Free Markets, Free People

ObamaCare – let the race to the bottom begin

Doctors in New York aren’t particularly happy about ObamaCare:

New York doctors are feeling queasy about ObamaCare — and many won’t participate in the new national insurance program because they fear they’ll go broke, The Post has learned.

“ObamaCare is going to send me more patients to see and then cut the payments to provide the care — that’s what’s going to happen,” predicted Donald Moore, a primary-care doctor in Prospect Heights, Brooklyn. “I will not accept it.”

Moore claims that President Obama made a big mistake by requiring uninsured residents to obtain medical coverage from for-profit insurers through the ObamaCare health exchanges instead of through public health programs like Medicaid.

Under tremendous pressure to keep costs down and profits up, Moore said he’s concerned that commercial insurers will pay doctors less for patient visits and services than either Medicaid or Medicare.

Many doctors, he argues, won’t be able to cover their costs with such skimpy fees.

Moore scoffed, “Who’s going to sustain the losses? The insurance companies? It’s basically going to be a race to the bottom.”

No kidding.  And that’s precisely what was predicted here long ago.  Just because you have insurance doesn’t mean a doctor is going to take you on as a patient.  Result?  The same solution – packed and overcrowded emergency rooms.  Hospitals going broke treating everyone who comes through the door on the pittance their insurer pays for the treatment.

And how do doctors feel about the beginning of ObamaCare?  Well they’re not sure at all how it works:

Despite a much publicized rollout, many other doctors said they haven’t decided whether to become ObamaCare providers, because they haven’t been notified by insurers or the state about ­reimbursement rates.

“I have not spoken with anyone who has made a decision to participate in the exchanges. We simply don’t have any information about which we can make a decision,” said Dr. Paul Orloff, president of the New York County Medical Society.

“We have no idea what the reimbursements will be or what the claims-form process will entail.”

Until they are, why would any sane medical practice take on new patients?


The Medical Society of New York State is conducting a survey of doctor concerns about the program and asking whether they will accept patients who buy policies.

“There’s a real question about how many doctors will participate. Doctors are concerned about being left holding the bag,” said Sam Unterricht, an ophthalmologist and the president of the state medical society.

The clumsy launch of ObamaCare in New York and elsewhere — with computer glitches and sketchy information — worries the medical community, he said.

“It’s really shaky right now,” Unterricht said.

Spooked about the payments they’ll receive under ObamaCare, other doctors said they’ve stopped hiring staff for their medical practices.

“I’m apprehensive. I’m certainly not hiring anyone new,” said James Reilly, an obstetrician who has delivered 4,000 babies and heads the Richmond County Medical Society.

“We want to see the impact on the bottom line,” said Reilly, who has a 12-member staff and pays a hefty $200,000 annual medical-malpractice insurance premium.

Yes, the enthusiasm for the new system is, well, overwhelming, isn’t it?  Of course they want to see the impact on the bottom line – they’re small business owners.  Government is involved in price fixing and they’d like to see if they can live with the fixed price or not.  If any other entity was involved in doing what the government is involved in here, they’d have been arrested.

But hey, when government decides it can make legal for itself what is illegal for you (consider the lottery, for instance) then you know you’re on the fast road to total decline.  The sign posts are whipping by so fast, no one can even read them anymore.


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20 Responses to ObamaCare – let the race to the bottom begin

  • Schadenfreud-a-licious…!!!
    Watching EVERYTHING we predicted come true, with a few bonuses like a Cracker-Jacks box of TERRIBLE execution thrown in.

    • Countdown to blaming Republican obstructionists, tea party “extreeemists”, libertarians, free market/capitalism, greed of { insurance companies, doctors, hospitals, big pharma, medical equipment manufacturers }, and George W. Bush.
      5, 4, …

    • The argument will go that meanie Republicans put pressure on the passage of the law so that it turned out to be something unworkable, not like the great example of the NHS or [insert European country].
      The mantra for the next election will be that voters need to stop the “obstructionists”, “extremists”, “war on women”, “war on kids with cancer”, etc..

      • Well, we do know already that the Feds made decisions about time-lines, management, and going ahead when they knew better on the basis of pure politics…PR.
        They were (rightfully) afraid of putting out the truth, and doing a competent job.  All things are subverted to politics in the Obamabanana Republic.
        I just listened to an interview with a guy with a software development firm of 27 years experience who said he’d be embarrassed to charge over a million bucks or take more than a month or two to put up a bullet-proof system that would give people a good estimate of their costs and options…without collection of a lot of very personal (AND extraneous) information.
        But, hey, just MAYBE that wasn’t the goal…

  • Being a specialist here in the People’s Republic of Illinois, life is – let’s say – a challenge.

