Monday, June 17, 2013

The Obamacare Radar Detector
The most essential gift for a good writer is a built-in, shock-proof, shit detector. This the writer’s radar all great writers have it.
Ernest Hemingway (1899-1961),  Interview in Paris Review (1958)
I do not profess to be a great writer.  But I like to believe I have built-in radar for what’s going on beneath the surface  of the healthcare news.
Here are two examples.
·         The biggest threat to Obamacare implementation is the IRS scandal.  It undermines trust in impartial government and  truths it claims to impart.  In today’s Forbes, Grace Marie Turner, founder and president of the Galen Institute, brings this threat to light in “Danger Ahead: Obamacare and the IRS.” She claims Congress has a duty to delay IRS funding to block Obamacare implementation. The IRS, she asserts, will have unprecedented and compromised powers – to collect $1 trillion to fund the law,  distribute another trillions of dollars  in subsidies, enforce compliance of many mandates,  introduce 46 new tax proposals,  collect information on citizens’ income, employment and health status,  and increase and monitor surveillance of their private affairs.  

These activities are beyond the IRS’s normal functions and will require $10 billion in additional funding and 16,500 IRS agents to enforce.  Furthermore, she adds, Sarah Hill Ingram, the top IRS official who oversaw the IRS office that targeted, delayed or stopped the Tea Party and other conservatives efforts from qualifying for tax exempt status,  will run the IRS implementation of Obamacare from the White House.    As Shakespeare said, “Something is rotten in the state of Denmark,” and it has a decidedly fecal smell .  The IRS has forfeited its claim to being politically impartial and should be stripped of its Obamacare enforcement powers.  All of these things empower government while disempowering individuals.
·         The other phenomenon going on relating to Obamacare is the movement of consumers and physicians away from traditional healthcare settings. – physicians offices, emergency rooms, and hospitals and their outlets.  Fear of premium “rate shock,” among the 25 million in young, individual, and small group markets triggers this movement.  It is occurring among relatively healthy consumers seeking more convenience, lower costs, and fewer hassles – and among physicians  seeking refuge from  third party straight jackets that drive up overheads and divert attention away from patients.  The alternatives to traditional care include:    retail clinics now offered by all major drugstore chains, generally run by nurse practitioners,  where the average cost is $78 dollars per visit;  worksite clinics, financed by one-third of major employers with over 500 employers; 1200 community health clinics, partially financed by government,  where costs vary from $35 to $300, depending on the nature of the visit; and  9000 urgent care walk-in centers,  which are growing at the rate of 300 per year,  where costs average $118 for each visit; and concierge practices  Among consumers, the appeal of these new settings is lower costs, less waiting, less bureaucracy, and in the case on conciege practices, more unfettered access.   Among physicians the main appeals are professional independence , escape from rules and regulations, and direct pay, which increases cash flow and lowers overhead.  If. as a physician, a consumer, or someone interested in direct pay strategies, you may want to attend a workshop, “Thrive, Not Just Survive," to be held at Hubert Humphrey School of Public Affairs in Minneapolis  on August 10, 2013,.  For more information and to register, call 612-333-4646.

Tweet:   Two Obamacare radar screen sightings: 1) negative IRS impacts on implementation; 2) rise of nontraditional lower-cost healthcare settings.

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