Many are speculating about the outcome of what I call UCA for the [Un]Affordable Care Act, also known as ObamaCare. I think there are two basic scenarios.
First is that UCA will do precisely what it was intended to do: inject economic chaos into the medical marketplace, driving prices for insurance and healthcare through the roof, so that people will beg for the sequel—single payer. That means everybody is forced into one big government plan.
There is no doubt in my mind that this was the intention of the authors of this bill, several of whom were the corporate players who would benefit from this. While it is worthwhile to understand various provisions of UCA, detailing its shortcomings without assigning malevolent intent to its authors is naive, I think.
This legislation was meant to “crash” the system. That is its purpose. Unaffordable care and insurance are its goals. This is a medical economic false flag from which only Uncle Sam can rescue us.
The second possibility is that, as prices for insurance skyrocket, people will act and adapt. One course will be for individuals and families to increase their deductible exposure if they have insurance in an attempt to keep their premiums in check.
Deductibles of $5,000 or $10,000 will be commonplace. Others will drop insurance altogether, figuring that at $2,500/month (typical premium payments in high-priced states like Romney’s Massachusetts), they could bank this money and in one year have a $30,000 cushion for whatever health expenses might come along.
Both the newly uninsured and the new high-deductible players will be doing something the medical marketplace is increasingly gearing up for: spending their own money. People spending their own money tend to ask the same question before buying:” How much is it?”
Those physicians and facilities not willing to reveal their prices upfront will lose these patients to those who are price-transparent. Those who are price-transparent will compete with each other for these patients.
This new and vibrant medical marketplace will cause the price of medical care to plummet. The price disparities between the transparent doctors and facilities and the others will become even starker.
This medical price deflation will slow if not utterly destroy the push for single payer as the UCA price crisis could paradoxically be derailed by this market competition. After all, low cost, high quality means no crisis. This is why cost was never addressed in the original UCA debates, only “coverage.”
Anything that slows the implementation of UCA will increase the likelihood that scenario #2 takes place, as more time will be available for the development of a vibrant market. Refusing to expand Medicaid is one critical part of the pushback. Various lawsuits could also help.
One of the most interesting slowing (if not derailing) strategies I have heard about comes from Ohio, where two legislators have figured out a simple way to capitalize on the fact that the states, not the federal government, retain the power to regulate insurance companies in their state.
Very simply, any insurance company that accepts an UCA insurance subsidy would be prohibited from writing any new policies in that state until that subsidy was returned to Washington.
I actually think that scenario #2 is more likely than single-payer scenario #1. One of the reasons I am optimistic is that the track record of the government is so bad in all areas that it might not even get its false flag right. For all the attempts to control healthcare from D.C., the unintended consequence may be the creation of a competitive marketplace.
UCA may very well ration and kill before it fades away, but I think the seeds of its own death are within the bill itself.
Dr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Oklahoma, owned by 40 of the top physicians and surgeons in central Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.
In 2009, Dr. Smith launched a website displaying all-inclusive pricing for various surgical procedures, a move that has gained him and the facility, national and even international attention. Many Canadians and uninsured Americans have been treated at his facility, taking advantage of the low and transparent pricing available.
Operation of this free market medical practice, arguably the only one of its kind in the U.S., has gained the endorsement of policymakers and legislators nationally. More and more self-funded insurance plans are taking advantage of Dr. Smith’s pricing model, resulting in significant savings to their employee health plans. His hope is for as many facilities as possible to adopt a transparent pricing model, a move he believes will lower costs for all and improve quality of care.