Free Markets, Free People

Prepare for a “sea change” in health care thanks to government intervention

This interview, soon to be forgotten by most who see it and probably unseen by the majority of the country, is a very important and significant interview.

Watch it carefully, because Dr. Louis MacIntyre is about to lay out our future health care system for everyone (for whatever reason the “embed” link is not cooperating, so I’ve linked it).

Three things jump out at you.  One: the fact that costs for insurance and regulatory compliance are rising while reimbursement is dropping has doctors being forced into looking at an entirely new model for health care.

Where now, it is marginally patient centered, the “improvements” are going to drive them and the system to a more process centered care.  Think VA hospital vs. private care.  In a VA hospital the physicians work for the VA.  They are, by contract, required to do things the VA way, even if those things they do don’t necessarily represent the best care for the patient.

In private practice, doctors are “outcome driven” vs. process driven.  Hence they work within standard treatment parameters to address the patients problem but are free to try other methods that are indicated via their training and experience.  We’re headed into a “process driven” environment.

Two: as the costs rise and more and more doctors are driven from private practice, they’ll seek employment in hospitals.   They will then, as Dr. McIntyre notes, unionize to protect their compensation from dropping rates of reimbursement (remember, that’s supposedly one of the driving concerns of reform).  They will then go from being a “profession” to a “trade association”.  And that trade association’s focus will not be patient advocacy, but instead, trade advocacy.

Three: left out of all of this “sea change” that is likely to happen?  The patient.  You.  Your choices are going to be limited.  You’ll have very little to no say in a process driven environment.  And the chances of an actual relationship with a doctor who will intimately know your case are virtually non-existent if, in fact, we end up with a system of VA like hospital care centers. 

Consider all of that carefully.  Then ask yourself this: what bright and talented person, knowing that was the environment they’d have to commit themselves too, would willingly spend the years necessary to obtain an MD just to become an employee of a hospital and not allowed to use any creativity or experience (or anything outside the processes protocols) to treat patients?

Yeah, not many.

But, don’t forget – health care will be “better” and “less costly” because government says so.

~McQ

Twitter: @McQandO

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39 Responses to Prepare for a “sea change” in health care thanks to government intervention

  • Then ask yourself this: what bright and talented person…?

    That answer is simple; the LESS bright, and LESS talented people will assure that the slots in medical schools are filled.
    Price controls of any kind TEND to depress quality of goods supplied.
    Really bright and talented people will find a way to practice medicine still…even if it is in Costa Rica or Burmuda, where the better-off Americans will go on medi-cations (medical vacays).

    • And the government will subsidize the less bright, less talented because they’ll have a quota to fill.

    • Bright people will have the option to do other things instead of medicine, also.

  • This is the path healthcare has been heading for decades.

    If you look at our “system”, (before or after ObamaCare), it is easy to how there was no other way it was going to go.

    As with so many other areas of the public/private integration, we socialize losses and we private profits. In healthcare, we do it by taking the very worst risks and socializing them (people over 65), and then on top of that, we allow(ed) private insurance companies to cherry pick from the younger population, leaving many of the worst risks in the younger population to the EMTALA laws that force providers to treat them with no hope of payment, such that the providers either pass them on to taxpayers or paying patients.

    This is why I have been arguing that we need a national health insurance (single or multi-payor) that covers catostrophic care, emergency care, and hospitalization. Beyond that, people would be free to purchase insurance in the private market to cover private GP’s or they could choose to pay cash for the services they want that are not covered.

    For people who have only the national health insurance, it would likely be process driven and the actual quality of care won’t be equal to the best care available in the country today. But as you can plainly see, that is going to be the expperience of EVERYONE in the system (regardless of ObamaCare) if we don’t make a change.

    I analogize this to the public school system. Everybody pays for it, but if you have the resources, you don’t have to use it and can pay more for what you believe is a better product.

    Medicare was a mistake. It was a response to a need, to be sure, and the legislature votes were there to serve old voters, but it never should have been put on the table. They should have either created a national health insurance for everyone, or no one. But that ship has sailed, and we face the consequences. So the question is, which way do we go? Can we go back and repeal Medicare? Is that politically possible? I don’t think so. So do we go forward and correct the mistake of socializing only the most expensive risks in our population? I don’t think there is any choice, the only question is whether we let it go so far that even we do fix it, the universal quality of healthcare will be so bad that there won’t even be good choices (in this country) for people who have the resources.

    I get it that some people don’t like the idea of a single payor national health insurance plan. I don’t blame them, I don’t like it either. But our political options are limited, and no action still has consequences. and they are described well by Dr. McIntyre. Medicare is unsustainable, and it is also un-repealable. Efforts to privatize Medicare (Part A) have shown that it costs MORE to cover these high risk patients, so that’s not a solution.

