Yves Smith at Naked Capitalism pretty much sums up how the ACA incentivizes corporatization of medical care and presents an existential threat to small practices.
As previously stated, I think some problems can be improved upon by centralization and technology. However, I don't think medical care is one of them, and I don't think centralization and technology should be the default approach for all complex problems.
Here in our small local pond, I see:
- Marshall Medical buying out so many medical practices it's becoming the company store in the company town. They are organizing the doctors into a Foundation in the hopes that it will improve "productivity". The doctors are unhappy with this as it in all likelihood will translate to more work and less pay. Such is life when you sell your autonomy.
- Hospitals and "healthcare systems" everywhere are cutting costs by replacing receptionists with automated phone systems. I don't think that's a good idea in what is ultimately a service, but that's where it's going. I personally hate being on hold, and I definitely don't want it when I'm trying to call my doctor, or my daughter's doctor. IMHO, the receptionist in my office is the voice on my phone and the first and last person you meet when you come to see me. I do not regard or compensate this as a rookie position, and have no inclination to replace Carolyn with a robot. How would my "productivity" improve by making me harder to contact?
- Computerization of medical records takes time away from nurses and doctors: the time it takes to enter notes or orders is time and eye contact not spent with patients. Additionally, sharing records and keeping medications up to date is worse than ever since those responsibilities are often given to the newest entry-level employees. The reason I haven't adopted electronic records is because I've used or beta-tested half a dozen of them and use the hospital's system for hospital patients. At the end of the day, medical care is all about time and eye contact with patients.
- Medical supply vendors like Robinson's are no longer available to us. Instead, patients have to go into Sacramento to whatever vendor submits the lowest competitive bid to have a virtual monopoly on medical supplies for the greater Sacramento region. Since when has taking the low-ball bid ever been a smart move? How are people in Placerville or Somerset or Grizzly better served by getting crutches or a wheelchair in Sacramento?
- Large employers got a reprieve from ACA insurance until next year, but not small businesses. I guess the best investment a corporation can make is in a US representative. I have no issue whatsoever with tax credits being available to folks based on their annual income. It's also good that you enjoy that break in premiums every month if you bought your own insurance. However, if you're a small business providing insurance to your employees you have to pay the full monte all year and take the tax credit as an end-of-tax-year deduction. This does not give small business any reason to provide insurance to employees, and over 40% of employees in this country are from small businesses. I don't think small business owners had much say in this part of the ACA, unless I missed the memo.
- As a matter of history or disclaimer, I am a traditionalist. I am in a family practice by myself, my wife is a registered nurse who works in the office and I take care of my patients in the ER, the ICU and the hospital and in hospice. I admit I stopped delivering babies after the 500-600th one, because I was never getting any sleep.
- At this point in time, remaining a traditionalist requires a level of canniness and responsiveness. However, I see no reason to stop practicing medicine the way it has been practiced for the last several hundred years just because everyone is deciding that they can get more sleep and be more "productive" by becoming an employed cog in a corporate machine. So far so good, and long may it last. We'll see if it continues to be better to fight on your feet than live on your knees.
