Obamacare: Medicare’s Travails and the Loss of Optimal Care a Precautionary Tale

Medicare is in deep trouble because it is a single payer health care system that seeks to cut costs by, among other ways, restricting physician and facility compensation. As a consequence, we are seeing the ongoing collapse of the system as doctors restrict their patient load and cease providing optimal care.  From the story:

Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you’re a senior covered by Medicare, the wait is eight weeks. How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he’ll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District’s Foxhall Internists group who recently announced they will no longer be accepting Medicare patients. “It’s not easy. But you realize you either do this or you don’t stay in business,” she said.

Doctors across the country describe similar decisions, complaining that they’ve been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress. And that’s not even taking into account a long-postponed rate-setting method that is on track to slash Medicare’s payment rates to doctors by 23 percent Dec. 1. Known as the Sustainable Growth Rate and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy’s overall growth rate. But after the SGR formula led to a 4.8 percent cut in doctors’ pay rates in 2002, Congress has chosen to put off the ever steeper cuts called for by the formula ever since.

The same thing is happening in Medicaid.

True, Obamacare isn’t single payer, but it intends to so hobble the private sector that we have no other place to go.

Solving this mess will require dynamic action. First, increase competition in the system, including by price.  Obamacare seeks to limit it.  Second, decentralize control to allow creativity and dynamism in the marketplace.  Obamacare stifles it. Third, we all need to pay for part of our own health care, perhaps means tested, and provide vouchers for people so they can buy private coverage.  Obamacare tries to give the proverbial free lunch, of which there is no such thing.  Fourth, we have to triage government generally—that is wipe out/consolidate whole sectors of federal bureaucracy that have less urgent functions.   Fifth, we need to cut regulations that stifle grown and the production of wealth.

Some of these areas are beyond SHS’s scope. But the unfolding Medicare/Medicaid debacle shows we are currently heading in exactly the wrong health care direction.