Unbending the Curve

Since the Latino Activist and The Illegals are focused on Armegeddon and the Nazi Holocaust because Illegal mean Illegal.

I want to focus on a real Armageddon coming down the pike, ObamaCare.

IBD:  An analysis from an objective source — Medicare’s actuary — says ObamaCare will increase costs and relies on projected savings that may be unrealistic. Now isn’t that a surprise?

The Obama administration has been trying hard to find good news in a new report by government experts on the outlook for the health care economy, now at 17% of GDP and continuing to climb.

To HHS Secretary Kathleen Sebelius, the analysis confirms that “the Affordable Health Care Act will cover more Americans and strengthen Medicare by cracking down on waste, fraud and abuse.”

More neutral observers will notice that the administration no longer talks about “bending the cost curve” in health care. The analysis released last week by Medicare’s Office of the Actuary tells why. It looks ahead 10 years and reaches two conclusions about the new health care overhaul: More people will be covered, and costs will continue to soar. The cost curve is unbending still.

But since costs wasn’t why The Democrats passed ObamaCare to begin with…

Chief Actuary Richard Foster pegs ObamaCare’s added costs (that is, beyond what was projected without the overhaul in effect) at $311 billion over 10 years. That’s just under 1% of overall expected health care spending, and administration officials are calling that sum a small price to pay for adding 34 million Americans to public or private insurance rolls.

But the president had set a goal of extending coverage without adding any new cost. More to the point, the problem of runaway costs that plagued the pre-overhaul health care system has not been solved. As Foster points out, much of what ObamaCare proposes to reduce the nation’s health tab, especially in Medicare, is politically unrealistic.

The overhaul projects a net decrease in projected Medicare spending (more accurately, a reduction in future spending increases) of more than $400 billion. But Congress has talked this way before and has been notably timid about pulling the trigger.

Under a 1997 law, for instance, a 21% cut in Medicare reimbursements to physicians was supposed to go into effect on April 1. But Congress two weeks later put the cut on hold as part of a bill to extend unemployment benefits. As usual, mobilized doctors and frightened seniors got their way.

This pattern of avoiding politically difficult spending cuts has been going on pretty much since the start of Medicare. ObamaCare promises that this behavior will somehow change. That would be a miracle, and actuaries tend to stick with more mundane probabilities.
And like any good actuary would be, Foster is unimpressed with the cost-reduction side of the ObamaCare equation. He says “the long-term viability of the Medicare … reduction is doubtful.”

Nothing in Foster’s report should come as a surprise, since it was clear from an early stage in the health care debate that the Democratic Party had one overriding goal — universal coverage or something close to it — with cost-reduction secondary.

The cost-cutting promises served mainly to obscure the actual price tag of the overhaul in future taxes and deficits. They were a means to the end of extending insurance, and to that degree they worked — as politics. But as policy they are empty promises.

Foster’s study is further evidence of how badly ObamaCare missed the point. All along, high cost has been the fundamental problem with American health care; the lack of universal coverage was only one symptom. To put it another way, the problem of coverage would have been solved long ago, largely by the private sector, if the medical tab in the U.S. were more like that in other advanced nations.

At 17% of GDP and rising, the nation’s health care economy is a case study in how to structure incentives, price signals (if any) and buying power to maximize inflation. Those who receive services hardly ever pay for them directly, and prices are rarely revealed, much less advertised.

Providers long ago learned the power of lobbying to keep the money rolling in and to defeat any attempts at fiscal restraint. What was billed as “reform,” in other words, actually reformed nothing.

But gave the government the in-road to taking it over completely, which was the plan all along…

And while the full effects of ObamaCare might not be felt until Tax Day 2014, the promise of free health care to millions of Americans will begin to prove hollow long before then.

Already Rep. Henry Waxman, D-Calif., says the public option might not be dead if insurance companies do not offer competitive rates within the exchanges. And Sen. Tom Harkin, D-Iowa, has revived a proposal that gives the secretary of health and human services the power to review premiums and block any rate increase bound to be “unreasonable.”

America’s primary care system is already under stress. Low reimbursement rates, bureaucratic paperwork and long hours are driving family physicians out of medicine and pushing new doctors into specialized practices. Half a century ago, one in two doctors practiced general medicine. Today, 7 in 10 specialize.

And the gap is growing. A mere 1 in 12 medical-school graduates now head to family medicine. In 2009, the American Academy of Family Physicians warned that we’d be short 40,000 family doctors in a decade, if present trends continued. Today, medical schools produce one primary care doctor for every two who are needed.

