Remember former Speaker of the House Nancy Pelosi‘s claim about ObamaCare that “we have to pass the bill so that you can find out what is in it, away from the fog of the controversy”?
The more we learn about ObamaCare, the more controversial it gets, independent of the predictions by its opponents that are beginning to come true.
There are those who claim that ObamaCare is actually designed to fail so that Americans would demand a single-payer health care system, just like (supposedly) the rest of the industrialized world.
What would that be like? Look north, and despair, says Reason, which tells the story of Dr. Jacques Chaouill, who decided to fight Canada’s health care system on constitutional grounds, going so far as to get a law license:
Ultimately, after many years, his efforts bore fruit. A lower-level court had ruled that Dr. Chaouilli was correct in contending that the prohibition of private health care violated ones rights to “life, liberty, and security,” as guaranteed by the Charter of Rights and Freedom, but that the development of a two-tiered medical system was unacceptable to the Canadian vision of “equality.”
In 2005, the Supreme Court of Canada heard Dr. Chaouilli’s appeal, and ruled that the Canadian single-payer system led to situations whereby patients suffer and die on government waiting lists, in violation of their rights guaranteed by both the Canadian and the Quebec Charters of Rights and Freedoms. The Supreme Court ruled as unconstitutional the prohibition of a parallel private medical system in addition to the government mandated single-payer system.
Dr. Chaouill’s heroic eight-year effort, during which time he sacrificed priceless time with his family and with his patients, left him financially distressed, but morally vindicated.
The Court’s decision has since led to the growth of numerous private clinics, throughout the provinces, where patients can obtain private medical care for cash, in a consumer-driven market, and avoid having to travel south of the border to get off the queue. …
The Canadian experience provides an opportunity to anticipate the future of health care delivery in the United States.
Over the past 20-30 years, the practice of medicine has been slowly morphing into a government-run enterprise, often with private health insurance companies acting as the intermediaries. Medicare price controls serve as templates for private insurance reimbursement arrangements. Managed care, encouraged and nurtured by federal legislation, requires providers to obtain authorization from faceless bureaucrats in order to provide many services they deem necessary for their patients. Guidelines and protocols, drawn up by committees and panels serving federal regulators, are imposed upon providers, requiring them to practice according to one-size-fits-all to models or face financial or even legal sanctions.
While not the simple Canadian style single-payer system, the U.S. system, especially with the advent of the Affordable Care Act, gets us to the same place—only in a more Byzantine fashion. True, there are multiple payers, but the insurance companies, as a result of the ACA, have become nothing more than publicly regulated utilities. The policies they will be allowed to offer patients are all designed and predetermined by the U.S. Department of Health and Human Services. The provider payment provisions, as well as the coding system, as has been the practice for years, will be pegged to Medicare reimbursement schedules.
Already we are seeing increasing numbers of doctors retire or slow down their practices in response to the changing practice environment. Many are selling their practices to hospitals and becoming shift-working hospital employees. Still others are dropping out of all insurance plans—even Medicare in some instances—and embarking on cash-only “concierge” medical practices.
In the meantime, demand for health care continues to rise, as 10,000 baby boomers become Medicare beneficiaries every day—and will continue to do so for the next 18 years. Emergency rooms continue to be overcrowded, as many people use them to obtain services that would otherwise be given by primary care providers, because they can’t get in for appointments.
As perhaps another 32 million people are added to the Medicaid or private health insurance systems—the purported goal of the ACA—without a commensurate increase in the number of health care providers, one can expect wait times for physician appointments to only grow longer, and emergency rooms and urgent care centers to grow more crowded. The experience in Massachusetts after its health care reform of 2006 (upon which the ACA is largely modeled) tells us what to expect.
If Canada’s experience serves as any guide, one can expect the one-tiered system in the U.S.—where anyone, regardless of socioeconomic status gets the same quality health care by the same physicians in the same hospitals with the same promptness—will slowly evolve into a two-tiered system, whereby those who can afford it will get state-of-the-art, prompt, courteous, consumer driven health care, while everyone else waits on line. …
The demographic cliff has been reached. With increasing numbers of Medicare and Medicaid beneficiaries stressing state and federal budgets—and future liabilities impossible to fund, provider reimbursements will continue to drop. Add to this the piling on of regulatory compliance costs, from electronic health records, to complex coding requirements, and we can expect to see more and more doctors unable to survive in private practice. The current trend of private practice consolidation and corporatization will only be matched by doctors closing their practices and becoming hospital employees. The old model of the private physician or small group practice giving personalized, one-to-one patient care will soon fade from memory.
Concurrent with the end of the physician as independent agent we see a shift in work incentives. Therefore, one can expect a decrease in physician productivity. Decreased physician productivity only exacerbates the physician shortage, which is, in turn, exacerbated by the sudden influx of Medicaid and privately insured patients. Wait times, a form of stealth rationing, will only get longer. It is worth remembering the adage: “Just because you have health care coverage doesn’t mean you will receive health care.” Ask any Canadian on a waiting list in the government-run system.
The Hippocratic Oath, which 98 percent of American doctors recite, stipulates that a doctor will keep his or her patients “from harm and injustice.” Of course, that’s an oath for physicians, not politicians.
Steve Prestegard.com: The Presteblog 
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