Choosing to Understand Choice

By Doug Magill

A recent Facebook post from my nephew about reduced physician choice under Obamacare resulted in a blizzard of rationalizations and angry rebuttals.  Very little of which had anything to do with the original point of the post.

People do tend to wander off topic relative to this subject.  It tends to bring in the dewy-eyed dreams of universal coverage and defense of Obama and idealistic belief in beneficent government.  However, if we stay close to the original concern – that of physician and coverage choices under Obamacare – we should examine what is happening and what will happen with the eyes of the business and health care executives who will be primarily responsible for implementing this monster.  Executives don’t tend to traffic much in opinions, they make decisions based on facts, implications, and results.  So, here are some things we know.

Let’s see, the heads of three major labor unions wrote to Pelosi and Reid recently that Obamacare is “undermining the health-care market of viable alternatives” and will “destroy the health and wellbeing of America’s working class.”  Wrapped in that is the understanding that coverage choices and physician options are being reduced for their members.  We know they are looking for a deal by making their concerns public – and why not, as this administration has a history of backroom and corrupt deals – but they are accurately representing the worries of their members.

We also know that major insurance carriers have recently bailed out of California altogether, as have a number in Massachusetts and New York where the strictures of guaranteed issue and community rating have already been implemented (in New York in the 90’s).  Obamacare will actually deregulate some things in New York (now there’s a little-known fact), but the market for individual insurance has collapsed in that state (a couple of million policies in the early 90’s to around 30,000 today).  What happened there is that all major carriers left the indemnity market and individuals just stopped buying coverage because they were guaranteed coverage.  Prices are considerably higher than surrounding states and they have enormous emergency room problems.  Does that help or reduce choice?

Sixty percent of the doctors who responded to a recent survey by the Deloitte Center are likely to retire sooner than planned in the next one to three years due to Obamacare, irrespective of age, gender or medical specialty.  And, according to the same survey nearly three-quarters of physicians think the nation’s best and brightest students will not consider a career in Medicine due to Obamacare.  That doesn’t seem to bode well for physician choice, does it?  We have a significant number of physicians in the area and they almost universally agree with that sentiment based on our private discussions (as does my former college roommate – the last physician in private practice in Goshen, NY).  Almost all private practitioners have sold their practices to large hospital chains because of the cost strictures and bureaucratic burdens of Obamacare (note they are making decisions based on the implications of the legislation).  By definition that reduces physician choice.

We meet regularly with a number of executives in the local large and nationally-ranked medical centers and they admit doctor choice will be reduced due to the approaches to team practices promulgated by Obamacare.  And, due to the impending shortages of physicians many medical examinations and procedures will soon be handled by PA’s and/or RN’s.  That certainly doesn’t sound like physician choice.

I have a number of friends who are farmers who are dropping insurance coverage altogether due to the price increases caused by the Obamacare mandates.  They will run without insurance and have major medical procedures done overseas.  They echo the surveys and meetings we have had with young people (40% of whom do not now have insurance coverage due to cost).  Incredible increases in premiums due to Obamacare have effectively reduced choice for enormous numbers of people.  This undermines the very foundation of the law – that young and healthy people will pay a lot more in premiums (pace, Justice Roberts – taxes) to subsidize people who are sick or without coverage. Plus, many young people who would have gravitated to entrepreneurial pursuits should affordable individual policies be available are now trying to hide in corporations for medical insurance reasons.  They feel they have been given no choice (and, by the way, what does that mean for small business, one of the key engines of economic growth?).

Up to 76% of small businesses are reducing hours and cutting their workforce due to premium costs and coverage requirements in Obamacare.  How does that help people choose and keep a physician?

I know at least one major international corporation that is dropping insurance coverage for retirees entirely due to Obamacare.  How does that help people keep their coverage and their physician?  The company will provide a subsidy, but it will not be adjusted for inflation and will not provide full coverage for anyone.  Expect to see this trend continue.

There’s more, but misplaced idealism and good intentions should not keep people insulated from the reality of a terrible policy and execrable legislation that is too complex to implement, crafted in the dead of night in a totally partisan fashion, founded on sleazy backroom deals and destructive to health care, insurance and the economy.

Most people are sympathetic to the intentions of Obamacare.  Those of us that are familiar with the legislation and its effects wish to have us all focus on finding solutions that increase choice and lower costs.  This isn’t it.



  1. Marilyn Matia says:

    As a senior (85)..with Humana Medicare coverage…premiums are already doctor is not taking anymore patients..the deductible is up..certain benefits have been cut and after all this..there is bound to be more..It is the worst legislation in the history of this country. If the pre-existing condition is the driver..pass legislation to solve that and go on to the next problem. For those living in our state legislators to vote “no” on Medicaid not validate any part of this attempt to a “backdoor” handout from the broken Fed. budget.

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