"Over 52% of physicians have already limited the access that Medicare patients have to their practices, or are planning to”

Dr. Atlas is a physician and a senior fellow at Stanford University’s Hoover Institution.

WSJ:

With the Affordable Care Act, the government has dramatically expanded its authority as final arbiter over health insurance and consequently over access to medical care. After the law’s Medicaid expansion and with the population aging into Medicare eligibility, the 107 million under Medicaid or Medicare in 2013 will skyrocket to 135 million five years later, growing far faster than the ranks of the privately insured.

Add to that centralization of power the Independent Payment Advisory Board (IPAB), ObamaCare’s group of political appointees tasked with reducing payments to doctors and hospitals. Even Howard Dean, former chairman of the Democratic National Committee, warned that “The IPAB is essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.”

The hidden truth is just around the corner—those more dependent on public insurance, mostly the poor and middle class, will have limited access to medical care. About one-third of primary-care physicians and one-fourth of specialists have already completely closed their practices to Medicaid patients. Over 52% of physicians have already limited the access that Medicare patients have to their practices, or are planning to, according to a 2012 survey by Merritt Hawkins for the Physicians Foundation. More doctors than ever already refuse Medicaid and Medicare due to inadequate payments for care, and that trend will only accelerate as government lowers reimbursements.

At the same time, ObamaCare is squeezing out the middle class from affordable private insurance that correlates with far better disease outcomes than government insurance. By bloating coverage requirements and minimizing the consideration of risks fundamental to pricing insurance, the law has already increased premiums by 20%-200% in more than 40 states, according to a 2013 analysis by the Manhattan Institute’s Avik Roy and others.

For cancer care, the overwhelming majority of America’s best hospitals in the National Comprehensive Cancer Network—including MD Anderson Cancer Center of Houston, New York’s Memorial Sloan-Kettering, Barnes Hospital in St. Louis, and the Seattle Cancer Care Alliance uniting doctors from Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Children’s—are not covered in most of their states’ exchange plans.

Meanwhile, concierge practices are increasing rapidly, as patients who can afford it, along with many top doctors, rush to avoid the problems of an increasingly restrictive health system. The American Academy of Private Physicians estimates that there are now about 4,400 concierge physicians, 30% more than last year. In a recent Merritt Hawkins survey, about 7% to 10% of physicians planned to transition to concierge or cash-only practices in the next one to three years. With doctors already spending 22% of their time on nonclinical paperwork, they will find more government intrusion under ObamaCare regulations taking even more time away from patient care.

WE ELECTED THIS ISSUE. AMERICANS CHOSE THIS PROBLEM.

Ever watch ROYAL PAINS?

Unless ObamaCare is drastically altered, America’s health care will also become even more divided, with rising inequality. Just as in the U.K. and other countries where governments take an outsize role in dictating health-care policy, only the lower and middle classes in America will suffer the full consequences of ObamaCare.