Basically, what’s happening is that doctors – looking for stability, which is easily the least reliable quality of Obamacare right now – are ending their private practices and going back to hospitals. The problem there? Well, as the New York Times notes (through gritted teeth), hospitals are using this as an opportunity to increase fees, not efficiency (which would hopefully lower them). The NYT is hopeful – somehow – that the system will work itself out under Obamacare; alas, we all know what happens when the government decides to deal with the problems arising from governmental distortion of markets with more distortion of the markets, yes-no?
Anyway, Walter Russell Mead notes:
Absorbing private practices is just one more way hospitals can make themselves bigger and more powerful. The market power of hospitals relative to insurers is already one of the most pernicious market imbalances in U.S. health care. This trend will only make it even less balanced. The bigger hospitals get, the more they can jack up their prices—up to 44 percent higher according to one estimate.
Pace Mechanic, this isn’t just a short-term problem. The more doctors start working in hospitals, the less sustainable our current health care system looks in the long term.
…Our current health care system is sustainable? Because it’s been looking pretty freaking rickety since about, oh, 2009 or so.
PS: NO REPUBLICAN VOTED FOR OBAMACARE.
7 thoughts on “Quote of the Day, #Obamacare Will Get More Centralized edition.”
Well, there’s also the increased paperwork, and the ruinously expensive computer charting software that the law mandates.
(I’ve met supporters of the law who were shocked that making it mandatory to purchase one of the few certified software suites somehow made the software more expensive, instead of driving its cost down. Of course, the same people are scandalized when I point out that labor is a commodity, and supply:demand drives its worth. So I guess I shouldn’t be surprised.)
Speaking as a physician and a one-time health system executive, I can make this very simple. In the current regulatory, legal, business, and labor climate in most major metropolitan areas, it is becoming almost impossible for private practices to survive. Hospitals have a higher ability to manage malpractice risk, a stronger grasp on regulatory needs, and a better approach to non-physician labor. Plus, they get the physician out of being a small businessman, which state frankly sucks these days.
And as far as excessive billing is concerned, the simple solution is to allow the hospital to reverse the perverse incentive to do too much, by tying fixed payments to the general health of the patient and requiring the health system to manage the risk. Like, for example, we did for years with Medicare Advantage. You know, that highly successful and popular program that was gutted by Obamacare? Yeah, that one.
I really don’t think that this is a deep conspiracy to destabilize the health system and usher in single-payor, though. I think it’s just a bunch of morons with machine guns aiming at a system they’ve never understood and vaguely dislike. It’s animus and confusion, handed neatly to a group of regulators without portfolio.
“I think it’s just a bunch of morons with machine guns aiming at a system they’ve never understood and vaguely dislike. ”
Depressingly, I think that this can be the default assumption with regard to a lot of the current administration’s policies. I say ‘depressingly’ because I’d rather have competent schemers running the country than incompetent idiots. Less to clean up after later.
Destroying private practices was one of the key steps for establishing Gov run healthcare in Austrailia. This ain’t no bug. Turn doctor’s into employees and then cut deals with the company execs. And as a bonus, the Unions can start working on organizing doctors.
Yep. Keep pushing that snowball, and pretty soon it will start rolling on its own, leaving a path of destruction in it’s wake.
Remember when people always used to encourage you to get a second opinion on major illnesses. How will you do that now? Doctors have been joining hospital groups ever since this thing passed due to the challenges of complying with the law.
Second opinions are one of those “defensive medicine” practices the Obamatons are intent on wiping out. Wasteful, you know.
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