A federally mandated healthcare program cannot be implemented without significant (read: dire) consequences. I will explore several areas of concern regarding any proposed governmental healthcare system. Please be aware that, regardless of the plans proposed by those in Washington, any proposed socialized healthcare system will be subject to the problems discussed herein.
Fees & Insurance
Fees and insurance are closely related, primarily because the insurance industry, not the doctor, sets the fee schedule for the modern medical system. Initially, with respect to fees charged, we will experience the following in the healthcare industry:
1. The government will define and publish the mandated fee schedule. This fee schedule will most likely be based upon the current Medicare fee schedule. The current Medicare fee schedule contains, by far, the lowest reimbursement (payment) rates to the doctor.
2. Any private insurers will also adopt the governmental fee schedule. The private insurers will claim that they must make this change, or they would go out of business. The real reason private insurers will adopt the governmental fee schedule is to maximize profits.
3. Doctors will be forced to accept the governmental fee schedule. This means that the salary of the doctor will go down.
4. Doctors may be allowed to opt-out of the insurance system. If any proposed plan allows the doctor to opt-out, it will be a complete opt-out, ie., the doctor will not be allowed to take any insurance whatsoever. The doctor will then be able to set his or her own fees. The doctors who chose to opt-out will have limited hospital privileges.
Medical Records
Everyone is concerned about the privacy of their medical records, and justifiably so. When any government health care plan is implemented, the government will require the full and complete access to the patient file. The following will occur:
1. Any doctor on the governmental plan will be required to disclose the complete patient file to the government when requested to do so. This will be drastically different from the “Minimum Necessary” standard used today in the private insurance system with regards to records disclosure for claim payment.
2. The access to the doctor’s records by the government will unlikely be limited to only those patients who subscribe to the governmental healthcare plan. The doctor will be required to disclose ALL records for ANY and ALL patients if requested to do so, even those who have private insurance. Failure of the doctor to comply will result in hefty fines and / or imprisonment. The doctor will, therefore, disclose records when required to do so. The doctor will not pay a fine because you think your records should not be released.
3. Patients will realize that the government will soon have access to their complete medical records. To prevent this, a small percentage of patients will attempt to get the originals of their medical records. These patients will get very angry, because the doctor is required by his or her state licensing board to keep the records for a certain number of years.
4. Significant parts of HIPAA, which are designed to protect the privacy of the patient’s medical records, will be replaced with an “access on demand” policy with regards to the patient’s medical records.
5. As a result of the above, the government will eventually have a complete dossier on the health history of every citizen. A central database will be created, which will, of course, be marketed as being in the best interest of all Americans.
The Doctors
1. The doctor’s reimbursement rates will be cut because of the new governmental fee schedule. The doctor, then, will have to see more patients in order to attain the same salary as before. This means the 10 minute office visit you used to get will be cut to four minutes.
2. If the doctor is well respected or highly skilled, he or she will most likely opt-out of the entire system if allowed to do so. The doctor, in this case, will then be allowed to set their own fee schedule. Anyone who sees this doctor must pay their going rate.
3. Many doctors will flee to foreign countries. Belize, Costa Rica, Honduras, Brazil, Mexico, and many island nations will probably see a significant influx of doctors who are looking for a less stressful system to deal with. The doctors will be welcomed with opened arms.
The Newly Insured
When the governmental healthcare plan is passed, all of the uninsured people today will join the ranks of the insured. This will have both a short term and long term effect on the healthcare system. The following short term effects will occur:
1. Upon getting their insurance card, the currently uninsured will see this card as a free pass to the healthcare system. They will flock to medical offices in mass.
2. The newly insured will bring a laundry list of complaints to the doctor’s office. The doctor will be faced with many pre-existing problems that have gone unaddressed for years. This scenario will result in medical test after medical test, likely costing tens of thousands of dollars.
3. Laboratories, imaging facilities, pharmacies, and other adjunct facilities will become backlogged. This will result in expansion of these facilities. Once the newly insured have had their problems addressed, the sudden influx of patients into the medical system will decrease rapidly. Those facilities that chose to expand will realize, in two or three years, that they have made a big mistake.
Many years later, the long term effects will be felt. The long term effects will be:
4. People who have serious medical conditions will have to stand in line behind people with insignificant issues. When an office is called for an appointment, the appointment will be weeks or months away, not today or tomorrow.
5. Even today, appointments with certain specialists must be made weeks to months in advance. This situation will only get worse over time due to the doctors who have left practice, and the decreased enrollment in medical schools.
6. Anyone with a serious medical issue, and able to afford it, will seek care outside the governmental healthcare system. This will include trips to foreign countries.
7. The long term effects will lead to a black market healthcare system. The black market healthcare system will be superior to the governmental system in every way. The black market system will, however, be legal in every respect, because it would be governed and administered under foreign law. This is because rich doctors and attorneys would have created the system for themselves.
Lurking Dangers
If the government is paying the healthcare bill of a patient, the government will undoubtably grant themselves certain rights. Consider, for a moment, the following:
1. A hypothetical patient requires a blood test for one reason or another. When the blood is shipped to the laboratory, additional tests, such as HIV tests, drug tests, and genetic tests, are also performed unknowingly to the patient. Results would be forwarded to the appropriate governmental agency.
2. Genetic databases would be formed. This would be marketed to the public as being in the best interest of the patient. For example, if you need a kidney transplant, potential donors could be matched very quickly. You, however, may be required to relinquish the rights to your organs when you die.
Find your favorite site below and spread the news.
