Tuesday, October 29, 2013

The One Good Thing About ObamaCare

I'm not a fan of the Affordable Care Act for many reasons, not all of them political. Essentially, I don't think politicians and bureaucrats should be making medical decisions. Some day I will write about this in more depth but today I want to let you know about the one thing I do like about ObamaCare.

As the program develops, hospital systems (face it, hospitals as we knew them are dead) will be forced to see more and more patients and get paid less and less to see them. Right now, a hospital system or clinic would be lucky to receive 20 cents on the dollar billed. That is not due to over-billing in the first place but rather to the fact that reimbursements are approved or disapproved by bean counters pouring over charts and converting a human activity, a sacred encounter between doctor and patient, into numbers. A lot is lost in the translation.

Remember these facts and you will begin to understand how health care works in the U. S: it's all about motivation and intention. A physician or nurse is motivated by two factors: the profit motive so that they can feed their families and enjoy a decent quality of life and making people better. Sometimes the two motives pull the same weight within an individual practitioner while in another one or the other motives is more important. Sometimes they change rank depending on the provider's personal and professional circumstances.

A hospital system on the other hand is motivated first by the profit motive (hell, maintaining the CEO's pool is expensive) and secondarily by image. While the first is never mentioned in public, take a look at the ads hospitals pay tremendous fortunes on and see for yourself. "Our hospital performs the most heart surgeries in the state;" "Our hospital has a 5-star rating in ..." and so on. Changes occur when hospital systems feel that their profits or images are at stake.

Lastly, the government-run insurance programs are motivated by two factors: saving as much money as possible and providing members with access to health care that is adequate at worst and exemplary at best. The former explains why we see only twenty cents on the dollar but it will also explain why I think something good is going to come out of ObamaCare. It can be summed up in one phrase: preventive care.

My friend, economist and financial adviser John Mauldin writes with a style and clarity that can only be described as inspiring. I'll give the link to an article that describes how the ACA is going to force hospital systems to change in order to stay in business. I'll let John delve into details. What I find ironic (and sad) is that we have been saying the same thing for the last 23 years. Preventive care saves lives and money in the long run. With very few exceptions (and you know who you are!), I feel like I've been preaching to the wall. But with the weight and influence of large hospital systems, the message will reach the masses.

Briefly, consider the cost of treating a patient with heart disease compared to the cost of teaching people how to eat and exercise in order to prevent heart disease. Again, a large segment of the adult population suffer from Metabolic Syndrome which is earmarked by obesity, hypertension, and insulin resistance. This Syndrome inevitably leads to Diabetes Mellitus II and all of its dangerous complications such as heart disease, circulatory problems, mental health issues, and more. I personally have gotten patients off of cholesterol and diabetes medications through diet and exercise alone. At the front end, this saves money on medications and in the long run, saves money on more intensive interventions such as surgery and expensive drugs.

Someday I'll write about what you can do right now to experience better physical and mental health without resorting to medications and surgeries. On your part, please look at Mauldin's article and understand why I have hope for the future.
Dr. Mike

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