Monday, December 15, 2014

A Ground-level Update On Obamacare

This is a difficult time for Obamacare. The Supreme Court is looking at it again and may wipe out the subsidies most people get, which will destroy the law if it happens. But even if the law survives that, it remains deeply unpopular and has become an albatross around Democratic necks. Indeed, it has been blamed by several Democrats (including now Harry Reid) as the reason they got blown out in the midterms, and many are trying to position themselves as critics of the law they passed. What makes it so unpopular? Well, here's an example I've run across personally.

When I went to the hospital ER, they gave me a referral to a wound clinic. Ok, I thought, I don't know what they will do for me, but I'll go. So, imagine my surprise to discover that the wound clinic could not take a referral from the ER. When I inquired why they couldn't take the referral, I was told that Obamacare forbids this and, thus, they now require patients to go back to their GPs to get referrals. What if I don't have a GP, I asked, or if my insurance doesn't require me to use a GP as a gatekeeper? It doesn't matter... Obamacare prohibits this.

So I had to see my lousy doc and blow another $80 in insurance money and a $24 co-pay just to get a referral that I had already been given. What a waste!

When I got to the wound clinic, I was shocked to discover that this group of nurses are fantastic. They are MUCH, MUCH more knowledgeable at treating wounds than any of the doctors I've seen. And in one week, I already saw more improvement than my doctors had managed in six months. In two weeks, things were going so well that I can visibly see healing and I've even had a couple days where I didn't need pain pills. Wow! Fantastic.

Anyways, I started chatting with them, as I tend to do. I learned some amazing things:
(1) They lost 20% of their patients when Obamacare kicked in, because many insurance companies dropped wound care as a cost savings measure to compensate for other things the law forced them to cover. The nurses are furious about this because they said these were most often the people who needed the care the most, and now they are basically on their own. And I can attest to the fact that you can't duplicate this at home... no way, and GPs aren't trained to do this either.

(2) They lost another 10% of their patients because their clinic, which had been associated with the hospital but not part of it, was forced into the hospital structure to comply with Obamacare. I have heard similar things from cardiology groups, a vascular group and a bariatric group, i.e. that the law made it impossible for them to remain independent and, thus, they had no choice but to join the hospital. The result is that the wound clinic must now charge a $100 per visit hospital facilities charge, even though nothing has changed in the way they practice or even the location where they are located. The result of this was to drive away the people without insurance, who couldn't afford the extra $400 to $800 a month.

(3) The referral thing is costing new patients an extra trip to their GP every so often. Again, this is wasteful.

(4) Some of the treatments they provided in the past had to be dropped because of price pressure.
So the result here is that around 1/3 of people who saw these expert nurses no longer see them. Those that do see them are paying a good deal more to do so, and some services have been cut. Wasn't Obamacare supposed to be about getting more people treatment? Apparently, that's not the point. Apparently, the point is to strip people of anything beyond basic treatment.

In fact, Paul "I'm An Idiot But I'm Smug" Krugman scratched out an article recently in which he praised Obamacare for cutting the rate at which Americans were spending on healthcare. He based this on a huge drop in Medicare spending. What he missed was that the drop wasn't because people were getting the treatment more efficiently... they just weren't getting it because Medicare stopped paying for it.

Oh, and while the leftist media continues to try to scream that this program has been a success (something the public clearly doesn't accept), keep in mind that the plan called to insure 46 million people. But so far, only 8 million signed up, and only 6 million bothered to pay. That's a 12% success rate. Was that worth disrupting our entire healthcare economy and the policies of 270 million people? Was it worth stripping 30% of wound care patients of needed treatment? Hardly.

17 comments:

Koshcat said...

I'm glad to hear things are going better.

Obama just took credit for this but because you are not greatful enough you might be a rightwing fanatic who needs reeducation.

LL said...

If you're not grateful enough, your file needs to be reviewed by the Death Panel...

Anthony said...

Retailers dropping part timers from health insurance coverage expanded the ranks of the uninsured and no doubt created a lot of Obamacare detractors among the working poor.

http://www.bloomberg.com/news/2014-01-21/target-to-drop-health-insurance-for-part-time-workers.html

Target Corp. (TGT) will end health insurance for part-time employees in April, joining Trader Joe’s Co., Home Depot Inc. and other U.S. retailers that have scaled back benefits in response to changes from Obamacare.

About 10 percent of part-time employees, defined as those working fewer than 30 hours a week, use Target’s health plans now, according to a posting yesterday on the Minneapolis-based company’s website. Target is the second-largest U.S. discount retailer by sales and had about 361,000 total employees last fiscal year, according to data compiled by Bloomberg.

