Laundry

My wife was recently commenting about her woes regarding laundry. She said it never seems to end. As soon as one load is washed, dried, folded, and put away another load is waiting to be done. It is a never ending process and I can understand the pressure of constantly having that required chore and never being able to get ahead of it. I compare her statements to the similar situation I have that the supply of patients seems to be endless regardless of the time spent every day. There is always more the next day. I suppose this is a good thing for me as my income depends on the constant flow of patients and my services are desired.

Patients and friends ask me what the effect of the new health care bill, Obamacare, will mean to my practice. Truthfully, I do not know except for the fact that initially as more people get insurance there will will be more patients seeking services. This may actually be a windfall for me and physicians as a group as the government taxes society and transfers the money to me to take care of the additional patients (via medicare, medicaid, subsidized private health plans). Yet ultimately I think it will be a negative. As costs to society rise over the next several years measures will have to be implemented to either ration care, cut payments to doctors or increase revenue to cover payments. There is no way around this, it is inevitable.

So where does that leave me? Like the analogy to laundry my service are a necessity to society. The skill set possessed by specialist physicians are difficult and expensive to obtain and restricted to a small group. These skills are sought out by patients and ultimately these doctors will be paid accordingly. In Obama care it will be the patient that takes the hit, either by rationing of care or by not being able to get a doctor to accept their insurance due to poor reimbursement. If the government rations care then people will have to pay out of pocket for services not covered. For instance, if the government decides they should not pay for me to remove wax out of patients ears then the patient will have to pay. The service is required.

If the government whittles down reimbursements to physicians to low levels then the doctors will not participate with the insurance plan and the patient again will have to pay out of pocket for the service. In either case it is society that will pay the price. This will happen as costs will rise and increasing revenue with a VAT is likely to be implemented.

I suppose another option is for the patient to just live with wax in his/her ears and not seek out a doctor to clear them. He/she would just live with a hearing loss. But this would be analogous in the case of laundry to spending ones life wearing dirty underwear every day. I am not sure which one is worse.