Friday, April 09, 2010

Try not to get sick, or just take a pain pill.

(Updates follow below)

If Massachusetts really is a small-scale test of Demcare/Obamacare, then the era of modern medicine in America is undeniably drawing to a close.

The health care system here in Massachusetts is already starting to implode. Three out of the four largest health insurers in the sate lost money in 2009. Governor Deval Patrick - whose campaign David Axelrod ran in 2006 - has essentially imposed price controls in order to prevent cash-strapped insurers from raising rates to meet costs. As a result, these same insurance companies have now stopped selling any new policies in Massachusetts because they can't afford to insure any more people. That's right: at this moment in time, small businesses and individuals cannot buy health insurance in Massachusetts.

This setback may seem ironic given that the intention was to provide health care to more people rather than fewer, but it's actually perfectly predictable because it's pretty much what I wrote about when the Obamacare bill passed a couple of weeks ago.

It turns out that some people in Massachusetts have been scamming the system by only buying insurance before major medical expenses are anticipated, and then dropping the insurance once the emergency is over. Since insurers are required to offer insurance to anyone - just like they soon will be nationwide under Obamacare - such scamming makes financial sense as long as the total price of short-term coverage plus penalties is lower than the price of a full 12 months of health coverage.

The really scary thing is that the Massachusetts health insurance policy is only a light version of Obamacare. Massachusetts isn't (yet) punishing insurers, hospitals, or health-care companies with new fees and taxes.

Needless to say, Massachusetts is becoming a less desirable place to be an insurance company, and by extension a less desirable place to practice medicine. My own experience seems to back this up, as I'm waiting almost three months to get my first regular check-up with a brand new doctor at Harvard-Vanguard.

It's too late for us to learn from the lesson of Massachusetts because Obamacare has already become the law of the land. Doctors, patients and insurance companies in Massachusetts can always flee to one of the other 49 states, but when Obamacare kicks in for real, there will be nowhere left to run. The only escape for doctors will be to leave the field, the only option for insurance companies will be to stop doing business, and only the wealthiest Americans will be able to fly overseas for cutting-edge procedures - IF there are any other countries left with free-market medicine.

So my advice to most of my countrymen is simply to not get sick. And when mortality inevitably catches up with you, just take a pill to dull the pain. As a matter of fact, that's exactly what Obama smoothly advised last year:

p.s.: (April 11) The last of the small steps towards fully socialized medicine is now easy to see. Once the private insurance companies either stop taking new customers or go bankrupt from the double-whammy of scammers and price controls, the government will "save us" with mandatory national insurance for all.

Another option is for Massachusetts (and the Dems nationally) to make a show of stopping insurance scamming by increasing the non-insured penalty until it's higher than the price of an insurance policy. At that point, the penalty fees might as well be used to sign those people up to a national program, which will be seen as more humane than just punishing them.

Update: (April 12) The webpage in question is currently overwhelmed with traffic, but CNS News is reporting that 60 hospitals planned for construction will have to be canceled because the 2000-page Obamacare bill has essentially outlawed any new physician-owned hospitals from being built. After all, what could physicians possibly know about running a hospital?? Once again, a bill that was sold as a way to increase access to health care seems to be doing the opposite, exactly as its opponents warned it would from the beginning.
( – The new health care overhaul law, which promised increased access and efficiency in health care, will prevent doctor-owned hospitals from adding more rooms and more beds, says a group that advocates physician involvement in every aspect of health care delivery.

Physician-owned hospitals are advertised as less bureaucratic and more focused on doctor-patient decision making. However, larger corporate hospitals say doctor-owned facilities discriminate in favor of high-income patients and refer business to themselves.

The new health care rules single out such hospitals, making new physician-owned projects ineligible to receive payments for Medicare and Medicaid patients.

Existing doctor-owned hospitals will be grandfathered in to get government funds for patients but must seek permission from the Department of Health and Human Services to expand.

To get the department’s permission, a doctor-owned hospital must be in a county where population growth is 150 percent of the population growth of the state in the last five years; inpatient admissions must be equal to all hospitals located in the county; the bed-occupancy rate must not be greater than the state average, and the hospital must be located in a state where hospital bed capacity is less than the national average.

The rules fall under Title VI, Section 6001 of the Patient Protection and Affordable Care Act. The provision is titled “Physician Ownership and Other Transparency – Limitations on Medicare Exceptions to the Prohibition on Certain Physician Referral for Hospitals.”

More than 60 doctor-owned hospitals across the country that were in the development stage will be canceled, said Molly Sandvig, executive director of Physician Hospitals of America (PHA).

“That’s a lot of access to communities that will be denied,” Sandvig told “The existing hospitals are greatly affected. They can’t grow. They can’t add beds. They can’t add rooms. Basically, it stifles their ability to change and meet market needs. This is really an unfortunate thing as well, because we are talking about some of the best hospitals in the country.”

