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Unexpected Impacts
Feb 28th, 2010 | 8 responses
Often when you are listening to the news they will use little fillers to take up the extra time in the segment. Earlier today I heard a couple I thought worth sharing.
As some of you may know the government has imposed new standards for the airlines to comply with. Specifically if the airline leaves passengers on the runway for longer than 3 hours they will be fined for each passenger. The fines could total several million dollars per plane.
I’m certainly not saying that preventing people being stuck out on the runway is bad. But at the same time in order to avoid the delays, and thus the fines, the airlines need to be much more conservative than they once were. You can’t predict for sure if a storm will clear or the runway will be plowed, so the airlines are cancelling far more flights than they used to.
I don’t know that this is neccessarily a bad thing. It’s better to be sitting at home than to be stuck in the airport (or worse yet on the plane). But at the same time there are going to be people who get upset over this, and it will be interesting to see the next steps.
Another tidbit is the fact that the bad economy may be contributing to a lower divorce rate. People who find themselves in tough economic circumstances are delaying plans to divorce. This doesn’t mean of course that they suddenly find a happy marriage, but it is an interesting impact. It is even possible that in some cases there might be time for the couple to work things out.
Just a couple tidbits to ponder as you wait for/watch the closing ceremonies in Vancouver.
8 Responses to “Unexpected Impacts”
Here's some news about effects in Oklahoma with Medicaid cuts. I wonder if Ben Nelson feels good.
The 3.25% Medicaid pay cut scheduled to take effect April 1 in Oklahoma will lead most of the state's physicians to stop seeing at least some Medicaid patients, according to recent survey responses from more than 200 doctors.
16.9% would continue to accept new Medicaid patients
45.9% would stop seeing new Medicaid patients
37.2% would stop seeing all Medicaid patients
http://www.ama-assn.org/amednews/2010/03/01/gvs…
Airlines have been over scheduling for years. AND they like to schedule for popular times of day, then they have been making people wait until the unpopular time comes around and THEN they take off. Simple matter of bait and switch which also overloads our airports at certain times of the day.
The hope is that the airlines will knock it off and schedule more reasonably.
They always say things like that when rates are cut. Then they figure out how to make more money anyway. “Broken finger? Ooooh, that needs and MRI. Let me send to to this “special” lab to get one.” The only thing being special is who owns it.
I think your assessment is largely correct but that still doesn't bend reality- that rate reductions for reimbursements lead to physicians changing their behavior in ways that don't help consumers. You might like to think that reducing the reimbursements just leads to cost savings and everything else stays the same, but it doesn't.
“Then they figure out how to make more money anyway.”
Access is a problem, Vey. No getting around that.
Making more money, procedure orientation? No surprise. As soon as the standard procedure and service codes became an industry staple with Medicare and Medicaid, so did upcoding. Erythropoetin overprescription for dialysis patients and cancer patients (in the news some time ago) was a well-known racket (compounded in the case of EPO by the maker's corruption, ahem, “rebate,” scheme to providers), for example.
Less money does reduce access, though. No question, especially where money is tight or providers already are losing money and only continue through cost-shifting to other parties. (The EPO scam in part exploited the problem of providers losing money on Medicare and Medicaid and looking for more money.) Cost-shifting can only be accomodated so far. (So is the basic problem the idiots overreacting to the Anthem rate increase overlook, but even knowledgeable liberals are identifying: the rate increases are circular with the individual insurance market because the more expensive it is, the more healthier people, who can take a risk more easily, are leaving the market, dropping out of the high-risk pools. It's the same thing as in expensive auto insurance markets where if the high-risk rates are too high, people drop out and simply drive without insurance, as in California, too, unsurprisingly.)
Medicare patients get rejected often, have specifically due to underpayment, the planned and threatened reductions in provider payments will compromise access more, and all these are magnified for Medicaid patients.
I have to deal with that personally and really don't need being lied to by agitated liberals and being the object of intellectually immature and other problematic behavior by liberals (not you, in this case, Vey) whose immaturity is getting raw and who are getting unglued due to desperation over lack of Dem legislation in Congress and the most ridiculous fixation or obscession with health care legislation (and continued overreach) in particular. Leave me and other normal people untouched by your defecient and incontinent behavior, thanks.
“Medicare patients get rejected often”
A problem that comes and goes around here. Depends on the “How's Business?” situation. There are some doctors I know of that won't accept HMOs. Used to be a whole rural county I lived in where the doctors refused to take HMO contracts. Eventually, greed won out.
Then for a couple of years, they refused to take Medicare or Medicaid patients until they got behind on the boat payments.
When doctors act in concert like this, I think the anti-trust laws should have been applied, but they weren't.
Access changes as the market changes.
On the subject of unintended consequences, I thought this was an interesting analysis.
I don't necessarily agree with Frum about all of those unintended consequences being negative (Congress doing less is generally a feature, not a bug, in my view) but he's probably right about most of the ways that reforms fail to do what they're intended to do (he could have made the article a lot longer if he'd included campaign finance reform.)
“A problem that comes and goes around here.”
I find your notes refreshing, after what I encountered earlier from someone else. Thanks.
I'm observant but my view is that of a patient, rather than a provider, though I'm a student of the entire situation and have had at least one doctor who was frank and ready to discuss anything and everything. (“There is a dark side of medicine…”) Where providers are losing money, access is a problema and is going to get worse. Several years ago, the providers' problems they discussed and what I saw were with lawyers and insurance companies. (The insurance nightmare is making many providers ready for the single-payer model.) Currently, cost is a big issue (which is unsurprising). What I also see varies in the different parts of the USA depending on the size of the population (the economy, the market) and other related things. I'm in a sparsely-populated, poor state now, and it has a low compensation and a well-known, terrible shortage of providers of all kinds. (The ER is my unofficial regular doctor, by default, because no one else is
taking any new patients, much less setting up standard regular care! The system here and its defects is actually creating many unnecessary, extra-high costs, when these should be especially avoided or reduced here.) The quality as well as the access problems are concerning and I'm already thinking ahead to having to think about moving elsewhere, to avoid 007 Care — License to Kill.
This is the future, with our aging society, more costly health problems and advances, in the USA.
“When doctors act in concert like this, I think the anti-trust laws should have been applied, but they weren't.”
This, or fraud, is just the worst of it. I foresee the big question in our fuure, long after the standard model for care is the public utility or service model (single-payer, Medicare for all, largely federal, though state and local government may still be involved), as follows: Will the final model for our future be Medicare or the single-payer model, or will the government presence be extended or advanced even more, to VA care for all? The reason it might? Cost control (and striking at waste, fraud, and abuse). Medicare or VA for all, that is the long-term question (2020-2030+ and if you think about it, 2020 is only ten years away now).