Sunday, April 20, 2014

Insurance does not mean health care

Four decades ago, the US fell into a trap. We essentially adopted government pricing healthcare. It had become clear that the Treasury couldn't handle traditional fee for service medicine. With the government paying, too few made the effort to drive a good bargain. So the government took on the huge job of putting out a fee schedule. Private insurance followed the government's lead because, frankly, it was a big cost saver not to have to do the work themselves.

The problem is that the government got the prices wrong. Specifically the payment ratio of primary care codes to specialist care codes has been off. Primary care codes have been too low to attract enough primary care doctors. This has distorted US medical care. Both right and left know that these ratios are not correct. It's not a matter of partisan difference. We just don't know where to get the money to pay the primary care doctors enough to attract enough doctors to make the system work right.

The US is too poor to do everything else we've committed to and to do this right as well. As a consequence we just have lived with too few primary care doctors. Enter Obamacare.

A number of California uninsured have been assisted by their free clinics to get on the exchanges but after a few months are right back at the free clinics. Doctors who are supposed to be in their networks are either not taking new patients or deny that they even accept their insurance. But the free clinic isn't allowed to take them either. They now have insurance and free clinics are for the uninsured.

For now, human compassion has led them to be accepted. But the bureaucratic rules won't be flouted forever as budgets get stretched and the theory that health insurance equals access to health care is exposed as the fraud it always was. The free clinics will be threatened with a loss of money if they keep allowing insured patients to use their services.

Not every Obamacare story is a horror show. But we simply don't have the data to exclude the horrifying possibility that after a half century of pushing for something like Obamacare, liberals have, on net, made things worse on the health care front. That's a travesty.