OBAMACARE AND ITS DISCONTENTS – AT 9:48 A.M. ET:  Obamacare is upon us.  Even those of us who aren't involved in it have already started to see its effects – with medical practices closing and doctors forced into corporate medicine.  Many docs are avoiding Obamacare completely.  From the Daily Caller: 

Obamacare plans have shrunk payments to physicians so much that some doctors say they won’t be able to afford to accept Obamacare coverage, NPR reports.

Many of the eight million sign-ups in Obamacare exchanges nationwide already face more limited choices for physicians and hospitals than those in the private insurance market. But with low physician reimbursement rates, the problem could get even worse.

For a typical quick patient visit, Dr. Doug Gerard, a Connecticut internist, told NPR a private insurer would pay $100 while Medicare would pay around $80. But Obamacare plans are more likely to pay closer to $80, which Gerard says is unsustainable for his practice.

“I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates,” Dr. Gerard told NPR. ”You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on.”

Narrow networks have become a hallmark of many Obamacare exchange plans, as one of few options left to insurance companies that allows them to save money by lowering reimbursement rates and covering fewer providers. In the health-care law’s first year, 70 percent of all Obamacare plan networks were either narrow or ultra-narrow, according to an analysis from consulting firm McKinsey.

But doctors are feeling even more financial pressure due to the changes and many believe there’s a risk that Obamacare insurance will go the way of Medicaid, where patients still struggle to find a doctor after low reimbursement rates led many physicians to stop accepting it.

COMMENT:  Yes, I've spoken to doctors who approve of Obamacare, usually for ideological reasons.  But the economics aren't working out.

Those in favor of Obamacare could do themselves a favor by helping physicians with issues like tort reform, which would lower the cost of malpractice insurance, and by modernizing student loan programs so physicians, especially those serving low-income areas, can get some help. 

I'd imagine that Obamacare will go through many revisions, especially if the GOP takes power.  It will never be inexpensive because modern medicine is so costly.  But we can do much better than the current rollout.

August 5,  2014