Obamacare's Sobering Vocabulary Lesson

Over the last three years, America has been embattled in a health care reform debate, ranging from the legislative debates to the townhalls and Tea Parties and later on to the actual vote and bill signage and Supreme Court decision. In reality though, we were never really discussing health care reform; we were discussing health insurance reform. The difference is huge and will become more and more evident as time progresses. More Americans may receive health insurance coverage as Obamacare is implemented, but that doesn't mean that they will receive health care. We need to look no further than Medicaid to see the failures when government gets involved in health insurance and health care. Medicaid has been in place for nearly fifty years, but has the potential to greatly expand in states that choose to do so. However, Medicaid is also illustrative of how health care reform is a complete misnomer.

The New York Times finally highlighted the burgeoning doctors' shortage on Sunday. Even prior to Obamacare's passage, a doctors' shortage was anticipated. However, the shortage of doctors more than doubles with the implementation of Obamacare. What do doctors' shortages do? As the NYT story notes of current doctors shortages (emphasis added):

Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.

Yes, the New York Times would follow up a sentence that notes patients would receive care by noting that the doctors' shortage would influence them to forego care hoping that their readers would miss their attempt at nuance. Medicaid, though, adds an additionally wrench in the physician shortage, as the NYT goes on to say:

Moreover, across the country, fewer than half of primary care clinicians were accepting new Medicaid patients as of 2008, making it hard for the poor to find care even when they are eligible for Medicaid. The expansion of Medicaid accounts for more than one-third of the overall growth in coverage in President Obama’s health care law.

If there is already of shortage of doctors and  Medicaid patients are hard pressed to find a physician that will take them as a patient, where is the reform of health care? It's almost as if the government has offered to give the entire country their own car, but only gave everyone a set of keys. One of the main reasons that doctors aren't accepting new Medicaid patients is due to reimbursement rates, which Obamacare is supposed to increase. However, while President Obama was attempting to offset the financial aspect of care on the backs of the taxpayers through projected reimbursement increases, he neglected to address tort reform, which would have decreased medical malpractice insurance for doctors, while only negatively affecting ambulance chasers and the Democratic politicians to whom they donate, not the taxpayers.

Since Medicaid is partial state funded, there is a state specific aspect of this too. Take Illinois for example, where in FY2012, Medicaid was underfunded by $2.1 billion dollars . Additionally, even if funding stayed flat as Governor Quinn projects, payment to providers is projected to average nearly a year's delay by FY15. The state is already $8 billion behind on their bills overall, prompting the state comptroller to provide emergency funding to a mental health facility reliant on Medicaid funding to prevent the agency from closing its doors.  The expansion of Medicaid as Obamacare is implemented is supposed to make matters worse. Although the Supreme Court decision allows the states to decide whether or not they are going to expand Medicaid, true to form, Illinois Governor Pat Quinn has already indicated he will. With a growing doctors shortage, a limited number of doctors accepting Medicaid, and the potential for facilities to close due to delayed payment, it would be a miracle if a Medicaid patient even got into the doctor!

Let's pretend though that a new Medicaid patient was able to get into the doctor, but they have a rare illness or are extremely sick and require a great deal of medications. Well, Illinois Medicaid has stated that they now will limit patients to 4 brand name drugs. This comes after last year, when Illinois cut availability of brand name psychiatric drugs. Fifteen other states have limits on brand name prescriptions as well. To be sure, there are a great deal of generic medications, but there are still situations where there are no generics available. Essentially, this is drug rationing.The implementation of Obamacare, which is predicted to double the number of Medicaid recipients in Illinois over the next ten years, will only exacerbate the problems already in place.

Obamacare may end up technically providing some form of "health insurance" to the majority of Americans. However, if past is prologue when it comes to government's role in medicine, this will not be legitimate health care reform, as people who now may not have health insurance or health care may inevitably end up with health insurance, but with delayed or non-existent care and limits on what medication they may receive.Of course, this is not what was promised by President Obama. Julia may get her free birth control, but she will likely have a heck of time scheduling an appointment for a doctor to prescribe it for her. Moreover, this is being done on the backs of the American taxpayer, or in the case of Illinois, the $2.1 billion Medicaid underfunding  came on the heels of a 67% state income tax increase and a more than 40% increase in state corporate taxes. This is the kind of newspeak that has become commonplace in the Obama administration, but hopefully proponents of government intervention in medicine will learn a sobering lesson. Health care and health insurance are not synonymous. Crossposted here and here.