CNN: “Doctor shortage, increased demand could crash health care system”

CNN reports:

Obamacare is expected to increase patient demand for medical services. Combine that with a worsening shortage of doctors, and next year you may have to wait a little longer to get a doctor’s appointment. And the crowded emergency room may become even more so. …

What happened in Massachusetts in 2006 when the state’s mandated health insurance rules went into effect illustrates the impending national problem.

When the Massachusetts law kicked in, wait times to get an appointment at primary care physicians’ offices increased significantly, and they’ve remained high ever since, according to anannual survey from the Massachusetts Medical Society. And Massachusetts has the second highest physician-to-population ratio of any state.

When patients couldn’t get doctor’s appointments they once again turned to emergency rooms. A Harvard study found all 11 of the emergency rooms that researchers studied in Massachusetts became busier after the law went into effect.

Read more at CNN.com.

(via FIRM)

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Government-run insurance exchanges: hampered by finances, complexity, and incompetance

In the Wall Street Journal, John Goodman explains why “The Government Is the Worst Vendor Possible for Managing Health-Insurance Exchanges.” Excerpts:

One problem is that too little money was budgeted for creating the exchanges, which are the online markets where people can choose among competing health plans and prices. …

A second problem is complexity. The Obama administration wants something the federal government has never done: a computer system that connects HHS, the Internal Revenue Service, the Social Security Administration, Homeland Security and perhaps other departments. This is a herculean task with unclear benefits. …

A third and much bigger problem is competency. … In July 2011, Fortune magazine reported that the government is spending $80 billion a year on buying and operating information technology, and much of it is simply wasted.  …

One of the worst mistakes the federal government makes is the tendency to try to reinvent systems the private sector has already invented. The government has been true to form under the health-reform law, completely ignoring private exchanges that are up and running.

John Goodman: Navigating the ObamaCare Maze – WSJ.com.

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AP: “Some unions now angry about health care overhaul”

The AP reports:

Some labor unions that enthusiastically backed President Barack Obama’s health care overhaul are now frustrated and angry, fearful that it will jeopardize benefits for millions of their members. …

While unions knew there were lingering issues after the law passed, they believed those could be fixed through rulemaking.

But last month, the union representing roofers issued a statement calling for “repeal or complete reform” of the health care law. Kinsey Robinson, president of the United Union of Roofers, Waterproofers and Allied Workers, complained that labor’s concerns over the health care law “have not been addressed, or in some instances, totally ignored.”

“In the rush to achieve its passage, many of the act’s provisions were not fully conceived, resulting in unintended consequences that are inconsistent with the promise that those who were satisfied with their employer-sponsored coverage could keep it,” Robinson said.

Some unions now angry about health care overhaul – Yahoo! News.

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Is Obamacare’s Fatal Flaw Taking Effect?

Paul Hsieh, MD writes:

The past month hasn’t been good for supporters of the Obamacare health law. One leading advocate, Senator Max Baucus (D-Montana), admitted that the implementation would be a “train wreck.” A recent study of Oregon health outcomes cast doubt on the benefits of expanding government health care, such that even the left-leaning Slate called it “bad news for ObamaCare.” The American public remains deeply skeptical of the law. In response, the federal government has been mounting a big public relations campaign to sell Americans on the alleged benefits of Obamacare.

More: PJ Media » Is Obamacare’s Fatal Flaw Taking Effect?.

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‘Risks’ loom for Colorado health exchange technology

Health Policy Solutions Reports:

As Colorado’s health exchange managers sprint toward an October 1 launch, a top manager warned board members on Monday that a recent decision to build a new “eligibility” IT system poses the greatest risk of delay and could undermine the quality of the online health marketplace.

Adele Work, who is leading implementation for the exchange, made a presentation about “key implementation risks” during a technology update for the board.

More: ‘Risks’ loom for health exchange technology | Health Policy Solutions.

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Health and Human Services Secretary Doesnt Understand What Insurance Is

Megan McArdle at the Daily Beast:

Kathleen Sebelius, the Secretary of HHS, thinks that catastrophic insurance isn’t really insurance at all.

At a White House briefing Tuesday, Health and Human Services Secretary Kathleen Sebelius said some of what passes for health insurance today is so skimpy it can’t be compared to the comprehensive coverage available under the law. “Some of these folks have very high catastrophic plans that don’t pay for anything unless you get hit by a bus,” she said. “They’re really mortgage protection, not health insurance.”

