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« Books by authors braver than I am | Main | Bribing enemy soldiers »

March 10, 2011


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.

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