Tuesday, December 2, 2014

Health Care Cost Squeeze

A “squeeze”, according to my dictionary, is to extract something by crushing it: for example to squeeze juice from a lemon.

For patients and doctors, this comes down to squeezing care out of the ObamaCare lemon without crushing one's budget.

The Bureau of Labor Statistics, says the middle class is caught between a rock and hard place with a lemon in-between.

The rock is stagnant income, 0.2% from 2007-2013, which is declining income when you factor in inflation.

The hard place is rising costs over that same 6 year period for these items.

1. Food at home, up 12.5%

2. Education, up 22.9%

3. Health care, up 24.2%

4. Home rent, up 26.0%

5. Health insurance, up 42.1%

6. Cellular phones, up 49.1%

7. Home internet, up 83.1%

These are basics you can’t do without in the computer era, if you want to eat, become educated, have a roof over your head, maintain your health, treat your illnesses, and remain connected in a social media world.

So what’s person to do?

If you’re a patient, how do you squeeze care out of the ObamaCare lemon, or water out of a rock in 2015.
You can:

1) Postpone or forgo care, as 1/3 of Americans are now doing (see reference #2).

2) You can go ER, be treated, and pay thousands of dollars later or try to fend off the hospital collection agency.

3) Pay increased premiums and deductibles, and co-payments, now the rule rather than the exception.

4) Go “naked,” without health insurance, trust your health holds up and no accidents occurs, and count on the Obama administration to delay penalties for 3 more years as it has proposed.

5) Sign up for the first time for a bronze, silver, bold, or platinum plan on the exchanges with the forlorn hope your plan will be affordable.

6) Don’t renew your plan by December 15, but allow the government to automatically renew it and pray you can afford the new expense of the old plan.

7) Try to qualify for Medicaid and hope your citizenship and income papers are in order and are acceptable.

8) Proceed directly to a retail clinic, walk-in clinic, or community clinic.

9) If you lucky and have an health savings account, shop multiple providers for lower costs or negotiate a lower price with your current physicians.

10) Consider going to a concierge physician or a surgeon for a direct cash or retainer transaction without insurance but with lower costs than available under your health plan.

Now comes the rock, physicians who are the bedrock of the health care system.

If you’re a physician, you can:

1) Retire early, see fewer patients, or work part-time.

2) See Medicaid or health exchange patients at a loss because these plans pay only 60% of private plans.

3) Limit Medicare patients, 65% of whom have 2 or more chronic conditions, for which Medicare pays 80% of what private plans pay.

4) Refuse to accept health exchange patients, with their low pay and heavy regulations, an option 25% of physicians have chosen.

5) Go to work for a hospital, integrated health care system, or a large medical group as a salaried employee.

6) Work harder, suck it up and accept a lower income, and a lower standard of living.

7) Become a concierge physician or a surgeon in an physician-owned ambulatory care center.

8) Remain loyal to your current patients, no matter what the economic consequences or the bureaucratic hassles, and tell them, in the words of Oliver Goldsmith (1728-1774), “I’ll be with you in the squeezing of the lemon.”


1. Ryan Knutson and Thor Francis, “Basic Costs Squeeze Families; Surging Price Tags for Health Care, Other Essentials Leave Less for Spending Elsewhere, “ Wall Street Journal, December 2, 2014.

2. Rebecca Riffkin, “More Americans Forgoing Health Care: in U.S. 33% have put off medical treatment because of costs; more put off serious conditions than non-serious; more with private insurance put off treatment in 2014 than 2013, Gallup, December 1, 2014.

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