PNL Benefits put together a presentation of what Obamacare may mean to different companies. They explain some common misconceptions.
Constitutionality arguments aside (the gneornmvet can now force us to do just about anything they deem in the public interest as long as there is a tax affixed), I absolutely agree that expanding access is fundamental to a solid healthcare system. However, a number of critical issues remain unaddressed. First, most people in the public sphere appear willing to discuss the hard fact of rationing. The current rationing system (employed or wealthy get care, un- or underemployed don’t) is obviously not a good one. But everyone gets everything is also untenable- the GDP just isn’t large enough. Thus some advanced services must be denied at some point in order to assure basic services for more people. For example, 80-year-old patients with advanced cancer perhaps should not, or in rare cases only, get advanced chemotherapy, ICU admission, etc. This hits close to home, as my own grandmother is suffering from lung cancer, so I understand the personal issues. No doctor would want to deny the patient in front of them any service, but when you look at the population as a whole, this becomes a necessity. Rationing absolutely has to go hand-in-hand with a large public system. Hence, longer lines, denial of some services, etc. The American public must learn to accept the fact of limited resources.This brings up another point- doctors, in general, are trained to take care of individual patients, not to address large-scale public health decisions. Epidemiologists may be the exception, or doctors who have sought additional training in public health. Is it any wonder we aren’t contributing enough to the discussion? Finally, expanded insurance access will require expanded primary care providers. But as Medicaid/Medicare reimbursement for primary care services dwindles and paperwork and the worry of malpractice increases, who would choose this path? I truly respect those who answer this calling. However, with current trends continuing, I think we will find more and more people having to see NP’s or other mid-level providers at their Medical Homes instead of doctors.
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