Health care in my small, rural community has been pretty much destroyed by this. A hospital system purchased the local hospital, hired the best physician to be hospitalist at this hospital and at a bigger one in a neighboring community that they also purchased. There is now only one good private physician - all other health care is through them and at triple the cost. To see a doctor in my old doctor’s office (now the hospitalist), costs three times as much for a much inferior physician. Bloodwork that was done in my former doctor’s office at a very low cost now must be done at the hospital for $350. For less than that, I can get the same blood work done at a specialist’s office 90 miles away *and* see the specialist. It’s crazy and I can’t afford health care. The physicians we are being sent are the ones not good enough for them to keep in their office. We used to have a number of physicians who grew up here and came back here to practice because it’s home. Those days are gone.

RE: “hospitals are increasingly acquiring private physician practices. . . . “

Right—and the reasons why private physician practices are selling themselves to hospitals right and left is because of the gargantuan costs of the overwhelming regulations they must now comply with, including the installation of the bloatedly expensive EHR, the monstrous liability coverage needed, and the masses more regulations.  A physician in my family had a lab years ago—but they regulated that out of existence and he now has to send his patients to the hospital to wait for however many days, whereas before they could get the lab results from their lab down the hall.

This is what we, the American people, asked for and voted for.

We wanted all sorts of larded up crapola and demanded all sorts of mandates and regulations and government involvement—and now we will get the consequences of that in ever more inflated costs.  We are in a “healthcare bubble” just as the housing bubble existed 10 years ago.

Oh well.

I’m just happy the finger is being pointed at the *driver* of costs for once, instead of the *middlemen* (insurance companies.)  As has been said since 2009, Obamacare never purported to be “health care reform”, but “health insurance reform”; and that’s one reason why it’s wrong-headed.  Everyone likes to pick on the insurers as greedy monsters, but don’t think twice (or haven’t until now) about profiteering providers.

Everyone likes to pick on the insurers as greedy monsters, but don’t think twice (or haven’t until now) about profiteering providers

And maybe someday soon they will look at the real source of the cost distortions…...the Federal Government, and to a lesser extent state insurance mandates.  It’s a perfect storm of choking regulations, stimulating demand for services by “free” 3rd party payer healthcare without expanding supply, and putting a hammerlock on prices which HAS to lead to rationing.

If Obamacare is so wonderful and great, and so popular, how come Obama is not campaigning on his singular accomplishment 24/7?

All of the above is correct.  I am amazed at how quickly the destruction of medicine is going.  In the last six months the system is falling apart and now I believe next year medicine will be destroyed completely.  Primary care is already gone.  Less than 2% are going into it.  The continous cuts in physician services by CMS and then followed by the insurance companies to track CMS have made the fee less than our overhead.  So nurses are taking over the care.  The vetrans are complaining that when going to the VA they only see a nurse.  In our area the nurse clinics are sprouting up like mushrooms.  While I love the nurses they just aren’t up to caring for complex conditions.  Last week we had a nurse send to our hospital MRI a 22 year old female whose complaint was “I hurt all over”  so she ordered a whole body MRI.  The patient was in the machine three and a half hours and the test was negative.  Of course all this was “free” for the patient.  Meanwhile we had five Blue Cross patients who had to be sent to the big city to get their MRI!  Now private practice is rapidly disappearing because of the unfundated mandates and legal dangers.  Hospitals are buying up everything because doctors have a choic of retiring, going all cash practice with no paperwork, or getting a salaried job with the hospitals.  As they say in Russia, “they pretend to pay us and we pretend to work.”  And very soon the insurance companies will be gone due to the torrent of new coverage that will cause them to have to raise the premium price so they are priced out.  Then there will be a single payer and everyone will be on Obamanational care, but no one to do the work.  Hope everyone will love all this that they have voted for.  I don’t however have much hope no matter who gets elected.

Very good points have been raised in all of the above replies.  I wonder why so many people do not realize that many regulations, no matter how well intended often result in shutting out the most vulnerable people to quality healthcare.