    I am sure I have convinced absolutely no one here, but hey, I did my best.

    • Single payer is pure idiocy.

      The problem in our system is that there is no price competition at point of service. Single payer won’t change that. It will only reinforce that.

      Single payer has two possible outcomes: 1) excessive costs 2) rationing. Since Americans are used to quality care, rationing is very unlikely in the near term for political reasons. so9 the immediate result is excessive cost, and a fast(er) trip into unsustainable debt.

    • Our local butt-boy for BIG GOVERNMENT and monopoly.
      Whenever, whatever, his knees jerk in the direction of genuflecting before the state and stripping people of choices.
      My health care is not a matter of “politics”.  It SHOULD be a simple consumer choice, like the myriad of others I make.

      • Oh, but he isn’t really for big government. He opposes it. Except that he realizes it isn’t politically feasable to oppose it, so you have to go along with it and even increase it.

        So yeah, big government is bad, but we still need socialized medical care and we need to dump massive amounts of money into solar and wind energy, stuff like that.

    •  
      As you say, in the present system,” the providers either pass them on to taxpayers or paying patients”. Under a single payer system, “the providers either pass them on to taxpayers or paying patients”. The difference? Under single payer a government bureaucracy makes all the rules and decisions; there is no competition or appeal or legal redress, i.e. checks and balances. Any system without checks and balances, aka negative feedback, will fail.
       

      • Exactly, but the current system has already removed much of the feedback.

        It is irrational to use employeer provided insurance to provide routine healthcare. It is done because of the tax code, beginning with FDR in the 40s.

        HMOs and other overhead in the system are the result of the insurance companies and government’s efforts to avoid being “ripped off”. Paying consumers wouldn’t need this, but a third party payer does, even though it doesn’t really work and adds overhead.

    • By the way, wasn’t it captain snarc who was praising Spain’s healthcare system early in 2009? The same time the left in general were praising their alternate energy system?

  • Medicare was a mistake. It was a response to a need, to be sure, and the legislature votes were there to serve old voters, but it never should have been put on the table. They should have either created a national health insurance for everyone, or no one.

    First, it wasn’t a response to a need. It was part of the leftist project to transform America.

    Second, putting everyone on Medicare isn’t going to fix the system. It will make the syustem even harder to reform politically, and increase the total cost, and accomplish nothing else.

  • But it’s going to be free! Yaaaay!

  • Dr Rich of the Covert Rationing weblog just finished writing his book on ObamaCare, progressive healthcare, and future of the US medical system. The working title is “Open Wide and Say Moo…”
    The drafts of the book chapters are available online until the end of summer:
    http://covertrationingblog.com/rebuilding/open-wide-and-say-moo-the-up-to-date-archive
    He describes in depth exactly how and why US medicine is being transformed from being patient centered into a vast system of “herd medicine.”
    As bad as you might think ObamaCare is, you’ll see that it will probably wind up being worse than you now imagine.
     

  • Go look at the forecast for healthcare spending before ObamaCare, it was dire then, it’s dire now. The main difference is that more people will have coverage so they want have to rely on EMTALA laws to get free (read taxpayer paid) care.

    Obamacare, at it’s core, is essentially a deal with private healthcare companies that goes something like this. If you don’t say no to anyone, we’ll make you get (almost) everyone in your plans. It represents an understanding of the problem, but it is still a long way from a solution.

    The idea that a national single (or multi) payor plan will be more government is almost funny considering how completely entrenched private healthcare companies are with government now. Honestly, the difference from the standpoint of government involvement would be like saying I don’t want Fannie Mae, that’s big government, give me Freddie Mac!

    • Go look at the forecast for healthcare spending before ObamaCare, it was dire then, it’s dire now. The main difference is that more people will have coverage so they want have to rely on EMTALA laws to get free (read taxpayer paid) care.”
       
      What, we have to pretend the government was paying MY healthcare now to make you happy?   uh….yeah.  See the problem here?
       
      No, probably not.   Did the worm on that hook taste good?

    • Go look at the forecast for healthcare spending before ObamaCare, it was dire then, it’s dire now. The main difference is that more people will have coverage so they want have to rely on EMTALA laws to get free (read taxpayer paid) care.

      The additional coverage will be from taxpayers. Companies will stop providing health insurance and the government will pick it up.

      The cause of the high prices is simple: the government has killed price competition in the system. Obamacare will simply kill most of what is left, full retard single payer will kill every last bit.

    • The idea that a national single (or multi) payor plan will be more government is almost funny considering how completely entrenched private healthcare companies are with government now. Honestly, the difference from the standpoint of government involvement would be like saying I don’t want Fannie Mae, that’s big government, give me Freddie Mac!