    Cigna insures all State of IL employees – we’re now getting reimbursed for services rendered November / December 2012.
    No one knows what the ACA will reimburse, but word on the street is it’ll be about Medicaid levels.  (I only take Medicaid patients if sent by one of our referring physicians – and then don’t even bill it.  It’s not worth the wait and hassle.)
    With the 15k to 20k pages of new regulations, no one can possibly be compliant.  So how will the feds decide who to prosecute / audit?  We know how the IRS did it.  And who is in charge of compliance for the ACA?  Why the IRS of course!  That explains the mass hiring of new agents mandated in the ‘health care’ law.
    Starting 10/1/14, we will be required to use a new system of diagnosis codes:  ICD-10.  We’re going from about 11k codes in ICD-9 to about 70k codes.  There are now at least 45 different codes for an ankle sprain – yet the most common sprain (anterior talo-fibular ligament injury) does not have a specific code.  Talking with consultants (now there’s a fun afternoon) we find they are advising their clients to have either 6 months of working capital on hand, or a line of credit equivalent to this.
    Electronic Medical Records (EMR) – it was sold to us with a carrot and stick approach.  The stick:  if we don’t do it we’ll be nicked for a percentage of reimbursements from Medicare.  The carrot:  if you do an attestation online verifying you comply with their requirements, you get money back.  It’s on the honor system, so what could go wrong?  After doing my attestation awhile back, I discovered I would qualify for the incentive $ except I was missing one item.  I declined as I prefer sleeping at night, but I’m pretty sure others behaved – differently.  So now we have the federal government with all this essentially fake data submitted by folks aspiring for reimbursements, with which they will now create government policy.  What could go wrong?
    And all those folks who took the government cash?  They’re on a list available to the public – as they should taking government money.  But forgive me if I’m a bit cynical.  What is to stop the folks in charge when things get really dire from pointing a finger at ‘those greedy doctors’ who took ‘your tax dollars’ to help pay for their EMR, then play the hero to the LIV’s by going after their ‘stolen money’?

    So you want your kid to go into medicine?  Not us – we’re encouraging him to be an orthodontist…

    • Dude, sorry for the great big bullseye painted on your chest!
      Thanks for the information!
      Keep your head down…

      • Thanks Rags.  Here’s another angle most folks aren’t aware of.

        I’m a solo practitioner in private practice.  In school, residence and early practice, the financial folks were telling us that we should put something away for retirement, but not-to-worry because when we sold the practice that would finance our retirement.  In the last two years I have two colleagues who just closed their respective doors and walked away.
        Another joined the corporate world after a health scare, thinking there was more stability.  He lasted 6 weeks.  Learned fairly quickly many of the promises made were never going to come to fruition, and patient care was low on the priority list.  The final straw was in a production meeting (don’t have those here in my office), when a long standing primary care physician stood up holding his file and told the assembled, “I’m not taking any vacations now because I can’t make my numbers.  How do you expect me to do this?”
        As for my friend, he had sold all of his equipment, left his office space, and had to start from scratch.  Frankly I’m not sure how he’s making it.


        • I often thank goodness for the doctor at Vanderbilt Medical School (I don’t even remember his name) who told me in 1978 that this state of affairs was coming. He thought medicine would be mostly socialized by the early 1990s, and if Hillary had gotten her way, he would have been spot on. That was one of the reasons I left medical school.
          It was painful at the time, but that decision looks better with each passing year.

          • Sage advice from your physician mentor.  Were you there as a patient or a Commodore?  Great school, great town, and their football team (though having a tough time this year) is on-the-rise.  Go Dores!

          • Spent a single year at Vandy in med school. I still live in Nashville, and ironically enough ended up lecturing at the Vanderbilt Medical Center doing the keynote for their Technology Day a few years back. Life moves in some strange circles sometimes.

  • This is what happens when you have a President and Staff in which only 8% have any actual business experience.

    • This is what happens when the President, Stafff, and the Media want to draw the country into communism no matter what.

  • “Hello Raul?   This is Barack.   Yeah, good to hear your voice too.”
    “oh, Michelle and the girls are fine, thanks for asking”
    “Right, right….look the reason I called, would it be possible for you to send us, I don’t know, 10, maybe 20 thousand of those Doctors you folks train for the 3rd world socialist paradises in Africa?”
    “Yeah yeah, greedy American doctors, I have a plan for that though….things are more flexible now that I’m on my second term”

  • The National Park Service director told Congress on Wednesday that he had to shut down the open-air memorials on the Mall during the government shutdown because of terrorism, saying that closing them was the only way to protect them “in a post-9/11 world.”

    Director Jonathan B. Jarvis also said his agency had received intelligence showing an increased threat of danger since the shutdown began – though he would not tell two House committees what those warnings were.

    I’m sure we all know that many battles from the Revolutionary and Civil Wars were fought on national parkland.
    The Park Service obviously fears that that could happen again.

    • A good portion of the budget goes to patching the holes they shot in the monuments from when they took cover behind them during the fighting.

  • Well, if the doctors won’t participate, then we need a law that says doctors have to take Obama’s patients, at the price Obama’s says is ‘fair’,and if they don’t then doctors will have to go to the camps. It’s simple really. After all, it works well in Cuba.

  • Don’t worry, new laws mandating that doctors MUST accept you as a new patient will solve the problem!

  • Price fixing, or maybe price controls?  Either way, any one who bought gas in the 70s knows how that goes.