via Vijay Goel, MD:
If “Health Reform” as presently constructed gets passed, what happens? Would love to hear what you think. Here are my predictions:
- The actual calculation of “Cadillac” plans will create a new audit function that will increase the cost of all plans
- Community Rating approaches will dramatically drive up premiums in individual-rated states. This will force non-sick people to drop insurance and pay the penalty, which will raise the penalty…
- Mandated coverage requirements will start out very rich. This will further increase the premiums paid into health care. The government will cut payments to docs and hospitals in response. This will reduce the people able to deliver care, which will hold down premium increases but reduce actual value for services delivered (and make for very long lines)
- States will declare bankruptcy as soon as the unfunded mandates for Medicare hit their (already shaky) budgets. The Feds will rush to rescue the states and act surprised
- Actual primary care physicians taking government insurance will decline dramatically. A small, but vibrant “concierge”/ cash world will emerge. Government will find some way to stop it, a la Canada, as a vibrant alternative would remove all semblance of actual delivery of care.
- Per capita health costs will skyrocket as now no one will care what anything costs. Out of pocket costs will be replaced with random taxes completely unrelated to the actual expenditures on health services by specific individuals…which means they’ll choose “Lexus” over “Hyundai” with price as a quality marker
- Lobbyist dollars from pharma and equipment manufacturers will explode. New pharma and device product pricing will now correlate surprisingly well with campaign contributions…
If the goal of this fiasco is to reduce crushing costs and improve health, I fear we’ll see the exact opposite locked into a political playground.
Yep. I agree with all of that. This will backfire.