Tuesday, December 18, 2012


My local newspaper, the Raleigh News & Observer, started a series on Sunday about what might be called unintended consequences of Obamacare.  Look around your town - has the sign on the outside of your doctor's office changed in the last two years?  Is he/she now affiliated with a local or regional hospital?  Here in the triangle area there is a huge competition between Duke Medical Center and UNC Chapel Hill Memorial hospital to suck up a variety of small practices and bring them under the big umbrella of the university's medical system.  Even the mammoth REX Hospital in Raleigh is now listed as part of UNC Health Care.

This is more evident in the rural areas.  For instance, my parents live in a town with a population well under 2,000.  There are three doctors there - two are practically dead but haven't fallen over - the other one is a young family man who moved there from Montana (geezus he must have been LOST).  The three practices all take Medicare/Medicaid and between them and the little 44-bed hospital that's been there forever, medical care for the townspeople has been very available and very reasonably priced.  Last spring, the signs on the hospital and the doctors' offices changed to include the word 'VIDANT'.  All four medical facilities are now part of the greater East Carolina University Medical system, the largest medical facility east of I-95.  Why?  My mom asked her doctor.  His one-word answer:  MONEY.  

  • “Prices are increasing, often for no other reason than the sign on the door changed,” said [a] spokesman for America’s Health Insurance Plans, a trade group representing the insurance industry.
  • Here’s why: Medicare and private insurers pay more for outpatient care – which includes an allowed facility fee for hospital infrastructure – than for the same procedure in a doctor’s office, which cannot charge a facility fee. A hospital can increase revenue by acquiring a practice and changing the billing to outpatient. Or the hospital can simply convert its doctors’ offices to hospital facilities.
Do the math.  By being part of a 'hospital' system, which can charge more for procedures in addition to the facility fee, costs to the patient have more than doubled.  This will cause a necessary rise in private AND government insurance costs.  I mean - who is the government going to pass these increases along to?  Look for your Medicare premiums to skyrocket.  Look for your private insurance premiums to ..... skyrocket.  Mom's doctor also told her he got his insurance payments WEEKS faster being part of VIDANT than he did as a private practice. You can't blame the doctors - it's about survival.

What if...... the federal government had never gotten into the health care business.

Here's the link to the first article [which, BTW was on page A1 of the Sunday paper ABOVE THE FOLD] in this series:



  1. It IS scary - but it's almost a foregone conclusion that the smaller practices will have to sign on - so many private practices are able to tap into the larger hospitals for referrals of MRI scans, for example.... it they don't go under the big boys' umbrella, they will be cut off from such services, and few smaller practices can afford those massive machines, let alone have room for them in their offices. This is going to be a giant consolidation of our medical care... I fear the day of the small doctor's office and that doctor/patient rapport..... is over.