The Future of American Healthcare
Politics, Politics - general, President Obama
Recent graduate of the University of Denver, retired D1 tennis player and aspiring entrepreneur. Interested in anything and everything to do with the ...
What have been the recent effects of Obamacare in medicine? Is the future bleak?
Question: Given the issues that obamacare is trying to combat, if you were in charge what would your solutions be?
The healthcare system that we had could have been fixed by mandating that they cover people with preexisting illnesses, otherwise everyone was getting cared for. No one in this country has really gone without healthcare. The only glaring problem with the past healthcare system was punishing people that had pre existing illnesses. We may be heading towards national healthcare because we live in a country where we’re importing so many millions of people a year who all need government services and healthcare that if we continue with our present immigration policies, there is no other solution than having national healthcare. It’s impossible to keep raising rates and putting everyone else on medicaid. We will need to go to a one payer system purely because of our immigration system. Eventually this will break us and force us to go to single payer system. A doctor can’t have more than 20% of his patients on medicaid or medicare without going broke. Doctors are all becoming employees of hospitals because they can’t afford their own offices and staff. Many people I know have had their practices bought up by hospitals.
There are several things that have hurt "obamacare" that I would change right off the bat. One is increasing the penalty for not being insured. The current penalty is extremely low. To make the ACA work you must have the young and healthy population in the mix. Without them the risk pool is very uneven and premiums cannot be kept reasonable. As the penalty increases, hopefully more of the "young invincible" will purchase insurance. In Colorado there is something called the Colorado Indigent Care Program (CICP). This is a discount healthcare program, not insurance, for the low income population that does not qualify for Medicaid. I would discontinue this program. This program has been kept in place and many people who qualify for it would rather take their chances with CICP rather than purchase insurance. This has also added to the uneven quality of the risk pool for carriers. I feel to make this work, we have to be "all in." Chipping away at the law will insure its failure.
Return medical care to the private sector, support training of more physicians by allowing them to have adequate reimbursement and control over the care they provide. Use tax subsidies to help patients that have no money. Let insurance carriers work across state lines to decrease costs. Allow peoples' pre-exisiting conditions to be uninsured with subsidies by the government instead of through Medicaid. Immigration reform in order to document the care of the undocumented. Continue with electronic medical records but without government intervention. Attempt to standardize costs within the medical field. Insurance should only cover essential things, such as necessary procedures. Repeal ObamaCare, or cut it down dramatically.
Question: What have been the most immediate effects of Obamacare?
There are three main immediate effects that have been realized. First off, the amount of people on medicaid has greatly increased, which was one of Obamacare’s main purposes. However, regular people who pay for their own insurance have seen their rates go up significantly along with their deductibles. Currently the first $10,000 of healthcare is essentially out of pocket for a normal working family. People are paying much more than they did before making it at least twice as expensive. The third change is that Obama told everyone that people would be able to keep their doctors, which is not the case. Under Obamacare, your doctor has to be in your insurance network otherwise your deductible will increase. The beneficial immediate effect is seen for people with preexisting diseases who would have previously been denied coverage, but for the average working person there are distinctly negative effects due to higher deductibles and rates.
Adding millions to Medicaid via the Medicaid expansion law, I think has been the most immediate effect. Millions of people who didn't qualify for this benefit before, now do. In addition, the "working poor" actually qualify for help now. These folks held down jobs and didn't expect the government to carry them and yet could not afford to insure themselves. They are the taxi drivers, hair stylists, dry cleaners, etc. With the Advance Premium Tax Credit, they are now able to purchase affordable insurance. However, because they did not previously have insurance, many of them are ill or have health issues that have gone unattended. This will make them more expensive and higher risk in the short term. "Guaranteed Issue" also greatly changed the landscape for insurance carriers. Our plan definitely experienced this in that a large percentage of our members have chronic diseases that made them previously uninsurable because of "pre-existing condition" clauses. Many of these diseases, such as HIV, are extremely expensive to treat and the loss ratios for carriers are extremely high.
Confusion, increased healthcare costs (dramatically), loss of insurance by the previously insured, increase in Medicaid for the uninsured, high levels of anxiety among people as to where they get their insurance due to totally inadequate management, and a transfer of control of your own healthcare from yourself and your doctor to the government.
Question: Are we going to see a decline in healthcare and healthcare worker quality? How soon?
There haven’t been noticeable differences (yet) in quality of workers, however, many have been feeling overworked and there has been an overall decline in moral. Hospitals have been cutting back and laying off workers and stopped giving raises to workers down the chain. There has definitely been a decline in how people feel about giving care, not necessarily their individual competency. The system is getting overloaded at a fast rate as there is more to do with less. The number of people paying for their healthcare is declining so there will undoubtedly be a drop in quality because there will eventually be an uneven balance of funds.
I would like to say "no," but unfortunately that is probably not true. I don't necessarily think it is the quality of the healthcare worker that will decline but rather their physical ability to accomplish the task at hand. Especially in the short term, the health care system is extremely taxed. With millions more Americans having insurance, there are millions more wanting to access care. There was a shortage of Primary Care Providers (PCPs) before the Affordable Care Act (ACA) took effect, this shortage is now exacerbated. My hope is that over time the fact that these people are insured will allow for additional providers to be hired and ease this strain. Although I admit to not knowing specifics, I understand that providers have many challenges associated with the ACA. Some of them I believe are important and should have happened anyway, such as the electronic medical record. Although expensive now, I would like to think the payoff will be high in the end.
Yes, we already have seen a decline in healthcare quality as well as healthcare worker quality. This is due to high rates of physicians closing their practices, government regulations, and huge amounts of time spent filling out paperwork instead of seeing patients, a transfer of healthcare provision to lower level care, hospitals focusing on avoiding government fines as opposed to providing care. Since there is a lack of primary care, people are now going to the emergency room to receive their primary care. There is a total lack of knowledge of what is actually in the healthcare bill on behalf of the general pubic. The recent revelations that passage of the bill was designed to misinform patients in the country about costs and outcomes in order to get the bill passed highlights this lack of knowledge. The level of care quality and ways to care for patients is now determined by the government rather than by physicians.