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Your Future Under Obamacare: Big Medicine Getting Bigger

More centralized control of health spending will inevitably mean more centralized control of health care.

by
Paul Hsieh

Bio

September 3, 2013 - 11:13 pm
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With both Big Law and Big Ed, those paying the bills are frustrated and seeking alternatives to the status quo. And they are making their preferences known in the marketplace. Over time, some members of the “old guard” (the top law firms and the top universities) may survive, albeit leaner than before. Some new business models will likely also emerge, for instance inexpensive MOOC (massive open online courses) as a partial alternative to traditional colleges. There’s no way of knowing exactly how things will shake out. But this uncertainty is a natural feature of the marketplace — a process that economist Joseph Schumpeter calls “creative destruction.”

In contrast, the shakeup in health care is towards greater — not lesser — consolidation. This is because the government — not patients — will be increasingly in charge of the money. Under ObamaCare, government is projected to account for a whopping 66% of overall health spending. More centralized control of health spending will inevitably mean more centralized control of health care.

Nor is this centralization of health care some “unintended consequence” of ObamaCare. Rather, it is an explicitly desired goal. In 2010, Obama health advisor Nancy-Ann DeParle wrote in the Annals of Internal Medicine that the health law will “accelerate physician employment by hospitals and aggregation into larger physician groups” and that “physicians will need to embrace rather than resist change.”

This consolidation of American medicine is merely a continuation of a much older strategy. In his book Liberal Fascism, Jonah Goldberg described how the Roosevelt administration sought similar consolidations of American agriculture and business during the New Deal:

[I]f you… want to use business to implement your social agenda, then you should want businesses themselves to be as big as possible. What’s easier, strapping five thousand cats to a wagon or a couple of giant oxen?

Similarly, it will be much easier for the federal government to regulate 1,000 large hospital groups and ACOs than 10,000 small private practices and independent hospitals. The New York Times notes that after physicians become hospital employees, they become much more accepting of government controls than their counterparts in private practice.

And it’s no secret that many on the political left desire the ultimate form of “Big Medicine” — namely, a “single-payer” health system fully controlled by the government. (Nor is it a coincidence that the president’s proposed “fix” for the current education upheaval bears eerie similarities to ObamaCare.)

There’s nothing inherently wrong with “Big” organizations as such, provided they arise naturally from market forces. For a while, Apple was the largest company in the world, but it gained that status by selling products to willing consumers in the marketplace.

Likewise, when a physician freely chooses to become a hospital employee rather than enter private practice based on genuine personal and professional preferences, that can be a perfectly legitimate choice.

But when the government tilts the playing field to drive doctors out of independent private practices and into more easily regulated large entities, that’s a different matter altogether. As Dr. Jay Parkinson noted, this means “the business model of a doctor’s practice is determined by bureaucrats in Washington.”

So how will this affect doctors’ freedom to practice and patients’ freedom to receive medical care? Stay tuned. Future articles in this series will discuss how government-spawned Big Medicine will affect patients, the role of mandatory electronic medical records in Big Medicine, and how patients can best protect themselves from Big Medicine.

Also read “Obamacare and the  Consolidation Wave” by Rich Baehr.

Next Week: “How Big Medicine will harm patients.”

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Paul Hsieh, MD, is a member of the Colorado chapter of Docs4PatientCare (www.Docs4PatientCare.org) and co-founder of Freedom and Individual Rights in Medicine (www.WeStandFIRM.org).

Comments are closed.

Top Rated Comments   
I have not only watched this, but I have got to live it since I got cancer 7 years ago. I had my own insurance through my own job and that covered almost all my iniatial costs. Once it was proven I was never going to return to my job, they quickly fired me to save money. I went on my wife's insurace she had through her job and I was denied NOTHING during my 11 months of chemo and as many operations. When obamma came to power my wifes non-profit legal firm was on jarrets enemies list (they were all republican laywers) and their funding dried up to the point that they went out of business. I was then forced onto medicare and the battle of "you cost too much" began for me.

Every single previous medication I was on for 2 years was denied out of hand because the bean counters had to "review" what the DOCTORS perscribed and "recomend" ( meaning force you) to change medications or pay 100% of the cost yourself, and that was AFTER being cut-off of my meds cold-turkey for 3 months! Then all the co-pays started to change to the point that my entire $1200 per month SS check that I got for paying taxes for 30 years, would NOT even cover the "CO-PAYS". According to them, it was OK to raise my co-pay from $30 bucks a month on ONE med to $800 a month, and that was after my & my doctors fight to get it on the "inclusive" list of approved meds.

After 2 years of this all of our savings was gone, all of our creditcards were maxed out, and I still was racking up medical debt at break neck pace.

