Wednesday, April 16, 2014

With O'care the "Concierge" arbitrage is going vertical

If you read my post about the 'changes' in insured measurement below, you might conclude that the Obami have 'won' - after all, rigging measurement to ensure that the program will 'achieve' the goal of fewer uninsured seems to guarantee it.  Unfortunately for all of us, the flaws of the system aren't primarily in the 'sign up phase'.  The real disaster comes after the so called 'success'.  Indeed, the more 'success' the Obami have in the launch the greater the smash up will be.  Here's one example of what has come to pass:

It costs more in effort, time and resources to practice medicine in a system administered by third parties.  This is because there are administrative costs as well as 'agency' and 'moral hazard' costs.  People don't watch their pennies when a third party is picking up the tab and the agent or doctor has an incentive to over treat because someone else pays.  But the explosion of third party payment and the inevitable ruinous inflation that it drives has led just as inevitably to more and more draconian interventions in the market to limit the consequences of previous manipulations.  For example, Medicaid and Medicare - utterly unable to stop outright fraud the way private insurers routinely do - has turned to Congress to criminalize more and more physician administrative errors.  Obamacare  adds to this coercive trend by adding a thicket of new taxes and administrative requirements to receive reimbursement such as useless but expensive medical record systems, premium taxes and so on.

So the third party 'deal' is getting worse and worse with no prospect of reversing the trend.  So the primary care physicians that serve the affluent find that they can step away from the third parties, gross fewer dollars but net more and sleep better at night.  They call this concierge medicine and it's booming.

This, of course adds more agony to the medical access catastrophe that the poor and working classes already face:  fewer docs, higher demand, more paperwork and punishment and the coerced corporatization of physicians practices all mean fewer doctor hours to meet and treat patients in a rapidly rising 'third party, moral hazard, agency problem' filled market.

Stay tuned for more brutal Federal flailing as the gorgon gets itself more and more enmeshed in the nets of its own making.  Its roars of rage will be deafening.

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