      The difference is that under single payer the government will have full control. Right now it only has partial control. We, as individuals, still have some control of our healthcare, and you want to give that away. Central government control of industry has worked so well in the past, let’s give it another try!

  • Obamacare, at it’s core, is essentially a deal with private healthcare companies that goes something like this. If you don’t say no to anyone, we’ll make you get (almost) everyone in your plans. It represents an understanding of the problem, but it is still a long way from a solution.

    The problem is lack of price competition. Obamacare does not represent an understanding of that.

    The problem isn’t that healthy people are not buying healthcare, the problem is that those who consume it do so on someone else’s dime.

  • I’ve been both a patient and worked in the ‘profit driven’ medical profession, and the Veteran’s Health Care Program, and I can say, after experiencing both, I’d rather be a patient of the Veteran’s Administration than any private clinic at which I, or any of my  friends, have been treated.  True, their treatment facilities are streamlined, but the waiting time is less than my friends, and  I have always received prompt, professional, and courteous service.  Maybe that’s why, “Patients routinely rank the veterans system above the alternatives, according to the American Customer Satisfaction Index. In 2008, the VHA got a satisfaction rating of 85 for inpatient treatment, compared with 77 for private hospitals. In the same report the VHA outpatient care scored 3 points higher than for private hospitals.”  [15]
     
    I’ve had everything from major surgery to regularly scheduled routine exams, with satisfactory results.  I know there are veterans who complain about the VA, but some people complain about everything.

    • And we want you to have the choice to use the VA or private providers.
      But you want to take choices from us.

      • “But you want to take choices from us.”

        No one is sayiing that private options should be removed from the system, just that a public plan should exist. I would fully expect to get private insurance to cover more than a basic national healthcare policy would.

        As I said, my analogy is public schools. We all pay for them, but we have a choice as to whether we use them or choose private options.

        Over 60% of all healthcare spending (before ObamaCare) went through the government, that number will increase a little after ObomaCare. But what you should recongize is that we are paying for universal healthcare already, we just don’t have it.

        You say choices are being taken from you. I say choices are being taken from everyone. People that don’t work for big companies do not have the choice to have the insurance available to their employees at the cost they pay. People who do not work for the federal government do not have the choice of purchasing the FEHBP. People who are not poor do not have the choice of Medicaid (okay I’m reaching on this one), and people who are not 65 years old do hot have the choice of Medicare. In fact, for people in most of American, there are one or two health insurance options, and to call what they do competition is like calling what a quarterback and center do competition.

        Here’s the deal, the main focus I think Americans should have with respect to healthcare is keeping providers as private and independent as possible. While people are haggling over the passthrough payment methodology, we are going to lose that.

        As to the GOP talking point idea of selling insurance across state lines, I used to like this in theory, then I realized what it really meant. One, it would mean taking the power of the states away to set the requirements of health insurers in their state, and two, it would be a race to the bottom. Health insurers would set up their plans based upon the most lax rules of any state in the country, and then sell these everywhere. Not much different than what happened with the credit card industry before there were federal regulations. Every company set up shop in the states that allowed the most usurious credit card rules and regardless of what your state financial regulatons were, you got the worst in the country.

        Health Insurance actually ties into my primary political focus, crony capitalism (or corporate socialism, or regulatory capture). According to the National Institute on Money in State Politics, the health care industry paid almost $400 million to politicans in state governments in the past six years. The Center for Responsible Politics discovered the industry spent over $1 billion in the past two years to oppose real reform.

        This is the government versus free enterprise, this is the insurance company purchasing anti-competitive legislation from the state and federal governments.

         You are protecting the problem.

        • “Over 60% of all healthcare spending (before ObamaCare) went through the government – ”
          Woah woah woah – 60%?   and where did that number come from?
           
          From -  https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html
           
          See – National Health Expenditures 2010 Highlights
          1st PDF link
          Last page
          Health Spending by Type of Sponsor1:
          • Since 2007, the economic recession and legislative changes led to a noticeable change in the
          shares of health care spending that were financed by businesses, households, and governments.
          • The federal government financed 29 percent of total health spending in 2010, a substantial
          increase from its share of 23 percent in 2007. Meanwhile, the shares of the total health care bill
          financed by state and local governments (16 percent), private businesses (21 percent), and
          households (28 percent) declined during the same time period.
          Even assuming the Fed & State & local are ‘government’ (and they are, but they are NOT for the purposes of OBAMACARE) it’s only 45% in 2010 according the government’s own statistics.  Right there – Federal spending was 29% of the total.

        • Standard collectivist bushwa; “The system we have (health care, education, etc. ad. inf.) is not perfect, therefore we need government to take it over”. Government imperfection is oh so much better than private sector imperfection.

