By Keith R. Jackson
As we venture into the beginnings of government-run health care, we will be witnessing the not so insidious demise of private practice medicine. The overall plan of our political class, in their well-intentioned and voter-supported effort to cut wildly escalating health care costs, involves organizing groups that they can control more effectively than they can the current system. Unbeknownst to the voting public, this effort cuts out private practitioners of medicine. Doctors who own their own businesses, employ their own staff, make their own decisions about how long they will work on a particular day, pay their own insurance, comply with increasingly onerous business rules and regulations, pay their own rent, and keep up with the most recent improvements in the field of medicine will just be told that they can’t play in the government’s new playground. The great “Borg” of ObamaCare will play with only the chosen few who are fortunate enough to sit at the table of the great planners.
ObamaCare isn’t, and has never been, about cost containment. Under the Affordable Care Act, costs will actually dramatically increase. Of course, this will be “unexpected” and “only temporary in nature, we’re sure,” to the mainstream media. But the costs will climb, nonetheless. And the reasons are obvious to anyone who can add. Hospitals and insurance companies are currently gearing up in their attempt to “play the game” the way they see the government has set up the “playing field.” What they are doing is attempting to aggregate as many private medical groups as they can, aligning them in an effort to be the “big dog” in their geographic area. As such, they can be irreplaceable and unchallenged in the eyes of the government.
The carrot on a stick that hospitals use to attract successful private medical practices into alignment is the CPT (current procedural terminology) code — namely, via the differential benefit between a private-practice CPT billing and a hospital-based CPT-generated bill. The private practitioner charges a certain fee for an office visit. With most insurance companies, there is a pre-existing, negotiated rate at which this visit is discounted for the practitioner to participate in the insurance companies’ pool of patients. Each service provided by the doctor has an agreed-upon value, deemed a CPT.
Interestingly, and because of currently justifiable reasons, the hospitals can charge much more money to the insurance companies for the same service, when that service is provided through the hospital itself. So the hospitals can turn to the doctors and say, “You can bill under our name and get more money. Any cost problems that occur in allowing us to be your new administrators should be covered up in the extra monies generated. And you won’t be shut out in the upcoming negotiations dealing with the 247 new bureaucracies of the ACA.” This cannot help but drive up costs.
This is a very frightening time to be a physician. Many doctors who own their own businesses are seeing such a dramatic drop in reimbursement that they go months between paychecks, even when they are extremely busy. Government threatens them with withholding payment if they don’t purchase expensive electronic medical records software. Insurance companies play games with payments, holding on to their cash as long as they can justify any reason why payment could be withheld. More and more people are uninsured and requiring care, often thinking that the government would be paying for their care by now. (Doctors have been taking care of the uninsured forever, but politicians will tell you that they are going to be providentially brought into the system through their compassionate efforts.) Legal costs, both from a small-business standpoint and medico-legal perspective, are almost fictional in their amounts. Is it any wonder, then, that doctors feel that their financial liquidity and bargaining position are rapidly diminishing?
Ultimately, accountable care organizations and nationally based insurance conglomerates will dominate the landscape. As with socialism in all other instances, large business will be more powerful and friendly with the socialist bureaucrats. This will be at the expense of small business — namely, the private practitioners of medicine. There will be instances of “too big to fail” that result in a continuous stream of Solyndra-like bailouts to the large groups. Certain hospitals, because of the rules of participation in the ACA, will necessarily get “dumped on” by the other hospitals that are trying to keep only the least sick patients in order to look good on paper when reviewing the statistics that keep their funding. The hospitals that do take the sickest people will be in a constant state of funding shortages and will necessarily have to be the “closest” to the administrations that dole out federal cash. Privately owned hospitals — businesses that are for profit and therefore evil in the eyes of the voting public — will go under.
Doctors are in short supply, and they should be in a fairly unique bargaining position. With all of us working for someone else, unionization will follow. This is, of course, the plan of the current administration. After all, aren’t unions the Democratic Party’s base? And what will happen with costs? Chances are they’ll rise.
Hang on, America. Voting has consequences.