Medicare cuts and the future of healthcare following ObamaCare?

Over at the Faculty Lounge, Sharona Hoffman reflects on how her elderly relative died of a cancer that her doctor failed to detect despite the fact that the tumor was egg-sized and visible to the naked eye:

However, when listening to her heart, her doctor never paid enough attention to see the egg-sized tumor that was clearly visible to the naked eye right beneath the heart area and never took the time to ask her whether there was anything else that was of concern to her.  My elderly relative told me that she always felt the doctor wanted to end the visit right away, and she never felt it was appropriate to bother him with any additional questions.  Thus,  the tumor was not discovered until it grew completely out of control and was a stage 4 cancer.

96 is a long life, but the tragedy is that the woman's life was still cut shorter than it necessarily needed to have been, if the doctor had had more time to diagnose the tumor.

Given that one of the ways in which ObamaCare purports to reduce health care costs is by imposing reductions in fees paid to doctors who accept Medicare, one wonders whether this sort of story -- "she always felt the doctor wanted to end the visit right away" -- will become even more commonplace.  I don't mean that in the sense that doctors will spend less time on patients to "get back" at Medicare, but rather than economic pressures will require that the reduction in per patient income be made up with a higher volume of patients, and hence less time per patient.

Comments

[Matthew Lewis]

The real culprit here is twofold, and while it's not necessarily addressed by Obamacare, blaming Obamacare for it is rather silly:

1) The way doctors are paid incentivizes them to see as many patients (and perform as many procedures and prescribe as many drugs) as possible. Obamacare does take a whack at this issue by bundling Medicare payments. More will have to be done, but this is a pathology of the current medical care market in the US, not of Obamacare.

2) Because pay is skewed toward performing procedures and surgeries, rather than just "being a doctor", when new doctors graduate Med School with mountains of debt, they naturally gravitate towards fields that pay better. That is to say, they become specialists. There has been a shortage of general practitioners in this country for a while, but again, this is a problem with the perverse incentives at work, not Obamacare. Will that shortage become more acute? Almost assuredly. More people will have insurance in the coming years, so more people will want to see GPs. We do need to figure out a way to make being a GP more enticing. But again, this is a problem with the bad incentives in the way doctors are paid.

Zooming out a bit, the reason the long-term fiscal outlook is so poor is because PROVIDER COSTS keep skyrocketing. It has very little to do with who is insured. We can all argue until we're blue in the face about why this is happening, but the point is that eventually we need to stop paying doctors more and more and buying more and more expensive machines and medicines. Otherwise we're all screwed, no matter who is insuring (or not insuring) us.

[Tung Yin]

I don't dispute any of what you say about the causes of health care costs. I do think that it is fair to view with skepticism ObamaCare's brute force cut in Medicare rates with no meaningful addressing of the underlying causes of skyrocketing costs.

[Matthew Lewis]

"No meaningful addressing" is a bit strong. Feel free to dismiss this as just lefty propaganda, but Ezra Klein is a smart guy, and it's worth reading what he has to say about cost control in the ACA here: http://voices.washingtonpost.com/ezra-klein/2010/03/modest_far-reaching_cost_contr.html

[amy amster]

It would be much harder for medical professionals to "refuse" care to any person if there was a "blanket" Medicare plan for all Americans. Sorry to say, but some physicians tailor the treatment of the patient to the particular type of health insurance coverage they hold.