Just in case anyone has forgotten, the Associated Press and New York Times ran stories this weekend on how the new ObamaCare law distorts incentives and backfires in the effort to truly reform health-care costs. We’ll start with the AP, which looked into the novel innovation among doctors that creates de facto health insurance plans, based on the model used by law firms and retainers. That allows the wealthy to ensure access while locking out others, especially Medicare patients whose reimbursements don’t cover the costs of care:
Every year, thousands of people make a deal with their doctor: I’ll pay you a fixed annual fee, whether or not I need your services, and in return you’ll see me the day I call, remember who I am and what ails me, and give me your undivided attention.
But this arrangement potentially poses a big threat to Medicare and to the new world of medical care envisioned under President Barack Obama’s health overhaul.
The spread of “concierge medicine,” where doctors limit their practice to patients who pay a fee of about $1,500 a year, could drive a wedge among the insured. Eventually, people unable to afford the retainer might find themselves stuck on a lower tier, facing less time with doctors and longer waits.
Medicare recipients, who account for a big share of patients in doctors’ offices, are the most vulnerable. The program’s financial troubles are causing doctors to reassess their participation. But the impact could be broader because primary care doctors are in short supply and the health law will bring in more than 30 million newly insured patients.
Most doctors negotiate fees with larger insurers based on volume they expect to receive from being part of a network. If the government starts dictating terms between insurers and providers, as will have to happen with the state-run “exchanges” and the blizzard of coverage and cost mandates imposed in the individual-policy market, they will have much less negotiating room. The retainer structure allows them to guarantee a certain level of income, and patients with the means to guarantee access and timely care.
The AP is confused about Medicare and Medicaid in this piece; it’s the latter that adds 30 million enrollees, not the former. But the impact on provider access is the same, or even worse. That is a direct consequence of adding demand while artificially keeping prices low, a situation that guarantees shortages. Instead of increasing clinic care and improving health, the new law will paradoxically send more patients to emergency rooms instead, increasing actual costs.
The NYT gets the difference between Medicare and Medicaid correct in its article, and explains that the flood of new enrollees will likely mean less care and more problems: