Monday, April 12, 2010

Two Important Questions about ObamaCare

Two questions where I think the answers will be extremely important, in the sense of how much freedom will be left in health services, once Obamacare takes hold are:

Will Obamacare force doctors to accept medical insurance, or can they
go to a strictly cash business?

Can a patient who pays into an Obamacare approved insurance firm (which I guess will be everyone, one way or another) choose to pay cash for services?

James C. Capretta, a Fellow in the Economics and Ethics Program at the Ethics and Public Policy Center, and probably one of the very few  that understands the details of the very hazy legislation, has been courageous enough to attempt to answer these questions for me:

On your first question, it appears the law is silent. I suspect they (HHS) could try to impose this requirement through regulatory authority (the bill grants vast new regulatory powers to HHS) but I would guess the political opposition to requiring doctors to participate in the new insurance arrangements would be very high in the short term if they tried to move this way.

On your second question, the law seems silent as well. But the regulations on insurers will probably make this difficult to do.

Those regulations will be set up to ensure enrollees who are low income pay no more than a fixed percentage of their income on cost-sharing and premiums. To make that promise a reality, the insurers will have to track all interactions between their low and moderate income enrollees and their providers. So while it may not be illegal to pay your own money for something that is covered, I suspect it will turn out to be very much outside the norm of what is expected and therefore difficult to do.


  1. Nicholas J. KasterApril 13, 2010 at 7:33 AM


    What do you think about the fact that Procter and Gamble recently bought a 100% stake in MDVIP, a network of concierge doctors? They must think that, for the relatively affluent, this is going to be how they handle ObamaCare - spending more to insure that they get access to primary care physicians, who are going to be in shorter and shorter supply once the full force hits in 2014.

  2. The revisionist history on this bill will be truly astounding and will start several years from now when the HC system is just starting to buckle under the weight of these new regulations and guidelines. The politicos will scramble to whitewash the record and distract people from understanding why it is that HC is suddenly so much crappier than it ever was before. The spin and attempts to explain this all as completely unrelated to the health bill, a spontaneous and unforeseeable crisis, will be truly comedic.