Here’s a Forbes review of a WSJ article that gives us a heads up about what exchange insurance products will look like and how they will work.  Dr. Scott Gottlieb points out that the design of Obamacare is identical to Medicaid, in that increased demand will be managed with less access.  

This will be accomplished in two ways.  Patients will be funneled to networks that are already extremely overworked, creating the waiting lines we know all to well in countries like Great Britain and Canada.  An additional rationing tool will be the physician reimbursement at rates lower than the market-clearing-price, a payment amount that will lead many physicians to limit their exposure to this population or quit participation altogether.  

Gottlieb writes:

“Yet the higher costs of taking care of the Medicaid population hasn’t been made up with more funding, but fewer services that these patients are able to get access to.”


Actually he’s wrong here.  In many states Medicaid funding has gone up while access has suffered, just what you would expect from a Postal Service business model.  Read more here.  Gottlieb’s description is rosy, it turns out.

Later in the article, Gottlieb writes:

“The Medicaid benefit is great on paper, but often stingy when you try to use it.”


Remember “coverage doesn’t mean care,” from Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons?  And what is Obamacare’s solution?  Expand Medicaid!


Dr. Todd Rice sent me the following quote recently which applies to this perfectly:

“If you think the problems that government creates are bad, wait until you see its solutions.”

G. Keith Smith, M.D.