Wednesday, March 17, 2010

So who will do well and who will not as the Medical Care "reform" is enacted

A recent poll of U.S. physicians was published in the NEJM,(see here).About 46% of primary care physicians indicated they would leave practice or at least seriously consider leaving practice if some version the Senate health care bill becomes law.

The law will increase the number of patients covered under Medicaid and if big cuts occur in the Medicare Advantage there will be an increase in the number of folks moving to regular Medicare.We will have a situation in which there will be more patients trying to obtain care from fewer physicians. Those physicians remaining in the Medicare/Medicare treating group will be faced with increasing regulations and controls and ultimately further decreases in payments as the approximately $500 million in projected "savings" in Medicare payments play out. This in turn is likely to spral down with more physicians "going Galt".

Waiting lists , shortages and decreased quality likely will result. In Massachusetts with its version of what is to come nationally there are much longer wait times for physician visits even in spite of the very high per capita number of docs in that state.

Having health insurance is not equivalent to receiving health care. Who typically gets the goods or services that are in short supply due to government controls, the well to-do and well connected or the poor and less well connected? Either through accessing retainer practices ( it will take a while to outlaw them) or other means of getting to the front of the line or getting care out of the country the richer and more connected will , as always do much better. Those who will not are some the same folks who are the alleged beneficiaries of this deconstruction/reconstruction of health care.

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