ObamaCare will add strain to an already burdened system. The new bill seeks to increase the load on family doctors while holding the line on costs by putting price controls on government insurance plans. In due course, price controls on private plans will be inevitable.

We saw them come into effect on April 1 in Massachusetts, when the state Division of Insurance rejected 235 of 274 premium increases proposed by insurers for individuals and small businesses. The rate increases — ranging from 8% to 32% — were deemed excessive.

The combination of increased coverage and emphasis on primary care, experts say, will increase demand for primary care docs by as much as 29%, or 44,000 doctors, over the next 15 years.

But just as demand is increasing, doctors are making plans to exit. A 2009 survey by medical recruiters Merritt Hawkins found that 10% of respondents were planning to leave medicine within three years.

Another poll of physicians conducted in 2009 by Investor’s Business Daily found that 45% of doctors would consider early retirement if ObamaCare passed.

So higher demand and lower supply equals what exactly? 🙂

Paging Dr Fine…

Let me tell you what happened to me on this last Monday. My blog was very late that day because I was at an Urgent Care center. I got there at 11am.

I was taken into exam room at 1pm.

Doctor came in at 1:45pm

I was out the door by 2:30pm because it was a lot serious in the end that I thought it was.

But what I am focusing on is that an “Urgent Care” facility had this long wait because they were short staffed for doctors I heard. They only had 2.

And waiting room full of people.

Then I started to hear about doctor shortages and the Health Care reforms that will short Doctors on their payments and making no less bureaucratic than it is now. Probably even more so.

I have already said one of the real reforms need is Tort Reform, where the doctor doesn’t run unnecessary and expensive test just to be pararnoid that if they don’t run it somewhere down the line they’ll be sued for not running them

This drives up the costs.

Then I ran across this article about Canada’s health care and the long wait times due to doctor-patient ratios.

The Hill: After more than a decade of public healthcare with mandatory coverage, so many Canadian doctors have left the practice and so many young people have entered other fields that Canada ranks 26th of 28 developed nations in its ratio of physicians to population. Once, Canada ranked among the leaders in the number of physicians, but that was before government health care drove doctors out of the practice in droves.

The fundamental fact is that we cannot cover 36 million new patients without more doctors and nurses, much less with the declining census of medical professionals the Canadian experience points to. A recent survey of doctors by the Pew Institute found that 45 percent of all practicing doctors would consider retiring or closing their practices if the Obama healthcare bill passes. This scarcity of medical personnel heightens the likelihood of draconian rationing, lengthy waiting lists and lower-quality medical care for all of us, particularly for the elderly.

This physician shortage leads to massive and never-ending waiting lists. In 1993, for example, there was an average wait of 9.3 weeks from the time a patient got a referral from a general practitioner to the time he could see a specialist. By 1997, the wait was up to 11.7 weeks. Now it’s 17.3 weeks — over four months just to see a specialist!

In Canada, unions control the entire healthcare process. In Manitoba, for example, there is an eight-month wait for colonoscopies, yet the unions do not permit weekend or evening procedures, thereby extending the waiting lists. The unions are doing to health care in Canada what they have done to education in America: stifling creativity, reinforcing bureaucracy and extending waiting times.

Because of these long waits for colonoscopies, there is now a 25 percent higher incidence of colon cancer in Canada than in the United States. And because the leading drugs that we routinely use to treat the malady in the U.S. are banned in Canada because of their high cost, 41 percent of Canadians who get the cancer die of it, compared with only 32 percent in the United States. Overall, the cancer death rate in Canada runs 16 percent higher than in the United States. Cancer does not wait for waiting lists to clear.

The proposed $400 billion cut in Medicare raises the probability that more and more of those doctors who do practice will refuse to accept Medicare patients, aggravating the doctor shortage among the elderly, the population that needs them the most.

Utopia awaits! 🙂

UK Telegraph 4/2009: “We’re not producing enough primary care physicians,” Mr. Obama said at one forum. “The costs of medical education are so high that people feel that they’ve got to specialize.” New doctors typically owe more than $140,000 in loans when they graduate.

And paying them less, and leaving malpractice insurance and paranoia of law suits, not to mention a Bureaucrat in Washington making decisions for them, sure sounds like a good career path to me. 🙂

Miriam Harmatz, a lawyer in Miami, said: “My longtime primary care doctor left the practice of medicine five years ago because she could not make ends meet. The same thing happened a year later. Since then,many of the doctors I tried to see would not take my insurance because the payments were so low.”