Connecticutian talks about “profiteering providers.”  Perhaps s/he is unaware of Medicare Part A and Part B.  Simply put, hospitals get paid under Part A, and more generously, while physicians get Part B, which as Country Doc points out barely covers or doesn’t cover overhead costs for private MDs.  And don’t even ask about how Medicaid reimburses.  Thus the growth of “concierge practices” in many urban areas.  It’s one way that primary care MDs can still make a go of it, stay independent, and keep some sanity in their practice.  The alternatives are to turn your office into an assembly line and see as many patients as possible, with the inevitable burnout factor, or sell yourself to the Big Hospital system to become a salaried employee, with perhaps more sanity (for now) but no effective autonomy.

I’m a hospital-based MD in an independent specialty group, although we need stipending from the hospital to make up for the miserable government-heavy payer mix that we have in our urban area.  It’s been breathtaking to watch how fast the two big hospital systems in my area have absorbed previously independent MD practices.  There are virtually no general surgeons left in our town that aren’t employed by one or another hospital system.  Ditto for internists.  And as this article suggests, hospital systems reap more bucks by charging facility and equipment fees for procedures and studies done on their property, including formerly private offices now rebranded as “Brand X” or “Brand Y” medical system.

I’d also note that there’s been a continuing medical arms race among various big hospital systems, both not-for-profit and for-profit, funded in large part by those Part A bucks. 

This is all to say that MDs are not the primary drivers of the all-too-real cost inflation that we see in American healthcare.  In my own specialty (anesthesiology), my group’s incomes have been flat (or actually declining relative to cost of living) for probably a decade.  Part B and Medicaid pays us a fraction of private insurance, all the while our patients are getting more and more complex.  And ObamaCare promises to try to exact savings by cutting over $500 BILLION from Medicare, setting MDs against much more powerful hospital systems in negotiating for bundled payments, and unleashing tens of millions more Medicaid patients on an already strained system.  What’s not to like?

Joshua, I’m not unaware of Part A/B (and C/D, as I work for an insurer.)  I intended “provider” in the broadest sense, not meaning to malign MD’s personally.  It would include *some* MD’s (for example, those few who submit fraudulent claims), groups, hospitals, hospital-owned services, labs, pharmaceutical mfrs, medical goods suppliers, etc.  Just so there’s no hard feelings. 

I might as well acknowledge that blame for the problems is shared among all the stakeholders - I called out providers because that’s what the story was about.  Insurers want to make a reasonable profit, suppliers want to expand markets, providers and their support staffs need to make a living, Government wants to secure votes via entitlements and power via tax policy… and let’s not forget the patients, who feel it is a natural right to live forever, according to any lifestyle they choose, whether or not they can afford the natural consequences of that lifestyle, and cost should not be a consideration.  I’m tired from my rant, so if you’ll excuse me, I need to go lay on the couch, and watch some TV over a bowl of ice cream, waiting for my ED meds to kick in. 

All of this makes my wife and me glad that we’re fortunate enough to be covered by the VA Medical Care System, which in our area is very good indeed.  Whenever I go for a scheduled appointment at the San Jose Clinic or the hospital in Palo Alto, the only time I see a nurse is for routine blood pressure and weight checks.  Otherwise, I’m seen by a doctor (usually my regular healthcare provider), and if I’m scheduled for a dental visit, by my regular VA dentist.  I’m rated as 100% disabled by the VA (I’m a full left leg amputee).  I’m otherwise covered by TriCare for Life and Medicare.  Since my wife is also a veteran, she’s also eligible for everything except dental care.  Otherwise, the healthcare situation in Los Banos is not good, with private care almost non-existent; having been bought by an HMO.

I’ll be happy when lawyers get to “choose” LEGicaid and LEGicare and are paid at the same rate as Medicaid (25%-ile) and Medicare for their clients and have to comply with the same level of professional insurance costs and overhead and regulations and become targets of a professional class devoted to plundering.

Of course, they DO have Congrss as an option.