Obamacare: What does it mean for healthcare? (Part I of III)

July 17, 2012

Mark L. Friedman, MD, FACEP, FACP

Now that the Supreme Court has validated the new healthcare law (the Affordable Care Act or ACA, often referred to as "Obamacare"), everyone wants to know what it means. If you have the time and inclination you can read the full text of the law on the Department of Health and Human Services website. The text of the law runs for 2,407 pages. Read that first and then apply the tweaks made by the Supreme Court. Once you have done that please call and explain it to me.


Obamacare: loved by some, hated by others, understood by few. 


This is exactly the challenge faced by the regulators at the Centers for Medicare and Medicaid Services, who will be tasked to write regulations to interpret, implement, and enforce the law. Needless to say, at this point in time no one really understands this law and what it ultimately will mean.

Nonetheless, I think we can make some basic predictions on what effect the Affordable Care Act will have on healthcare in general, and perhaps on certain classes of individuals based on the general provisions being discussed in the media and the way things work now.

First of all, let's start by defining what the ACA is not. It is not a national system of healthcare. In fact, it is not even a national system of health insurance. It is, in effect, another "patch" in the patchwork quilt of programs and institutions that comprise the uniquely American "system" of healthcare we have all come to know and love / hate.

What the ACA means for healthcare in this country includes the following:

Roughly 40 million people who didn't have it will gain access to health insurance (please note: health insurance is not synonymous with health care).

Hospitals, emergency departments and some institutions will have to deal with this volume, causing longer waits for services.

Doctors will not, creating a problem of access to both primary and specialty care for those with "insurances" whose payments are deemed inadequate by private physicians. "Concierge" practices that charge an annual membership fee and physician non-acceptance of certain insurances (including Medicaid, the new government options, and soon even Medicare) will become the new norm. A two-tier system of healthcare, similar in some respects to what has occurred in the UK, may emerge in the US.

Government regulation (which some would call limitation) of care will expand as it struggles to contain the mushrooming cost of providing essentially unlimited free services for more and more people.

Healthcare will continue to grow as a percentage of the economy as more and more resources flow in, likely at the expense of other sectors.

Taxes (and unseen costs of doing business that relate to healthcare) will increase.

Next: Obamacare - What does it mean for you?

Originally published Jul 17, 2012 2:38:11 PM.