Tuesday, August 28, 2012

Will big box medicine actually lower costs? There are valid grounds for doubt.

From the article "Reform Driving Physicians Out of Private Practice to Reduce Costs" a few issues are raised about rapid and dramatic changes occurring in health care, about which consumers have little knowledge.  Health care conglomerates are being forcibly created due to the new payment structure, which can only increase costs considerably in the short term.  And increase doctor dissatisfaction.  I haven't seen patients any happier.  And fewer and fewer can pay for their insurance.  Author Thomas Frank suggested in Harper's that Obamacare is derived in part from a Heritage Foundation proposal for health care.  Hello?
... When Congress passed the Affordable Care Act (ACA) in an attempt to redirect the unsustainable trajectory of our $2.9 trillion, extraordinarily complex healthcare system, it did so with about 2,600 pages of potential progenitors of the Butterfly Effect.

The casualties of the first flutters wrote large are being seen already. They are doctors being driven out of private practice and into the safe refuge of employment by hospitals, large clinics, and integrated health systems. These consolidated systems, with near monopolies in many geographic regions, will be powerful enough to demand higher rates and new fees from payers. As a countermeasure, government reformers are pushing accountable care organizations, with bundled bills, budgetary caps, and capitated rates, shifting risk to closed systems of physicians and hospitals.

Will big box medicine actually lower costs? There are valid grounds for doubt. If and how long the federal government can afford to keep the new system afloat with cash as it conversely heaps on mountains of new regulations and unfunded mandates lengthens the odds of success considerably.
Exacerbating the entire situation is the present public health concern of physician shortages building to crisis proportions as so starkly outlined by Annie Lowrey and Robert Pear in their July 28, 2012 New York Times article, “Doctor Shortage Likely to Worsen With Health Law.”

Putting physicians who have invested a decade or more in intensive training with six figure school loans out of business and into a big box lab coat is far removed from putting a general store owner out of business and into a big box retail vest. The level of dissatisfaction among physicians is already profound, and worsening. Of greater concern — they have choices other than clinical medicine and resources to pursue them.

So, the question is:  Is driving a systemically distressed, contracting, dissatisfied and undercompensated physician sector to be forcibly absorbed by a traditional antagonist, but symbiotic hospital sector on the edge of distress itself and binding them together with miles of red tape and questionably reachable incentives going to reduce costs? ...

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