affordable prices. That’s why the government stepped in. The US is the only wealthy nation with a for-profit healthcare system, which may explain why we pay twice as much as necessary for a substandard product.
Healthcare costs are increasing much faster than general inflation and are projected to consume a more and more onerous proportion of GDP. President Clinton recognized this 20 yrs ago. President Obama recognizes it now. Conservatives prefer the status quo.
We do not lack the know-how, but we do lack the political will.
November 27th, 2010 | 11:17 am
You forgot to mention the most effective component of health care reform – personal responsibility.
Given how astoundingly unhealthy the US is and how many are too undisciplined to eat and live within the parameters of our evolution, some drastic changes in lifestyle would go a long way to reducing diabetes, heart disease, and other chronic conditions.
Blaming big guv’mint is always easier, though.
November 28th, 2010 | 1:03 pm
How about: Eliminate the government subsidy of employer based health insurance.
This amounts to some $300 billion per year and is one of the reasons we pay twice as much as necessary for healthcare.
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