Medical Tuesday Blog
America is looking disturbingly like Europe
When a policy generating a lot of fame and fortune starts to go wrong, the temptation to ignore new data can be irresistible. For over 50 years, mainstream U.S. health policy makers have promoted research supporting Kenneth Arrow’s 1963 assertion that “it is the general social consensus, clearly, that the laissez-faire solution for medicine is intolerable.” That is, only government intervention can reduce medical spending, raise medical quality, and provide care for all.
Evidence compiled since Arrow’s paper suggests that government is more likely to be the cost problem than the cost solution. Unfortunately, those invested in the proposition that government control lowers costs tend to avoid engaging with evidence that suggests the opposite.
The mandates created a system of “integrated” care depressingly similar to the centrally controlled health systems in other industrialized countries. It was designed to limite total health spending, develop tracking systems to control physician and patient behavior, and establish clinical pathways dictating the “right” tests and treatments for every single person. Unaccountable experts combine their notions of “value” with average results from population health studies to cut spending by deciding whether you should get the medical care you need.
In practice, the ObamaCare restructuring has forced the adoption of immature health information technologies, raising costs and exposing millions of Americans to identity fraud. It has imposed costly administrative burdens on clinicians with little evidence of a commensurate improvement in care. In 2016, Sinsky et al. reported that physicians providing ambulatory care in 4 specialties now spend two hours on electronic record keeping and other paperwork for every hour of direct patient contact. In response to spiraling administrative burdens, the American College of Physicians has called for quality-of-care impact reviews for new and existing administrative tasks imposed by oversight organizations, payers, and vendors.
There is growing evidence that ObamaCare’s substitution of government run care for private sector arrangements increases costs. Health coverage premiums were artificially raised when ObamaCare made many private coverage arrangements illegal. Eliminating those arrangements forced many people into Medicaid, likely reducing their access to physicians, preventive care, and high quality treatment.
Charles Blahous has explored the expenditure side of Medicaid. He notes that a June 2017 Centers for Medicare & Medicaid Services (CMS) estimate of future Medicaid expansion costs predicts per capita costs will be $7,436 per person in 2022. In 2013, CMS predicted 2022 per capita costs would be just $4,875. Meanwhile, the Medicare Payment Advisory Commission (MEDPAC) estimates that one of ObamaCare’s more hyped health system transformations, Medicare Accountable Care Organizations, increased Medicare spending by $216 million in 2015.
How do ObamaCare proponents even know the U.S. spends too much on health care? People place a high value on health and physical functioning. Why not conclude instead that countries with long waiting lists for medical care spend too little on health care rather than that the U.S. spends too much? We know that before ObamaCare U.S. patients benefited from higher spending with more preventive care, faster diagnosis, more rapid access to curative medicines, a higher likelihood of surviving cancer, and lower chronic disability rates in old age.
To be knowledgeable in the medical care industry and where we went wrong, please read total paper at
Government medicine does not give timely access to healthcare, only access to a waiting list with costly delay in necessary care, increased morbidity and lower quality of care.
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