Sunday, May 26, 2013

Obamacare: Wait and See and Waiting to Be Seen
Change will not come if we wait for some other person or some other time.  We are the ones we’ve been waiting for.  We are the change we seek.
President Barack Obama, campaign speech, 2008
Americans are an impatient people.  We do not like  like waiting.  We do not like waiting to schedule an appointment to see a doctor.  We do not like  waiting in the waiting room. We do not like wasting a day driving to and from the doctor,  or waiting to find a parking spot, waiting to fill out the paperwork at the doctor’s office, waiting to be seen by the doctor,  waiting to have the prescription filled,  or waiting to see what to see what the Affordable Care Act portends for us.
When 2014 arrives, Americans will have waited four years to see what Obamacare holds for them.  That’s a long wait for an impatient people.   There are hints on what is to come.  Massachusetts has a health bill resembling Obamacare.  In Boston, people now wait 2 months to see a doctor (versus 3 week in the rest of the U.S.),  and  1 in 5 Boston patients leaves the emergency room without being see because they are tired of waiting.
The waiting situation will only grow worse when 2014 comes, when 32 million more patients enter the system courtesy of Obamacare,  and when over the 4 years between 2010 and 2014, the population has grown by 10 million or so and 16 million more aging  Americans will have joined the Medicare ranks,  the doctor shortage will have grown to 50,000,  and 75% of doctors will be working 40 hour weeks as hospital employees. In the 4 years since Obamacare passed, the demand for care will have grown while the supply of doctors to see them will have shrunk.
So what happens in 2014 and what is happeining now?  Well, according to John Goodman, writing in the May 23 issue of Forbes,  “Coming Soon to America: A Two-Tiered System Canadian-Style System,” we’ll have a two-class system. 
·         In the first class system,  i.e, those who can pay  $1500 to $2000 a year,  for the privilege of not waiting, patients will go to concierge doctors, who will see them on the day they call – no waiting there.   Doctors who practice in this system will have pared their patient panels from 2500 patients to 500 in order to give patients the attention they deserve and to eliminate waiting time.  The other 2000 will just have to wait to be seen elsewhere.

·         In the second class system for those on Medicaid, those on Medicare unable to afford the concierge fee, those  on federal subsidies of one sort or another,  or those who simply can’t afford to pay for one reason or another ,  there will be rationing by waiting, whether that be at the doctors’ office, community health centers,  or hospital emergency rooms.
The end game will be a waiting game.   Those who can will advance to the head of the line;  those who can’t will go to the end of the line.   Don’t worry, if you are one of the less privileged one, “All things will come round to him who will but wait, ” as William Wadsworth Longfellow (1807-1881)  said in Tales of A Wayside Inn (1863).  You will just have to wait by the wayside  to be seen, and  meanwhile,  you may  have to wait a year or more to see if waiting for Obamacare to come full-bore has been worth the wait.
Tweet:  A 2-tier health system is evolving; one for those with who do not have to wait to be seen , another for those who must wait to be seen.


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