This was all BEFORE obamacare. Now even diagnostic imaging of ANY kind carries a percentage that you have to pay out of your pocket, and that pectage changes often. 1 xray for me $80... 1 MRI for me $2000.

Now it is even worse and the pace of forcing you to pay more or go without is going faster while hospital profit margins sit around 4000% mark-up on average in the USA.


Soon the death panels or as the VA likes to call them "end of life councilers" will expand from talking our vets into killing themselves out onto the general public and have a team at every hospital in the country with mandatory sessions for all medicade paitents to attend or lose your coverage.
50 weeks ago
50 weeks ago Link To Comment
All Comments   (15)
All Comments   (15)
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To low information citizens Social Security and Medicare appear financially viable on the surface. Anyone paying attention knows they are unsustainably bankrupt. But these are both relatively smaller populations for which to provide benefits to compared to Obamacare's affected population.

The US may be seem to be decades behind European nationalized health care's descent into bankruptcy - but unfettered immigration of millions more Obamacare recipients may well catch us up at a frighteningly quick pace.
50 weeks ago
50 weeks ago Link To Comment
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50 weeks ago
50 weeks ago Link To Comment
Short of the overthrow of our “republic” and massive suffering, there will be improvement.
50 weeks ago
50 weeks ago Link To Comment
This is going to wreak absolute havoc on people like me who have migraine. It's a highly individual disease that's absolutely pernicious. If you have it, you lose a lot of days to it until you can get it under control, but because it's highly individual, you really need a doctor who understands it very well, knows all the possible treatment permutations and is willing and able to work with you to come up with a plan that really works for you. That makes it very expensive to properly treat migraine suffers, but when it works, it's so worth it.
50 weeks ago
50 weeks ago Link To Comment
The thing is, somehow every other 1st world country in the world, and even many 3rd world countries somehow manage to have universal coverage via socialized medicine and yet somehow manage to only pay a small fraction of what we do.

If their medical coverage somehow actually worse? Maybe, maybe not. But my experience with the health care system indicates it can't possibly any worse. My mother had heart problems and then later cancer. Both times it was absolute nightmares, constantly fighting with the insurance company.

The hospital would have to discharge her because the insurance company wouldn't pay any more, so we'd constantly have to take her right back to the emergency room to get her re-admitted.

The whole thing just killed about my father and certainly didn't do my well being any favors.

God forbid if actually giving everyone health care means delays. Can't have rich people and those with great insurance inconvenienced, meanwhile people like my mother can just die, apparently.
50 weeks ago
50 weeks ago Link To Comment
Do not be so hard on discojer.

What happened to his mother was not right.

Medicine has not been a free market since the whole concept of medical insurance came to be. This is not a box of Cheerios.

The market became infused with cash when doctors and hospitals could negotiate fees with insurance companies instead of just having the patient write a check. That has had some upside and medical care rode that wave of employer benefit insurance money to build and provide better care.

There is no free lunch. It had to happen that corporate medicine evolved to better meet the negotiated fees, which have little to do with actual charges, Medicare brought government into the picture in an ever expanding role. All of this happened long before Obamacare.

Now government wants to call more shots because they can. We all know that government tends to least efficient and most costly of all options.

So I have seen these things happen over the last few decades and have run the gamut. I was trained in the county run government big city hospital which was an excellent experience for a resident. We were in it up to our eyeballs there. No regrets.

I have since had a long run in a private group practice which was run over by a big box corporate institution. I have been hospital employee, practiced with a smaller company as employee, and am now with another private practice trying to maintain position in this sea of instability.

All I ever wanted was to be able to do my work without thinking much about the politics and reimbursement. Mostly I have had that opportunity. That freedom will diminish as government controls.

Anyway I am sorry about what happened to Discojer and his family. I do not control anymore the bill for my services. That has been taken away from the providers long ago.
50 weeks ago
50 weeks ago Link To Comment
Well, it certainly is simpler in those countries. You get what you get without appeal. However, those countries also deliver second or third rate treatments at best, and if there's a better treatment that you might need to save life or limb? Too bad. You get what you get. And if you have a rapidly deteriorating condition or an aggressive cancer and the line is six to nine months long to wait for your treatment, you just better pray your condition isn't really that bad so that you're still alive and maybe treatable when it's your turn.