        • Poke around a bit and look at the projections – https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html
           
          “By 2021, government financing is projected to account for nearly half of all health
          spending (up from 48 percent in 2014) reaching a total of $2.4 trillion, of which, the federal
          government is projected to pay two-thirds. This increase in the federal share is associated with
          Medicaid expansion, the baby boomers reaching Medicare age, and costs related to the exchange
          and cost-sharing subsidies. Between 2014 and 2021, the share of health spending financed by
          private businesses is expected”
           
          2021 – Nearly half….of which the federal government will payt two-thirds.
           
          Where did 60% BEFORE Obamacare come from?

        • You are protecting the problem.

          No, you are.

          The root of the problem goes back to the perverse tax policies of FDR and the Medicare/medicaid systems of LBJ.

          Your plan isn’t to undo the problems we face, but to double down on the stupid amplfying them. The only way “single payer” is a solution is that it makes the whole bubble pop sooner, bringing down the whole system, but those of us who actually care want to solve the problem without breaking everything first (and risking who knows what might result).

        • Since ‘we’ are the primary source of government revenue, we’re paying about 57% (government 29% AND the household 28%) of this medical bill already.
           
          Well, unless we’re in the 49% that doesn’t ACTUALLY pay any income taxes, then we’re just in it for the 28% (and frankly, I’ll bet if we aren’t paying income taxes, we aren’t paying our household 28% for medical bills either…..)
           
          http://www.taxpolicycenter.org/briefing-book/background/numbers/revenue.cfm/
           

        • Once a public plan exists, the subsidization of it drives private plans out

    • My experience in private care has been prompt and good quality service, and our private care system uis vastly better in quality then the Euro crap socialist care systems.

      As far as the VA, in 2009 I looked at their budget, they had 5.8M patients and a medical budget of about $42B, which extrapolated to a 308M population comes to a program cost of $2.1T. The VA system does not represent a sustainable plan if expanded to cover the entire population.

      Socialized healthcare isn’t sustainable. It is as simple as that.

      • “which extrapolated to a 308M population comes to a program cost of $2.1T”

        Seriously, you think there is any statistical value in comparing the cost of treating war veterans with the general population?

        I have read where people extrapolated the cost of Medicare fromt he current covered group to the general population to make the same argument. Sure, we should jsut assume that there is no difference in the cost in treating an 18 year old and a 85 year old.

        • Vets range from their 20s to their 90s. Sure, a small % have serious war injuries, but on the flip side you are also not treating many babies and birth defects in the VA system. It is obviously just a first order estimate, but it should be considered by anyone who is going to throw the VA out there as a model. Anyone who is arguing that the VA is the model we should use needs to first explain how it would be sustainable.

          It also doesn’t include the VA money that is contributed and not part of the budget.

          • Another point is that the 5.8M (or however many there are now) on the VA system can’t vote themselves better health care, they depend upon the sympathy of the nation for that, and we have seen it vary over the years between crappy care and expensive care.

            If the VA model was the system for the nation as a whole, the patients could vote themselves better healthcare.

            If you want a system that can’t be reformed, go ahead, support single payer.

        • Tad was the one who trotted out the VA as the standard, try addressing Tad for bringing the muddy dog into the parlor, not Don for shoeing him out.

        • Curses….shooing….curses…..

    • “I’ve been both a patient and worked in the ‘profit driven’ medical profession, and the Veteran’s Health Care Program, and I can say, after experiencing both, I’d rather be a patient of the Veteran’s Administration than any private clinic at which I, or any of my  friends, have been treated.”
       
      Lucky you. Others have different experiences.  And what, pray tell, is a “streamlined treatment facility”?

      • ““streamlined treatment facility”?”
        Shoot, he must have one of them fancy highfallutin big city medical services – out here in fly over land, all we got is Doc Barkley, normally he treats horses and mules and his office is out by the town stable.  He’s generally drunk, rude, and can be a mite unprofessional if you catch him on a bad tequila night.

  • Health Insurance actually ties into my primary political focus, crony capitalism (or corporate socialism, or regulatory capture). According to the National Institute on Money in State Politics, the health care industry paid almost $400 million to politicans in state governments in the past six years. The Center for Responsible Politics discovered the industry spent over $1 billion in the past two years to oppose real reform.

    Somehow your “primary focus” manages to be OK with Obama’s crony capitalism rewarding his bundlers with millions in tax dollars. My guess is you are just fine with that, and will vote for the biggest crony capitalist enabler of all time come November.

    Center for Responsible Politics? Sounds so damn responsible. No doubt the “real reform” you mention was actually Obamacare.

    You need to find a better beard to hide you defense of socialism and big government. Seriously.