The organization says physician-owned hospitals have higher patient satisfaction, greater control over medical decisions for patients and doctor, better quality care and lower costs. Further, physician-owned hospitals have an average 4-1 patient-to-nurse ratio, compared to the national average of 8-1 for general hospitals.

Further, these 260 doctor-owned hospitals in 38 states provide 55,000 jobs, $2.4 billion in payroll and pay $509 million in federal taxes, according to the PHA.

In one ironic aspect, President Barack Obama’s two largest legislative achievements clashed. The Hammond Community Hospital in North Hammond, Ind., got $7 million in bond money from the federal stimulus act in 2009. It will likely be scrapped because of the new rules on physician-owned hospitals, according to the Post-Tribune newspaper in Merrillville, Ind.

Doctor-owned hospitals have long been a target of the American Hospital Association, which represents corporate-owned hospitals as well as non-profit hospitals.

An AHA study from 2008 says that physician-owned hospitals “lessen patient access to emergency and trauma care;” “damage the financial health of full-service hospitals and lead to cutbacks in service;” “are not more efficient than full service community hospitals;” “use physician-owners to steer patients;” “cherry pick the most profitable patients;” and “provide limited or no emergency services.”

One AHA fact sheet asserts that physician-owned orthopedic and surgical hospitals costs are 20-30 percent higher than average hospitals. Further, these hospitals lead to higher profits just for doctors, the AHA asserts.

“We don’t cherry pick patients, period, end of story. We take patients based on their need for care, not on their ability to pay,” Sandvig said. “It [the health care reform] puts control outside the hand of physicians and patients and into bureaucrats’ hands really.

The Association of American Physicians and Surgeons (AAPS) is one of many organizations suing to have the law declared unconstitutional on the grounds that the federal government cannot compel someone to buy a product.

While the provision on physician hospitals is not part of the lawsuit, it will affect it, said Dr. Jane Orient, AAPS executive director.

“If the law is declared unconstitutional, then the prohibition is part of the bill,” Orient told “There are vested interests in getting rid of physician-owned hospitals because they do a better job and are more affordable.”

The provision in the legislation and efforts opposing these hospitals can be simply explained from Sandvig’s view.

“It’s anti-competitive. I think it’s pretty clear,” Sandvig said. “We’re a model that makes sense that’s affecting innovation. We’re trying to do something better than it has been done. Anytime you do that, there’s going to be a clash between the existing and the new. Unfortunately, it’s a real David and Goliath battle.”


The Western Chauvinist said...

There is a third way. Get a government job - preferably in Congress and enjoy the upper tier of the two-tier system employed in all the socialist countries. That gets you the "key" (literally) to the hospital penthouse on the top floor where the best care available is provided.

BTW, have you heard Hugh Hewitt's theory that Deval Patrick will be Obama's supreme court nominee? He says Patrick is a friend, is in trouble in his re-election bid and is very smart and qualified. What do you think?

Jody Wilson said...

Yes, of course the members of the Politburo get the best of what the socialist state has to offer.

Well, Patrick read Axelrod's words off of the teleprompter with as much skill as Obama did, so I guess that qualifies him for just about anything.

ismellarat said...

What's the situation for Canadian government employees? Do they die on waiting lists like everyone else?

That would make for a good story here, or for Mish.

Jody Wilson said...

A better question is how many Americans have been dying up until now due to a lack of health insurance. That, after all, is the most heart-wrenching excuse for socializing medicine in the first place.

But to answer your question: No, members of the Canadian government have been able, up to this point, to travel to the U.S. for superior critical surgery. Now that we're going to Canadian-ize our system, I guess Canadian officials will have one fewer option.

ismellarat said...

I was wondering more along the lines of if some special, alternate health care system exists *within* Canada, for the "elite." I'm actually surprised that this guy went to the US for treatment, so this at least might mean that they do put themselves in the same boat as everyone else.

But I still can't quite believe it - would a member of Parliament really be told to wait a few months for open heart surgery, the same as any commoner would? And if not, where and how do they draw the line between the commoners who must wait, or who are denied certain treatments altogether if too old or sick, and those whose lives are considered to be "worthwhile" at any age or condition? I'd imagine that drawing such a line would be very problematic for them - giving, say, an 80-year old Prime Minister costly life-saving treatment denied other 80-year olds must be a PR nightmare.

As it should be!

Cathy said...

One word: rationing

Ugly word.

Jody Wilson said...

Two words: Death. Panels.

Cathy said...

One word: HELP!!

Cathy said...

Oh yes. I'd seen that business about those cancellations.

It begins.

And we need to thwart it in November.