I confess that I haven’t paid that much attention to the horse race politics of insurance enrollment under the PPACA (Obamacare). Overall, even if 7.1 million signed up, pay their premiums, and weren’t previously insured, it still means that only a small fraction of the 50 million uninsured now have coverage.
Several people have asked me what I think about Obamacare since it was passed. I don’t want to spend a lot of time on this, but I thought I’d hit just a few high points.
1) Obamacare does little to grow family medicine or primary care. It promised a 10% increase in some of our basic fees, which was supposed to start in 2013, but still hasn’t taken effect, and is set to revert back to the old fees at the end of 2014. The same onerous and unnecessarily complex rules that CMS wrote in the mid-1990s that restrict what family physicians can bill for an office visit, prohibit payment for encounters such as email or phone visits, and create ridiculous documentation rules are still in place. Basically those rules force family physicians to give away 20% to 50% of our work. Plus, all the insurance companies use the same rules.
2) Obamacare pays for increased prevention, but there is no positive impact for primary care. Just because it requires services like mammograms and Pap smears to be free to the insured doesn’t mean that payment was improved for family physicians. I have found that several people in the media just don’t understand this concept.
3) Obamacare does little to break up the status quo. All of the hospital systems and insurance companies have their same payment mechanisms and rules in place. Accountable Care Organizations have few real victories to show for the protections that were created. Basically, the law incentivized hospital systems to try to create these cooperative ventures, which have mostly been a colossal failure. A very few may have slowed the cost growth a little, but almost none have reduced costs. And remember, we still spend nearly twice as much on healthcare as the rest of the developed world.
4) The best summation of Obamacare is that it just continues to buy more of the same dysfunctional system we already have. We still have cardiologists performing unnecessary stents, hospitals charging outrageous fees, people generating $1,000+ bills when they go to ERs for primary care problems: these are just a few examples. Obamacare does nothing significant to reverse these excesses.
That’s why I haven’t paid a whole lot of attention to the roll out of Obamacare. Nothing significant has changed.