You must be a big supporter of the public school system, too.
50 weeks ago
50 weeks ago Link To Comment
DiscoJer, My condolences for your mother, but you have it wrong. With a free market, you have many more options to save life and to address corruption or malpractice. With a government system run by nameless, faceless bureaucrats, you'll get nothing. Note how those with the power, exempt themselves, like Congress and the IRS. That tells you all you need to know. Obamacare is a scam. It's not designed to improve healthcare. It's meant to take away your options and make you entirely dependent on power mad tyrants who don't give a damn about your mother or you, while taking all of your money for their use. And if you complain, you'll be threatened, imprisoned, silenced, slandered, possibly killed as a right wing anti-government terrorist if you get too much notice. Don't expect justice or mercy from the politicians in power, liars and hypocrites all, who constantly lie to you telling you that they'll make the world more fair, more just, if you just sign away your life, your money, your liberty to them for eternity. Don't let your grief turn into anger that is used by politicians to pit you against your neighbor.
50 weeks ago
50 weeks ago Link To Comment
how many Free socialized medicine countries have you visited? the UK has some of the worst medical staff, if you want to commit suicide go to Gov run healthcare- the entire healthcare scam by USG is a vote buying campaign & countries like Canada just go and see how free is FREE? sounds great but like Food Stamps and Welfare it will be abused by the masses until they kill it
50 weeks ago
50 weeks ago Link To Comment
Let me add, I'm not in favor of socialism, but there's no free market possible in medicine.

The minute the government starts regulating things, and handing out lawsuit money, it means that costs just go up and up and up.
50 weeks ago
50 weeks ago Link To Comment
No one denies that our health care system had problems, but ACA is looking to be a miserable way to "fix" things. You asked if the European systems were worse? How many stories have we seen over the years of seriously ill folks both famous and indigent flown to the US for treatment? Famous because they could afford to pay out of pocket, and the special cases because some charitable organization stepped in and footed the bills.
50 weeks ago
50 weeks ago Link To Comment
And the minute the government gets involved, it ceased to be a free market. So do you want tell me again how the free market isn't possible because we haven't seen it.
50 weeks ago
50 weeks ago Link To Comment
I have not only watched this, but I have got to live it since I got cancer 7 years ago. I had my own insurance through my own job and that covered almost all my iniatial costs. Once it was proven I was never going to return to my job, they quickly fired me to save money. I went on my wife's insurace she had through her job and I was denied NOTHING during my 11 months of chemo and as many operations. When obamma came to power my wifes non-profit legal firm was on jarrets enemies list (they were all republican laywers) and their funding dried up to the point that they went out of business. I was then forced onto medicare and the battle of "you cost too much" began for me.

Every single previous medication I was on for 2 years was denied out of hand because the bean counters had to "review" what the DOCTORS perscribed and "recomend" ( meaning force you) to change medications or pay 100% of the cost yourself, and that was AFTER being cut-off of my meds cold-turkey for 3 months! Then all the co-pays started to change to the point that my entire $1200 per month SS check that I got for paying taxes for 30 years, would NOT even cover the "CO-PAYS". According to them, it was OK to raise my co-pay from $30 bucks a month on ONE med to $800 a month, and that was after my & my doctors fight to get it on the "inclusive" list of approved meds.

After 2 years of this all of our savings was gone, all of our creditcards were maxed out, and I still was racking up medical debt at break neck pace.

This was all BEFORE obamacare. Now even diagnostic imaging of ANY kind carries a percentage that you have to pay out of your pocket, and that pectage changes often. 1 xray for me $80... 1 MRI for me $2000.

Now it is even worse and the pace of forcing you to pay more or go without is going faster while hospital profit margins sit around 4000% mark-up on average in the USA.


Soon the death panels or as the VA likes to call them "end of life councilers" will expand from talking our vets into killing themselves out onto the general public and have a team at every hospital in the country with mandatory sessions for all medicade paitents to attend or lose your coverage.
50 weeks ago
50 weeks ago Link To Comment
An Ass masquerading as a President once found a Doctor’s white lab coat
which had been left out in the sun to dry. He put it on and spoke to his
countrymen. All bowed, both men and women, and he was a proud Ass that
day. In his delight he lifted up his voice and brayed treatments and
prescriptions and timetables and qualifications randomly and incoherently and unleashed mindless and ravenous bureaucrats upon the land to look for trouble, find it everywhere, diagnose everything incorrectly and then in a very grouchy manner force Doctors to misapply the wrong remedies, and then everyone knew him for the Ass he really was ... ... ... but by then the majority of the nation, especially in Congress, had devolved from Lions and Foxes into Mice and Sheep and so it was too late.
50 weeks ago
50 weeks ago Link To Comment
this issue of Dem led healthcare has been going on for 20+ years it has been nothing more than a vote buying campaign by the DEMS, remember when Bill & Hilary were pushing the issue in 1990's? vote buying all it is
50 weeks ago
50 weeks ago Link To Comment
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