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From Forbes and Paul Hsieh of Modern Paleo.
"Now that President Obama has won re-election, repeal of the ObamaCare health law is no longer realistic. Although some state governors continue to resist and there are some still-pending legal challenges, prudent Americans should prepare for the law being eventually implemented in full.
ObamaCare will worsen the current physician shortage. The law will also drive physicians to become hospital employees or to join large Accountable Care Organizations (ACOs), where their treatment decisions will be monitored with mandatory electronic medical records. Government and private insurers will increasingly link payments to adherence to “comparative effectiveness” practice guidelines. Physicians will face significant conflicts-of-interest when their patients might benefit from treatments outside the guidelines, but the physician risks nonpayment (or losing his ACO contract) as a result.
So how can ordinary Americans best protect themselves under ObamaCare? Here are 5 practical recommendations:
1) Get a good primary care doctor, if you haven’t already done so.
The Association of American Medical Colleges projects a shortage of 60,000 physicians by 2015 and 90,000 physicians by 2020, roughly a 10-15% shortfall. Although the shortage preceded ObamaCare, the new law will make matters worse. The Physicians Foundation predicts a “silent exodus“ of physicians retiring early or reducing work hours in response to ObamaCare.
Many primary care physicians are overloaded and closing their practices to new patients. If you don’t have a doctor yet, get one before it’s too late.
Similarly, if you’re approaching Medicare age (65) and your current doctor will retire in a few years, consider switching to a younger doctor now. Many doctors no longer accept new Medicare patients, and this problem will worsen with anticipated Medicare payment cuts. However, most doctors will continue seeing their current patients even after they turn 65. But if you wait until after age 65 to look for a new doctor, you may have a hard time finding one.
2) Use a Health Savings Account (HSA).
HSAs are tax-free savings accounts where patients can deposit their own money to be spent later for medical needs. Most patients use HSAs for routine predictable expenses (e.g., flu shots, well-baby checks), coupled with a high-deductible insurance plan to cover unlikely-but-expensive serious accidents and illnesses.
Because patients with HSAs control their own medical spending, they and their doctors have greater control over treatment choices without requiring approval from government or private insurers. Patients with HSAs enjoy comparably good outcomes as patients with traditional insurance, while spending significantly less. As an added bonus, many doctors’ offices offer HSA patients a significant discount, because they don’t have to deal with insurance paperwork.
3) Consider a concierge or “direct pay” physician.
More and more primary care doctors are establishing “concierge” practices. Patients pay an annual fee in exchange for guaranteed 24-hour telephone access and longer personalized consultation time for complex medical problems (as opposed to the rushed 15 minute appointments common in many overcrowded primary care practices). Most concierge physicians will also act as your advocate if you require hospitalization for a serious illness, coordinating your care with the various specialists based on his detailed knowledge of your full medical history. “Direct pay” practices are similar, but without the annual retainer.
Because you pay your physician directly, he is not beholden to the government or other third parties.
Concierge practices can be a win-win for both patients and physicians. Physicians spend more time with their patients and can practice according to their best medical conscience, for reasonable reimbursement. Patients receive higher quality care for a fair price.
Nor are concierge practices necessarily expensive. Some services are surprisingly affordable, costing approximately $150 per month — i.e., the cost of a daily latte at Starbucks.
4) Consider medical tourism, when appropriate.
Certain non-emergency medical conditions are amenable to “medical tourism.” A hip replacement costing $30,000 in the United States might cost only $10,000 in India. Many overseas medical tourism facilities are modern high-tech clinics catering specifically to Western patients, staffed by American and European-trained physicians, with success rates comparable to good US hospitals.
Entrepreneurial doctors have also started offering “medical tourism” services within the US, for patients willing to pay cash for certain elective procedures. Provided you properly investigate a facility’s quality and success rates, medical tourism can be an excellent option for many patients.
5) Help your doctor work on your behalf.
Ask your doctor if he will be joining an ACO. (Not all doctors will.) If so, ask if your personal medical records can be excluded from his ACO practice statistics. If ACO rules allow it, this will help him practice outside the guidelines when medically appropriate (e.g., ordering an MRI scan sooner than usual or prescribing a stronger but more expensive antibiotic) without fear of hurting his overall statistics.
Of course, don’t ask in a hostile or accusatory manner. Rather, ask in a way that demonstrates your desire to help him better work on your behalf without conflict-of-interest.
Most doctors want to do right by their patients. But they will be much more willing to make an extra effort (or challenge the ACO administrators) on your behalf if you demonstrate an active concern in your own health. Conversely, doctors will be less likely to stick out their own necks for you if you don’t appear to value your health.
For now, the 2012 election entrenches ObamaCare as the law of the land. However we can and should take maximum advantage of the freedoms we still enjoy, while working to move American health care in a better direction. Nothing is certain in politics. But if enough Americans exercise these freedoms and create a robust constituency for HSAs and direct pay medicine, the government will be less likely to eliminate those choices. With respect to our medical freedom, the old adage still applies: “Use it or lose it.”
All this just to circumvent a drug re-importation plan deeply opposed by Big Pharma, and a chance to work at doing away with employer-sponsored, pre-tax, health insurance. If successful, they could then move onto the mortgage deduction (which they've already already acknowledged as expendable), and the personal exemption will take care of itself with the fiscal cliff, so all three top (and most expensive to the government) tax deductions will be wiped out in one fell swoop...doubling our taxes paid without raising a single rate! Clever, huh?
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