Health care reform is the latest piece of the puzzle to be put in place. If you add this to what has happened in the financial industry and the banking industry a bigger picture begins to emerge. With the proposed financial regulations, there seems to be a movement towards the consolidation of power in a few institutions, systematically removing free competition, setting up the too big to fail phenomenon, thereby giving people less choice that will ultimately cost everybody more in the long run.
Since the passage of healthcare reform, there has not been a lot of talk about the role that hospitals will play. What no one talks about is the fact that there has been a quiet movement or shift of doctors from private practice to hospital employees. Many smaller community hospitals and doctor owned hospitals have gone out of business because they could not afford to keep their doors open. In addition, there has also been a quiet consolidation of hospitals. For example, in Atlanta, groups of specialists have become hospital employees. With the movement of various specialists, hospitals have now become specialty centers for specific patient care.
It is not hard to visualize a future where there will only be a certain number of hospitals that are able to provide care for specialized diseases such as cardiac care, or orthopedic surgery. If that happens, access will be restricted since patients will be limited as to where they will be able to go to receive their care. If there was only one specialty heart center in the city and only a certain number of doctors on staff, by definition, there will be a limited number of patients that can be treated at any specific time. Unfortunately, these changes will likely lead to the de facto rationing of care. In addition to the problem of access, costs will likely go up because of the lack of competition.
The demise of Lehman Brothers and the consolidation of other large financial companies have led to very few winners in the financial industry – the biggest of which is Goldman Sachs. The banking industry has seen a few surviving large institutions such as Chase and Citibank. What the larger banks didn’t acquire in mergers, the FDIC removed by taking over and closing hundreds of smaller and community banks. Makes you wonder if the credit unions will be next on the list.
Like the banking industry and financial industry the biggest and most powerful entity will survive and competition will be crushed. In medicine it is the hospital. The hospitals wield a lot of power. Recently, the Georgia Hospital Association tried to carve out an exemption for hospitals at the expense of physician owned ambulatory surgery centers (ASCs). There is a proposed 1.45% “bed” tax on medical services to create a Medicaid fund. The hospitals had language inserted into a bill (HB307) that would “protect hospitals from bills that are harmful to hospitals for three years” essentially giving hospitals the power to “veto” any language in a bill that they didn’t like. When you take in to account that: 1.) doctors were not at the negotiating table; 2) non-profit institutions get to draw from a fund to treat indigent patients while private physicians don’t; and 3) by law 2-4% of the patients treated in private physician owned surgery center must be indigent. i.e., they must treat them for free to keep their facility open (yet they must pay all of the taxes as a small business). Fortunately physicians were able to contact members of the Georgia legislature and stop the carve out. If the move had been successful, the hospitals would have been in a position to remove competition from the private ACSs which provide a less expensive alternative for patients. You see how uneven the playing field is.
Access to physicians, was one of the main promises of Obamacare. If this trend persists, it looks like you might have to wait longer and travel farther to receive the care that you need.