How Does Obama Care Affect Your Access, Your Healthcare Quality and Your Doctor?

Obama care aims for universal health coverage, but we also need to make the healthcare system work better for patients and physicians; not only we need to redesign healthcare, but most importantly we need to change the whole production function of health so not only we treat people when they are sick, but we also put emphasis on preventing illness. We need to provide vital support to primary care doctors so they can manage their patients’ conditions for the best possible outcomes. The ultimate patient access system should aim to keep people out of the hospital by providing a reimbursement system that allows primary care physicians to provide care at the most efficient site, such as home, hospital, office, etc.

Your doctor’s office: The current Medicare reimbursement system reimburses a physician for a drug based on ASP (average sales price) plus a nominal mark-up, say 6%, and thus allows physicians to earn a profit. However, this profit is about 25% less than what they used to make just a couple of years ago, and practices which have a big portion of their business coming from Medicare patients, may go under. It is for this reason that over 40% of private plans have been reimbursing at higher rates, some as high as ASP+15%, to allow physicians to stay in practice.

Amplify universal coverage into a massive Medicare model: You can see now how a primary care practice, one that under the Obama plan switches from say, 40% Medicare patients, to 100% Medicare, can realize massive reduction in profits can practically go out of business. The alternative will be for doctors to consolidate practices to achieve economies of scale, aim at driving more patients into their offices to make up for lost profit. The not so lucky practices that can not consolidate, will face the Medicare type of inefficiencies plus increased costs from obligatory expenses to install electronic prescribing tools and computerized record systems proposed by the Obama plan. This of course will result in long lines, delay of service, perhaps a shorter patient-to-doctor care time with the ultimate result – poor health outcomes and hence inefficiencies and additional cost. We can expect doctors to devise their own survival mechnisms, such as turning down lower insurance carriers and demanding to be paid in cash – the end result being reduction of access to care.

So how do you fix the current healthcare system? First, the reimbursement system has to be fixed to allow patients to be treated at the appropriate site of care, whether this is the home, outpatient clinic, nursing home, etc. Second, care coordination has to be financed to allow for appropriate utilization of resources for each site of care. Third, the system has to reward physicians according to best outcomes that improve patient care as well as quality of life and productivity, a system that many private plans have in place as well as several other EU countries. Fourth, slightly change the medical training carriculum to include health outcomes and pharmacoeconomic training which would allow physicians to appreciate the ultimate budget impact of achieving cost-effective results. Fifth, provide the opportunity for the uninsured to get coverage, just like Congress enjoys. The combination of private competition, better outcomes, cost-effectiveness and better access should do a much better job than turning over the entire system into a Medicare/Medicaid hybrid.