Back to Being Me, Part 2

To continue my thought that was so rudely interrupted by the oil spill:
Why the new healthcare law will fail miserably (part 2):
1. It totally fails to address the real problems in the US healthcare system.
a. Over-indulgence by the insurance companies. (see previous post before continuing)
b. Unsustainable growth (in this case, by Universal Coverage).
Several years ago, I was managing a sub/sandwich shop. We expanded to a new location because business was good. The new location was huge and nice, all new equipment, all new staff, etc. On our 5th day in business, the owner showed up and announced that he had put an advertisement in the local paper, to print on Friday. What he failed to tell us was that the print ad was a buy one, get one free. When Friday night rolled around, the shop was swamped. We didn't have enough staff, the staff that we did have was under-trained and unprepared, and worst of all, there wasn't enough product. It was a fiasco. The horrible service that night did irrepairable damage to the store's future business. It was labelled as 'slow,' 'inefficient,' and 'inaccurate.' And all were true for the same reason: demand flooded supply.
Now, back in 2010, we understand the lesson, but fail to make the application to healthcare. If there are suddenly 30,000,000 more 'customers,' we have a huge and sudden problem. There are not enough docs to go around. There are not enough exam rooms. The clinics are understaffed. In a normal, supply-vs-demand, free-market world, the demand rises slowly and supply follows. Unsustainable growth in patients requires sudden growth in facilities and providers. We will see niether of those.
Polls among medical students and early-practicing Primary Physicians are all reporting that less people plan to be practicing primary medicine next year than this year...and the trend is sharply downward for every foreseeable year. The reasons? Over-worked and under-reimbursed. The only way that supply catches up with demand is when there is incentive for growth. Half of the previously-uninsured people, entering the healthcare realm, will be on public insurance. The reimbursement from state aid is as low as 6 cents on the dollar; substantially less than it costs to actually see the patient. *And no one seems to be asking the question about where the states are going to get the money to 'insure' the 15M people. That money is not addressed in the healthcare law, it is laid on the already-cash-strapped states to fund for themselves.*
The point is...it's hard to recruit doctors who will not make any money or build clinics that will operate in the red. The options are few, but here is what is being talked about in the healthcare circles that I am in:
1. limiting the number of patients seen...all walk-in clinics, first come, first serve. This is known in the European/Canadian healthcare system as 'rationing'
2. having advanced practice nurses doing the work of primary care physicians. This is also known as 'reducing quality.'
BOTH of these were warned about, but the government ignored the warnings.
3. charging people a 'retainer fee' in order to have a primary care physician (this is already done in Massachusetts...it had to be done as soon as the state passed their mandatory coverage law).
or the most frightening, and yet most realistic:
4. Hospitals/clinics/physicians opting OUT of the federal/state programs. They simply don't contract with the government. They pay higher taxes, but they are not obligated to provide care for Medcicare/Medicaid patients. They close their Emergency Rooms, and only accept clinically-referred patients to their inpatient units. This is already happening all over the country, in response to the new law. And think about this: the places that are already caring for the non/under-insured patients will close their doors to both. The bill may provide more people with insurance...but end up PROVIDING CARE TO FEWER!
This law will collapse on itself because it fails to understand one of the simplest laws of business...supply and demand.