So that where the so-called “doctor fix” comes in. You bribe them with an “off the books” bribe of $250 million dollars so that it’s not counted in the 1 trillion plus accounting legerdemain that both houses of Congress are engaged it.

If we don’t count it, it won’t count. Magically disappearing debt!

Simple, right? 🙂

Democrats plan to make ObamaCare “deficit-neutral” by moving nearly a quarter-trillion dollars off the books, one of the great fiscal deceptions of the century.

In January, doctors fees are scheduled to fall by 21.5%, and 40% over the next five years. That would force many doctors to stop seeing Medicare patients, so Congress intervenes every year and temporarily overrides the cuts.

But now they are going to cut as much as $500 million from Medicare to pay for the new Albatross on the block. But to do that means even more cuts, so very likely, less Doctors to treat you.

So we have the fix of the century. And it doesn’t count. 🙂

And it’s not their fault. 🙂

Self-interest is more important than principles.

Hill: The drug industry backed ObamaCare and, in return, got a 10-year limit of $80 billion on cuts in prescription drug costs.

WSJ: The American Medical Association’s asking price for supporting ObamaCare is scrapping the SGR (Created in 1997, the SGR slashes Medicare reimbursements if costs rise too steeply, as they always do).

So now Democrats are simply going to “untether” this spending on doctors from ObamaCare, hiding even more of its true costs. At a meeting on the Hill last week, Mr. Reid and White House Chief of Staff Rahm Emanuel made the quid pro quo explicit, telling the AMA and about a dozen specialty societies that in return for this dispensation they expect them to back ObamaCare, no questions asked.

The AMA does support Obama. As does AARP.

The Hill: The AARP got a financial windfall in return for its support of the healthcare bill. Over the past decade, the AARP has morphed from an advocacy group to an insurance company (through its subsidiary company). It is one of the main suppliers of Medi-gap insurance, a high-cost, privately purchased coverage that picks up where Medicare leaves off. But President Bush-43 passed the Medicare Advantage program, which offered a subsidized, lower-cost alternative to Medi-gap. Under Medicare Advantage, the elderly get all the extra coverage they need plus coordinated, well-managed care, usually by the same physician. So more than 10 million seniors went with Medicare Advantage, cutting into AARP Medi-gap revenues.

Presto! Obama solved their problem. He eliminates subsidies for Medicare Advantage. The elderly will have to pay more for coverage under Medigap, but the AARP — which supposedly represents them — will make more money.

Feel those bus tires on your back yet? Or are the knife wounds getting in the way? 🙂

It turns out the AMA is a cheap date. President J. James Rohack now looks ready to embrace whatever else Democrats offer up, even though the new bill only delays the SGR cuts for 10 years instead of doing away with the formula permanently. Never mind that the AMA’s other legislative priority—tort reform—is dead on arrival. ObamaCare is stocked with other provisions that punish doctors, such as a Medicare commission tasked with cutting spending but barred from raising the eligibility age or reducing benefits. In practice, this means it will only be allowed to crank down Medicare’s price controls on providers.

This doctor maneuver is such a cleverly dishonest solution to their many contradictory promises that we’re surprised Democrats didn’t think of it sooner.

So these endorsements are not freely given, but bought and paid for by an administration that is intent on passing its program at any cost.

Evil Capitalism Alert: When the supply goes down and the demand goes up– What happens to the price? 🙂

Ironically, just a little more than a decade ago, there was a doctor surplus. In 1996, a committee of the Institute of Medicine warned that the United States had a surfeit of doctors caused by foreign-trained physicians coming here to work and recommended freezing med-school class sizes and limiting first-year residency positions. A year later, Slate ran an article on an alternative strategy for reducing the number of doctors approved by the federal Health Care Financing Administration. Under the Graduate Medical Education Demonstration Project, 41 teaching hospitals received $400 million in exchange for not training between 20 percent and 25 percent of the medical residents they would otherwise have trained over the next six years.

According to some estimates, the demand for doctors will rise to between 1.09 million and 1.17 million by 2020—many tens of thousands more than we’ll actually have.

So, Paging Dr Howard, Dr. Fine, Dr. Howard!

“Sorry they can’t see you”

You’ll just have wait for Dr. Gov-Cheap N. Easy.

How does February sound? 🙂