The U.S. Patient Protection and Affordable Care Act is the largest regulatory overhaul of health care since the 1960s, creating a system of penalties and rewards to encourage people to obtain medical insurance. The law known as Obamacare doesn’t require most companies to cover part-time workers, and offering them health plans may disqualify those people from subsidies in new government-run insurance exchanges that opened in October.

Tennessee Jed said...

If you get a chance, read Rob Long's "The Long View" in the Dec. 8th issie of National Review. It is truly l.o.l. funny and involves a series of emails between Gruber/Obama and Gruber/Pelosi. Here is but a sample from one of the emails: "P.S. there is only 1 more video to be found left to be found, I think, but there may be an audiotape floating around from a presentation to salon.com in which I pretend to be a typical voting, and strap on a drool cup. Just an FYI

BevfromNYC said...

Of course, NONE of this was not predictable...as we predicted it...in 2009/2010...when we read the legislation.

I find it amusing that the Liberals are taking the statistics that "less people are going to the doctor" to somehow mean that MORE people do not HAVE to go to the doctor now that we all are insured. Hey, we've all been healed! Of course...it just means that less people can afford the co-pays/premiums/deductibles that no one warned them about, so people are afraid to use their insurance. And they can't get in to see doctors because there is a crisis in primary care and not enough doctors. And doctors who no longer take Medicare/Medicaid patients and so on and so one and so on. Who could have predicted it?? Oh, yeah, we did. Little comfort if you need to be treated...

AndrewPrice said...

Koshcat, Thanks! I'm really surprised. They've done some thing I thought my legs wouldn't be able to take and not only was I wrong, but the amount of healing has been fantastic. I'm trying to get permission to go twice a week.

Sadly, I don't doubt the re-education camps are coming. In any event though, every doctor and nurse I've spoken with is furious.

AndrewPrice said...

LL, Yikes! LOL!

AndrewPrice said...

Anthony, That's the other aspect why people remain upset. This law just keeps causing people problems in all aspects. The Democrats have a real problem and I can't see their attempts to become "critics" of their own law working to separate them from the blame.

AndrewPrice said...

Jed, LOL! That sounds pretty funny.

As an aside, it's issues like those in this article that I think the Democrats are missing. This is why people are getting so angry and remain angry.

AndrewPrice said...

Bev, Exactly! NO ONE could have seen this coming!

It is fascinating that the Dems are trying to sell people getting less care as somehow the same as people wanting less care, the opposite is the case.

tryanmax said...

Krugman's reaction is not surprising. After all, part of the rationale behind Obamacare was that doctors were ordering unnecessary procedures to line their pockets. From a bureaucratic standpoint, what makes more sense than to have every decision run through a GP, you know, just to make sure those shifty ER docs don't have something on the side with the specialists.

AndrewPrice said...

tryanmax, I agree. It makes sense to a box-checker to add yet another box to be checked in the belief that this will add more protection to the system. Of course, it doesn't, but to their way of thinking, it does.

And I agree about Krugman. He thinks that the system was wasteful, so starving it of funds will force it to become better, even though that's not the history of regulated programs. Less money means more fief protection, not greater efficiency.

BevfromNYC said...

"...Less money means more fief protection, not greater efficiency. "

And it just worsened the tiered system of care that they swore they would make better. Only those who can afford "care on demand" are still the same who are getting it on demand.

Btw, this is the last week of open enrollment this year for Obamacare...obviously the press has been very active in ignoring the same problems that came up before. Fortunately, Obama has had riots and protests, Ebola outbreaks, and Torture reports to distract the masses from more failure.

Tennessee Jed said...

yes, nothing says big government quite like "fiefdom protection." It has always been a 2 level issue for me. 1) big government intrusion by definition trades liberty for (supposedly) security. 2) Government is like the bloated corporation of the 70's. Layers and layers of bureaucrats whose main interest is in perpetuating their own job and department. Since government has no true competition, operating efficiency (aka getting value for your tax dollar) never happens.

AndrewPrice said...

Bev, Exactly. Changes like this tend to (1) cut off the poor, (2) overstretch middle class budgets even worse, and (3) lead the rich to find new ways to get these services in ways that the left then whines are unfair to the poor. That's what happens every time the left "helps" people.

On enrollment, they are betting that the numbers will be good because everyone will be automatically re-enrolled. I'll be curious to see if they get much beyond 8 million total.

AndrewPrice said...

Jed, Absolutely true. The purpose of big government seems to be to find ways to make the government even bigger...without any regard for how well it delivers on services.

Kit said...

""Changes like this tend to (1) cut off the poor, (2) overstretch middle class budgets even worse, and (3) lead the rich to find new ways to get these services in ways that the left then whines are unfair to the poor. That's what happens every time the left "helps" people."

So the moral is "Never let the Left help you?"

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