The future of health care
To the Editor:
For more than a decade many have predicted the collapse of healthcare as we know it as the system runs out of money. That collapse now seems firmly upon us and is unfolding at a rapid pace. The forces directing this have an admitted plan of forcing drastic reductions in resources expended for healthcare. Since the system has run out of money, the realities are unavoidable.
Many within government (legislators, regulators, policymakers) are executing an evolving plan to centralize, consolidate, and control the delivery and financing of healthcare. The ACA (Affordable Care Act, often called ObamaCare) is one step in this process. Some leaders are committed to moving our healthcare system to a centrally-planned single-payer “socialized” healthcare system. This requires a step-by-step process.
Private practices (indeed, any for-profit activities in healthcare) are to be eliminated to shift profits back into tightly-controlled patient care. Thus payment regulations have driven most physicians out of private practice to become hospital employees. The next step in this process is bundled payments and Accountable Care Organizations (ACO) whereby the hospital systems are paid a flat sum of money to provide the full spectrum of care to a regional population of patients.
This creates incentives for hospitals to strictly minimize the volume of care to preserve their resources. Previously, more treatment created more billing created more income. But that is now being replaced with regulations whereby more care provided will expend more of the hospital’s resources. This creates in-house rationing of care, reducing services to save money. This should at least reduce waste, but at what cost to care? Healthcare will radically change very quickly.
Rules also call for annual reductions in fee-for-service reimbursement for care provided in private practice settings, annual caps on billing per year per patient, and providers asking permission to treat a patient. These emerging Medicare rules become models to be followed by private insurances. An example is new rules among these insurances requiring physical therapists to apply to health care rationing companies (OrthoNet, OptumHealth) for permission to treat patients within strictly limited care.
There are further steps being taken system in the form of insurance mandates to drive care to a centralized single payer. Employers will be fined for not providing employer-purchased private health insurance, plus individuals will be fined for not purchasing individual private health insurance. These fines are far less costly than actually purchasing private health insurance, which all but assures employers and individuals will opt out of private insurance purchases.
Additionally, requirements that private insurance insure people with pre-existing conditions will actually encourage people to not buy insurance until they become ill, forcing enormous costs onto the insurance companies. These mandates could doom private insurance companies, leaving only the government-sponsored heavily-regulated health insurance exchanges…thus creating as single-payer system with one government sponsored insurer and one centralized government-run healthcare delivery system within the community hospitals which, by this point, will be de facto government-run healthcare facilities.