Showing posts with label Obamacuts. Show all posts
Showing posts with label Obamacuts. Show all posts

Thursday, May 8, 2014

The Coming Two-Tiered Medical System

Scott W. Atlas, writing at the Wall Street Journal (Cross-Posted at the Razor), warns about the coming two-tiered medical system.

About one-third of primary-care physicians and one-fourth of specialists have already completely closed their practices to Medicaid patients. Over 52% of physicians have already limited the access that Medicare patients have to their practices, or are planning to, according to a 2012 survey by Merritt Hawkins for the Physicians Foundation. More doctors than ever already refuse Medicaid and Medicare due to inadequate payments for care, and that trend will only accelerate as government lowers reimbursements.

In order to cut costs insurance plans are narrowing their networks, removing access to the best hospitals in the country (including Barnes Hospital in my hometown.)

For cancer care, the overwhelming majority of America’s best hospitals in the National Comprehensive Cancer Network—including MD Anderson Cancer Center of Houston, New York’s Memorial Sloan-Kettering, Barnes Hospital in St. Louis, and the Seattle Cancer Care Alliance uniting doctors from Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Children’s—are not covered in most of their states’ exchange plans.

Elements of this are already in place. The best paying jobs on physician job boards are “closed practices” run by large companies for their employees, or concierge practices that do not accept insurance.

Meanwhile, concierge practices are increasing rapidly, as patients who can afford it, along with many top doctors, rush to avoid the problems of an increasingly restrictive health system. The American Academy of Private Physicians estimates that there are now about 4,400 concierge physicians, 30% more than last year. In a recent Merritt Hawkins survey, about 7% to 10% of physicians planned to transition to concierge or cash-only practices in the next one to three years. With doctors already spending 22% of their time on nonclinical paperwork, they will find more government intrusion under ObamaCare regulations taking even more time away from patient care.

Moving towards socialized medicine inevitably leads to a two-tiered system. Having lived for 5 years under socialized medicine in Japan, I’ve seen the both tiers, and the quality of care diverged significantly between them to the point where we chose a private hospital for the birth of The Kid. The only question will be whether the quality of care good enough for the vast majority of Americans, or the care will stagnate and decline as the best and brightest health care providers move into the higher-paying private practices and hospitals.

Tuesday, January 15, 2013

Obamacare’s Other Shoe l Mark Steyn

The Pentagon and Chuck Hagel

Former senator Chuck Hagel

National Review: If you had buttonholed me in the Senate men’s room circa 2003 and told me that a decade hence Joe Biden would be America’s vice president, John Kerry secretary of state, and Chuck Hagel secretary of defense, I’d have laughed and waited for the punch line. The Leahy administration? President Lautenberg? Celebrate lack of diversity! But even in the republic’s descent into a Blowhardocracy staffed by a Zombie House of Lords, there are distinctions to be drawn. Senator Kerry having been reliably wrong on every foreign-policy issue of the last 40 years, it would seem likely that at this stage in his life he will be content merely to be in office, jetting hither and yon boring the pants off whichever presidents and prime ministers are foolish enough to grant him an audience. Beyond the photo-ops, the world will drift on toward the post-American era: Beijing will carry on gobbling up resources around the planet, Czar Putin will flex his moobs across Eastern Europe and Central Asia, the Arab Spring “democracies” will see impressive growth in the critical clitoridectomy sector of the economy, Iran will go nuclear, and John Kerry will go to black-tie banquets in Europe. But Chuck Hagel is a different kettle of senatorial huffenpuffer. And not because of what appears to be a certain antipathy toward Jews and gays. That would be awkward at the Tony Awards, but at the Arab League the post-summit locker-room schmoozing should be a breeze. Since his celebrated “evolution” on marriage last year, President Obama is famously partial to one of those constituencies, so presumably he didn’t nominate an obscure forgotten senator because of his fascinating insights into the appropriate level of “obviousness” the differently oriented should adopt. So why Hagel? Why now?

My comrade Jonah Goldberg says this nomination is a “petty pick” made by Obama “out of spite.” I’m not so sure. If the signature accomplishment of the president’s first term was Obamacare (I’m using “signature accomplishment” in the Washington sense of “ruinously expensive bureaucratic sinkhole”), what would he be looking to pull off in his second (aside from the repeal of the 22nd Amendment)? Hagel isn’t being nominated to the Department of Zionist and Homosexual Regulatory Oversight but to the Department of Defense. Which he calls “bloated.”

Leon Panetta, who’s strongly opposed to the mandated  “sequestration” cuts  to the defense budget, Hagel thinks they’re merely a good start.

That’s why Obama’s offered him the gig. Because Obamacare at home leads inevitably to Obamacuts abroad. In that sense, America will be doing no more than following the same glum trajectory of every other great power in the postwar era. I feel only a wee bit sheepish about quoting my book After America two weeks running, since it’s hardly my fault Obama’s using it as the operating manual for his second term (I may sue for breach of copyright and retire to Tahiti). At any rate, somewhere around Chapter Five, I suggest that, having succeeded Britain as the dominant power, America may follow the old country in decline, too:

“In what other ways might the mighty eagle emulate the tattered old lion? First comes reorientation, and the shrinking of the horizon. After empire, Britain turned inward: Between 1951 and 1997 the proportion of government expenditure on defense fell from 24 percent to seven, while the proportion on health and welfare rose from 22 percent to 53. And that’s before New Labor came along to widen the gap further.

“Those British numbers are a bald statement of reality: You can have Euro-sized entitlements or a global military, but not both. What’s easier to do if you’re a democratic government that’s made promises it can’t afford — cut back on nanny-state lollipops, or shrug off thankless military commitments for which the electorate has minimal appetite?”

Democrats put it slightly differently: In 2004 John Kerry demanded to know why we were building firehouses in Iraq but closing them in America (the municipal fire department apparently falling, like everything else, under the federal government). Barack Obama prefers to say that it’s time for the United States to do some nation-building at home — the pilot program in Afghanistan having worked out so well. Either line will do, and, like Britain’s inverted budget priorities, both implicitly acknowledge that a military-industrial complex and a dependency-bureaucrat complex are incompatible. And that’s before you factor in Washington-size borrowing, under which, within this decade, the interest payments on the debt will be covering the entire cost of the Chinese military. America can fund the Pentagon or the People’s Liberation Army, but not both, not for long. Having gotten the citizenry to accept a supersized welfare bureaucracy, Obama reasonably enough figures he can just as easily get them used to a shrunken American presence in the wider world.

So the president is looking for his equivalent of Denis Healey, the Labor cabinet minister who in the 1968 defense review announced an all but total withdrawal of British forces from “east of Suez” — a phrase that in the imperial imagination is less geographic than psychological.

Kipling’s English Tommy on the road to Mandalay: “Ship me somewheres east of Suez . . . ” And then a cheeseparing defense minister says: No, we won’t. Not now, not ever again. It’s over.

Who would you hire for the Pentagon’s east-of-Suez moment? According to the Washington Post, Obama picked Hagel to “bridge the partisan divide.”

By Mark Steyn  - Author of After America: Get Ready for Armageddon, America Alone: The End of the World As We Know It, and America Alone: The End of the World As We Know It