Published on TheHill.com on April 22, 2014
ObamaCare has signed up 8 million people. Democrats are breathing a sigh of relief, but their trials have only just begun.
Now a large swath of America will experience firsthand the shortages of doctors, the limited access to hospitals, the high deductibles, the large co-pays, the significant co-insurance requirements and the long delays in care that will accompany Obama-Care’s implementation. These Americans will see, firsthand, what government-run medicine is like. And the rest of the electorate will have a front-row seat from which to watch the debacle.
The fundamental problem facing ObamaCare is the same as it was when the misbegotten program was launched: You cannot expand the number of patients without expanding the number of doctors. If you try, as the Affordable Care Act does, you will have long waits to see doctors, big increases in costs and unsatisfactory patient outcomes.
The increases in cost that we are now seeing in the healthcare sector come, of course, from an increase in demand with no commensurate rise in the supply. These price hikes will trigger the most deeply disturbing — and controversial — of ObamaCare’s provisions, the Independent Payment Advisory Board (IPAB).
Appointed by the president and confirmed by the Senate, this 15-member board will be charged with requiring alterations in Medicare practice to hold down costs sufficiently to cut program spending by $500 billion over the next decade. The formulae it develops will, undoubtedly, be adopted by states seeking to contain Medicaid costs and by private insurance firms.
The IPAB has not yet come into existence because the rate of medical inflation has not required it. But now, with prices rising, it will become central.
Each January, the IPAB will issue a cost-reduction plan. It will proscribe the use of certain high-cost medicines, limit access to diagnostic tests and condition approval of certain surgeries and treatments based on the number of “quality-adjusted life years” left to each patient, all to bring Medicare costs into line.
Congress may override the IPAB recommendations by a three-fifths vote of each House. Otherwise, they automatically take effect by Aug. 15.
Each year, the administration will face a bruising fight over the IPAB recommendations. Patients will protest, and doctors will warn of bad outcomes. Sarah Palin’s “death panel” will begin its reign.
At the local level, cancer patients will find that the nearest and the best hospitals won’t take them. Pharmacies won’t fill their prescriptions. Doctors will turn away patients. As the ObamaCare bureaucracy struggles with the rising costs it caused, it will ration access to medicines, hospitals, surgeries and elective procedures for all in its reach.
Meanwhile, all Americans under the age of 65 who are not on Medicaid — both those on ObamaCare and covered by private plans — will find huge premium increases throughout the remainder of 2014 and during 2015. Deductibles will skyrocket. Stories of the financial hardship of paying the new premiums will abound.
And the cancellations will continue. Small employers will shut down their policies rather than accept the new higher premiums, and their workers will have to fend for themselves in the high-cost ObamaCare market. Those insured by large companies will see big increases in premiums and deductibles. And employees will continue to see a reduction in their weekly work hours as their bosses squirm and maneuver to limit ObamaCare’s universal coverage mandate.
Meanwhile, many of the 8 million enrollees will not pay up, eroding the program, and those who go without health insurance will hate every penny of the fine Obama will impose on them — or, they just won’t pay it.
For those who feel the political damage of ObamaCare is behind them, you ain’t seen nothin’ yet!
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