She said this in response to a report from the American Society of Actuaries arguing that premiums are going to rise by 32% when Obamacare kicks in, as coverage gets more generous and more sick people join the insurance market.  Sebelius’ response is apparently that catastrophic insurance isn’t really insurance at all–which is exactly backwards. Catastrophic coverage is “true insurance”.  Coverage of routine, predictable services is not insurance at all; it’s a spectacularly inefficient prepayment plan.

More: Health and Human Services Secretary Doesnt Understand What Insurance Is – The Daily Beast.

via. Heartland Institute, Consumer Power Report #366.

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Will you lose your employer-based coverage and be herded into an insurance exchange?

Medicare actuary Richard Foster has predicted that “nearly everyone” will end up buying government-approved health coverage through exchanges.  Several independent analyses have given credence to this.

After all, a Ways and Means Committee report shows that Fortune 100 companies each save more than $400 million by not offering insurance and sending employers to exchanges.  Deloitte finds that at least nine percent of employers will drop coverage. McKinsey’s estimate is 30%.  The Congressional Budget Office estimates that seven million employees will lose employer-based coverage. The Economist reports on similar trends.

If you end up buying health coverage through a government-run exchange, worry about having a narrow provider network and long waits for appointments.  Also worry that the the policies will cater to healthy plan holders and under-provide to the sick.

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ObamaCare: Three Years of Broken Promises

At National Review, Cato‘s Michael Tanner writes:

The Patient Protection and Affordable Care Act, a.k.a. Obamacare,  turned three years old this week. But unlike fine wine, the ACA is not getting better with age. A torrent of recent studies and reports has provided new evidence — as if we needed more confirmation — that nearly everything we were told about this law was untrue.

Tanner takes on these promises:

If you like your doctor, you will be able to keep your doctor, period. If you like your health-care plan, you’ll be able to keep your health-care plan, period.

— President Obama, June 15, 2009

This law will cut costs and make coverage more affordable for families and small businesses.

— President Obama, June 22, 2010

This legislation will also lower costs for . . . the federal government, reducing our deficit by over $1 trillion in the next two decades. It is paid for. It is fiscally responsible.

— President Obama, on signing the Affordable Care Act

It’s about jobs. . . . In its life [health-care reform] will create 4 million jobs, [and] 400,000 jobs almost immediately

— Nancy Pelosi, February 25, 2010

Quality, Affordable Health Care for All Americans

– Title 1 of the Patient Protection and Affordable Care Act

Read more: Three Years of Broken Promises – National Review Online.

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Colorado Health Benefits Exchange: poor access & narrow provider network?

At Forbes, Scott Gottlieb, MD provides a warning for Coloradans who will to buy health coverage through the Colorado Health Benefits Exchange (“Connect for Care Colorado”):

There’s an astute article in today’s edition of the Wall Street Journal by veteran healthcare reporter Anna Mathews. It outlines the scope of health plans that will be offered on the new exchanges taking shape this fall. And why Obamacare is looking more and more like Medicaid.

Mathews notes that hospitals are giving up discounts to the new exchange-based health plans. In turn, the hospitals plan to make up these discounts through the narrow networks of providers that consumers will be able to choose from. The bet that these hospitals are making is that they can offset the discounts by getting more volume. …

[Wi]th fewer out-of-pocket costs, consumers will also have far less skin in the game. In turn, they will have less incentive to constrain their demand for services.

That constraint will instead be applied by the providers themselves, through the limitations that they place on access. Not by outright denying care, but by funneling patients into overworked networks that make it much harder to actually get appointments and schedule needed services. This is exactly how rising demand is managed under Medicaid. It’s one more reason why Obamacare coverage is likely to resemble Medicaid over time.

More: The New Obamacare Insurance Is Looking More Like Medicaid – Forbes.

See also: Survey: Medicaid-Level Rates Could Cripple Health Insurance Exchanges.

 

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Tech troubles could hobble Colorado health exchange

Health Policy Solutions reports:

Colorado’s health exchange is supposed to debut in just six months, but having the technology ready by Oct. 1 may be an impossible task.

Critical problems threaten the system, ranging from a lack of coordination with the state’s technology office and historic problems with state IT systems to poor oversight by exchange managers and contractors and the potential for serious conflicts of interest among those charged with creating the complex multi-million dollar exchange system.

More: Tech troubles could hobble health exchange | Health Policy Solutions.

See also Avik Roy at Forbes: “CMS on Obamacare’s Health Insurance Exchanges: ‘Let’s Just Make Sure It’s Not a Third-World Experience‘”

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