Monday, December 9, 2013

The Race to the Bottom: Excluding Top Hospitals
The race is not to the swift, nor the battle to the strong.
Ecclesiastics,  9:11
You can bet your bottom dollar on this: ObamaCare is about a race to the bottom of the health care system.
I do not wish to be narrow minded about this issue, but there is ample evidence of what I am saying.
·         Many health exchange plans are excluding top hospitals such as Memorial Sloan Kettering in Manhattan, Anderson Cancer Center in Houston,  Cedar Sinai in Los Angeles, Childrens in Seattle,   and  many academic health centers elsewhere across America.

·         Health insurers everywhere are narrowing networks of physicians and hospitals with which they will do business, i.e. including them in their network,  in order to survive economically ostracizing  providers who  charge higher prices because many see sicker patients who require a higher level of services.

·         Obama health policies are creating an avalanche of patients, by the far the greatest number signing up for health exchange plans,  to rush into Medicaid,  the bottom rung of health care, whose patients many doctors do not accept because of low reimbursement and onerous paperwork.
For the Obama administration, this race to the bottom makes sense.   Costs are lowered for the bottom tier of the population, many of the uninsured gain access to insurance, and, presumably, the system can deliver on its off-repeated promise of offering insurance to greater numbers of disenfranchised patients at lower costs.
For the insurers, the race to the bottom  is rational.   Plans can offer lower premiums,  cope with the problem of delivering expanded “ minimum benefits” the health law requires,  and cull those so-called “inefficient” and “costly”  hospitals out of their networks.
But for Americans accustomed to access to “the very best” at top institutions  and from top specialists, the race to the bottom represents lower quality and less access.  
The race doesn’t make a lot of sense for the U.S health system either, which is designed to the provide the best care at the top.   And it makes little sense to doctors and hospitals at top institutions who tend to care for sicker and poorer and more complicated patients,  who are more expensive to diagnose and treat.    Poverty, not greedy doctors and hospitals  is the greatest driver of high costs.  
Caregivers caring for the poor are doing what they do – providing care for the sick  with the resources available.  Cutting high end providers of the care out of the health plan loop solves nothing. It merely limits access to the poor and raises prices and deductibles for the middle class.  And it fails to achieve its goal of attracting the healthy and avoiding the sick.   The healthy among the young and uninsured are not enrolling in Obamacare-sponsored plans,  and the sick in Medicaid  and Medicare will have a harder time finding doctors.     
It’s a lose-lose proposition. Every tube must stand on its own bottom, even top doctors and hospitals must meet their bottom-line, but that is hard when your bottom is shrinking.
Tweet:   The net effect of Obamacare health-exchange plans  will be to exclude top hospitals and top doctors.

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