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Welcome to Third-World Health Care


I participated in a meeting in the Capitol the other day. There was a time when I would have said that with pride – “Look at me! Ain’t I the Big Shot?” Not anymore. Today, going to the Capitol, “the People’s House,” is a degrading, humiliating, and gut wrenching experience.

The architecture is still marvelous, the artwork magnificent, but the atmosphere is grim. First, unless you are on a guided tour the only way you are allowed in is by first going to one of the House or Senate office buildings and getting escorted by legislative staff. No mere citizens are allowed.

Yes, I know there are reasons for the precautions — terrorism and the Navy Yard shooter and all that. Still, the message is stark – this is a government that fears its citizens. Curiously, state capitols are not restricted like this. I haven’t visited that many in recent years, but I’ve visited a few and seen reporting of demonstrations in the capitols in Madison, Wisconsin and Austin, Texas that seem pretty wide open. Perhaps the federal capitol has become such a target because the federal government has grown too big.

But that is all atmospherics, the real degradation is the reason for going there in the first place. I was with a group of physicians. They were there to plead with members of Congress to be allowed to continue doing their jobs. These are highly skilled, extremely well trained, very popular and successful doctors. Men and women dedicated to serving and healing their patients. And there they were, hat in hand, like paupers begging for scraps of food, like Oliver Twist — “Please, sir, may I have some more?”

Whether they may continue is very much in doubt, and is entirely at the whim of a handful of bureaucrats and politicians. Already they are being required to spend money on electronic medical records that don’t work very well. Dr. Dan Morhaim, who is also a Democrat member of Maryland’s House of Delegates recently wrote in the Washington Post:

“Perhaps the most pernicious side effect is the erosion of the provider-patient relationship. When I first began working with electronic health records, I caught myself staring at the computer screen instead of engaging patients, who rightly felt ignored. Like many colleagues, I’ve reverted to the practice of talking with the patient and taking notes with pen and paper. After the evaluation is over and the patient has left, I type in the data. This takes much more time, but it is the only way to complete a proper history and exam.

“The result is decreased productivity and frustrated providers — and a lack of meaningful data to manage patient care.”

A recent study found that Emergency Room physicians are now spending 43 percent of their time on data entry and only 28 percent on direct patient care.

More importantly, these physicians are finding that their patients are being forced out of the insurance plans they have, because Jay Carney and Zeke Emmanuel have deemed them “substandard.” Some of the doctors said they will try to continue caring for their patients even after the insurance runs out, others said they just can’t afford to give away free care.

Obamacare is no answer. The health plans in the exchanges are using “skinny networks” to save money. That means no payment if a patient goes to an “out-of-network” provider, and in many cases only a third of an area’s physicians and hospitals are in the network. Naturally, these are the cheapest and worst providers in the region. The Anthem plan in Maine, one of only two choices in that state, will make no payment for any out-of-state provider, even though most patients with serious conditions in Maine go to Boston for treatment.

Private Medicare plans, too, are dropping physicians by the thousands because Obamacare slashed Medicare Advantage payments starting in 2014.

The physicians visiting the Capitol are in a panic. Even if they provide care for free, they can’t pay for their patients’ lab tests and hospital stays. People will die.

This is not hyperbole. The state high-risk pools that provide coverage for the very sickest of our citizens will shut down on January 1, 2014. Hundred of thousands of people in the middle of treatment will be suddenly uninsured, unless the exchanges are working like a charm in six weeks.

The Republican Members of Congress the physicians met with are sympathetic, but their hands are also tied by bureaucracy and procedures. Even if they successfully repealed Obamacare, it is too late. The risk pools are gone. The individual market is gone. Within a few months small employer coverage will be gone, never to come back.

A replacement plan will take months, even years, to enact and implement. And it will still be a political solution. Political solutions are the work of committees. They are never very good. They may be more bad or less bad, but they are never good.

I had to tell these physicians that I see no way out. The politicians, bureaucrats, and special interests have destroyed what was a reasonably effective health care system.

Henry Chou, the fellow from CMS who oversaw the web site development, famously said last spring that he was hoping the web site wasn’t “a third-world experience.” That’s the least of it. We are now facing an entire health care system that is a third-world experience.