Paging Representative Howard, Senator Fein, Doctor Howard….

Something that has been big in the news for the last year or so has been the Affordable Care Act, also known as “obamacare.” It has a number of provisions that people don’t seem to like. It has that whole tax penalty if you don’t have health insurance. It has that whole central database idea for diseases popping up, and a number of other things that people are a little nervous about. The purpose of the law was to make it so that medical care was affordable for all Americans. It operates on a solid, logical assumption: If every American has medical insurance, then the Health Insurance companies can reduce deductables and premiums, because the majority of Americans are not sick all the time, and the amount that the Insurance companies pay out of what comes in would be a much smaller percentage. The idea might have worked if not for one thing: Insurance companies are for-profit corporations, and have a legal requirement to make as much money as they can for their shareholders. This means that, ultimately, they have no incentive with a requirement of insurance to keep premiums low, and, instead, have every incentive to do the opposite.

However, the goal of the Affordable Care Act is noble. It wants to make it so if, say, someone in your family got cancer, they would not be bankrupted by the bills. The whole political discussion is about repealing or defunding the law. Why is there not a “We don’t like that law. We think we can do better. Here! Here is better!” Why is there no greater discussion going on? Isn’t that what we Americans elect our Congressmen to do?

The answer, unfortunately, is money. And, no, it is not money from the doctors or drug companies. It is money from the banks and the insurance companies. You see, when a doctor graduates, gets his medical license after his residency, he has debt. LOTS of debt. He can pay it off quicker then other professions, sure….except that he also has to pay huge amounts of money out to the Malpractice insurance companies. Think about it like this: Say you pay $100 for an office visit. A likely breakdown is going to be something like this: $30 goes to Malpractice insurance, $20 goes to student loans, $30 goes to paying his staff, lab access fees, paying rent on his office, utilities, and hospital access fees. This leaves him with $20 out of that for himself. Now, figure that our doctor’s office is open the standard 8 AM to 5 PM, with a 1 hour lunch. Remember that most of the money from a patient is going to practice, and that any necessary things are coming out of that 20 per patient. Let’s assume that our doctor is going to give plenty of time per patient, say, 30 minutes. This means that, on a single day, he is going to have 16 patients a day, or 320 dollars for himself. This means he would be making $1600 a week, or $83.2K. Seems nice..but this is assuming that the doctor can collect all that. Most doctors offices have patients who haven’t paid, and have unexpected bills that come up, like when a law changes and they have to hire lawyers to brief them on what changes they need to make, and have to pay for the latest medical journals, and new equipment.

And, the Malpractice Insurance companies want it like that. They up their premiums yearly, while the Health Insurance companies drive the doctor to charge less per patient so they can make more money, so that doctors have to see more and more patients, and then, they start charging higher rates for patients who don’t have insurance(because the Insurance companies negotiate rates..and require them for their patients) because they have to. Imagine, for example, an Insurance company tells our doctor that he can only charge 70 dollars for an office visit(and some companies do!), and that is the dominant company in the area..that doctor is not just not making any money for himself, he is in debt for every patient from that company. This drives the doctor to have to see more patients, just to reach the point where he is making the money to cover all his expenses.

Ultimately, though, the issue comes down to this: We have to change the whole system. Out of 100 dollars, the doctor should not be having to pay half of that for malpractice insurance and student loans. He should be able to just charge $50 dollars per patient and make that comfortable 80K before taxes a year.

And all this is just talking about the family practioner or a specialist who only does exams. This is not even talking about surgeons, or VERY specialized doctors, who have even higher student loans and malpractice insurance. When a surgeon is doing more then one surgery a day because he has all those hospital fees, malpractice insurance, etc to pay….that can even cause the fatigue that leads to the errors that cause malpractice.

But, yes…let’s argue about the Affordable Care Act. That will fix the problem….or make people not think about what the cause of the problem is…

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