Perverse Incentives Under ObamaCare - Granite Grok

Perverse Incentives Under ObamaCare

It is not about state spending, Healthy states are about libertyForbes has an interesting article on incentives and doctors in the age of ObamaCare.

We all know about the PR campaign in which supporters of the Patient Affordable Care Act were willing to accuse doctors of being no better than unscrupulous used car salesman or as confidence men in lab coats.  They were portrayed as ordering unnecessary surgery but Democrats were going to stop that.

(If you didn’t know lawyers are predominantly left wing, more government, greater complexity, Democrat supporting institutions.)

No Democrat ever admitted publicly, to my knowledge, that the fear of lawsuits promulgated by lawyers and supported by the left’s unwillingness to address tort reform, practically forced doctors to be overly cautious, while also driving up health care costs to allow physicians to compensate for higher rates on malpractice insurance (caused by the ease by which they could be sued and found guilty or forced to settle)–another requirement brought on by a lawsuit-happy ambulance chasing, legal culture.

Get hurt, hit it big – with lawsuit lotto (while your lawyer(s) get 30%.)

Well ObamaCare creates a different set of problems (in the form of government incentives) for doctors.

ObamaCare includes pilot programs to replace the current fee for service model with “bundled payments.” Hospitals and doctors would receive a fixed sum for treating a patient’s condition (e.g., pneumonia or stroke), regardless of what it costs the providers. If the hospital and doctors treat the patient for less than the bundle, they keep the excess. But if their costs exceed the bundled payment, they must absorb the loss. In theory, bundled payments eliminate incentives to overtreat patients. But they can also create dangerous incentives to undertreat.

A hospital administrator might ask a physician, “Does Mrs. Smith really need the stronger, more expensive antibiotic that covers 99% of the bacteria? Or can she get by with the cheaper drug that only covers 85%? We’ve already burned through her bundled payment for this hospital admission, so anything we do now comes out of our pockets!”

The federal government has also proposed linking physician payments to “appropriate use criteria.” Such government practice guidelines may be appropriate for many patients. However, there will always be patients who don’t fit the guidelines. In those cases, doctors will have to choose between what’s medically appropriate for their patient vs. adhering to the government-approved treatment guidelines.

I don’t think this is a scenario any of us are surprised by.   It is the very thing we didn’t want in the ‘reform’ and were told would not occur.

Those of us on the right who understand the corrosive nature of mandatory interference knew this would happen. That this must inevitably affect care and by extension quality of life.  The design mandates that government interfere with the doctor patient relationship; that panels and committees of bureaucrats must make arbitrary decisions about cost without regard to circumstances.   This underpins the idea of death panels which is simply the most extreme result of the mandated interference.

But it was never workable and anyone who took the for their word was either in on it, willingly ignorant, or just plain stupid.

Democrats insisted that they could add tens of millions of people to a health care system run by the state, managed by tens of thousands of new bureaucrats (pay, benefits, pensions), and in the end make it all cost less, all without the government getting between you and your doctor.  This fraud makes the “You can keep your plan lie” look like a fib told by a two-year old with a cookie behind their back.  And that’s not just becasue no nation has ever managed to do it.

It just can’t be done.

Everything will not only cost more, the quality of care will– by design–decline, as will access.  The only cure for the ills caused by Democrat reform of Health-Care will be the very thing the progressive left insists it hates more than anything else; income inequality.

ObamaCare deforms the health care industry so severely that the only people who will have the option of getting care without bureaucratic interference are the wealthy.  We are destined for the glory of Cuban health Care. A majority of Americans will have limited access, through doctors who are less and less their own, to treatments defined forever downward by bureaucrats, and without the means to escape it.

Health Care privacy will also be something limited to the rich, by design.  Doctors who are paid in cash instead of through the insurers in the mandatory exchanges, do not need to report the details of their examinations or treatments to the government.  Even if you have an insurer you can still pay cash for visits or treatments and those do not need to be reported.  It’s as if they built in a system of bribes to keep things off the books, a grotesque incentive that will favor back-ally health-care entrepreneurs and those who might frequent them.

All in all, this is not a reform for the huddled masses or the ideological peasants in fly-over country.  It certainly isn’t for the people whose lived Democrats claimed they wanted to improve.  It is a one-size fits all boot on the neck of healthcare nation, from under which only the wealthy can easily escape.

The end result is a two class health-care system where those at the top can get whatever they need or want without any interference while everyone else is forced to expose themselves to the feds in exchange for a downward slope of treatment based on arbitrary bureaucratic incentives forced on doctors and hospitals that have any desire to stay in business.

Having to operate under totalitarian health care has the same effect on health care workers as does on anyone living under any despot.  You eventually just try to get to tomorrow without the state finding an excuse to investigate you.   If that is your idea of health care for the future, there is something very wrong with how your brain is wired–the irony of that being this; those who will be able to afford to be treated for the condition are the ones who will continue to brag about how well it works.  Everyone else will be screwed.

 

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