Ontario, Canada's most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate "incentive fees" to generic drug manufacturers.
British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit -- an idea that critics say is an illegal user fee.
It's almost as if, in health care, big government is not the solution, but part of the problem.
The great mystery surrounding the historic health care bill is how the corporations that provide coverage for most Americans — coverage they know and prize — will react to the new law’s radically different regime of subsidies, penalties, and taxes. Now, we’re getting a remarkable inside look at the options AT&T, Deere, and other big companies are weighing to deal with the new legislation.
Internal documents recently reviewed by Fortune, originally requested by Congress, show what the bill’s critics predicted, and what its champions dreaded: many large companies are examining a course that was heretofore unthinkable, dumping the health care coverage they provide to their workers in exchange for paying penalty fees to the government.
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It’s not just the calculus of mandates and penalties that has employers considering the option of dumping health care and paying more in salaries instead. The mandate to keep “children” on plans until the age of 26 has employers seeing a steep cost curve. For Caterpillar alone, the 26-year-old mandate will cost over $20 million a year. Under those conditions, the penalties look pretty good. Add on the “Cadillac tax” on some health plans and the expected jump in medical costs from providers dealing with their own set of mandates, and health insurance looks like a very bad risk.
What will it cost the government to provide subsidies for tens of millions of Americans who used to get health insurance through their employers? No one really knows for sure, but Fortune takes a stab at it:
What does it mean for health care reform if the employer-sponsored regime collapses? By Fortune’s reckoning, each person who’s dropped would cost the government an average of around $2,100 after deducting the extra taxes collected on their additional pay. So if 50% of people covered by company plans get dumped, federal health care costs will rise by $160 billion a year in 2016, in addition to the $93 billion in subsidies already forecast by the CBO. . . . .
But some of us predicted that the numbers used by Democrats pushing ObamaCare bore little connection to reality — and that it would incentivize employers to destroy the net of employer-based health insurance. It looks like that day is fast approaching, and that’s no myth.
CitizenJane Sturmtook the mike to ask how the brave, new world of Obamacare would treat people like her 105-year-old mother. At age 99 her mother's heart specialist confided that without a pacemaker he couldn't keep her alive, but at her advanced age he couldn't justify the operation. Jane sought out another specialist, and when he saw her mother was still very much alive and enjoying life, he agreed to do the operation.
Over five years later, her mother was still living happily with her family as a result of the highly advanced medical technology she received. So Jane, still displaying her own spirited fight for her mother's life, very articulately asked the President if under his vision for health care there would be any consideration given for a certain spirit, or joy of living, or quality of life, in providing medical care for those of advanced age. Or would there just be a cut-off at a certain age.
The President replied that we as a culture and a society have to learn to make better decisions about end of life care. And when the wise, central planning Washington bureaucrats discover the evidence shows the care is not going to improve health, they can let your doctor know, and let your mom know, maybe this is not going to help, maybe you're better off not having the surgery and taking the painkiller and going home.
Jane just told him that without the surgery her mother would be dead, and he responds with a hypothetical that maybe she would be better off taking the painkiller and going home. And President Obama's mind is so hypothetical and so theoretical that he is certain that far off Washington bureaucrats would know from the evidence when she should take the painkiller and go home, and could let her yahoo doctor know.
Moreover, from Jane's perspective, this was not an issue of end of life care. She just told him that after the surgery more than 5 years ago her mother was still very much alive and spirited. But those of us who have been paying attention have learned that President Obama is so certain that he has all the answers that he never really hears what anyone else is saying.
The message from the President to America's sickest and most vulnerable should be the theme for Election 2010, and the message the American people will now send to Washington's ruling Democrats: Take the Painkiller and Go Home.
And -- wouldn't you know it? -- Obamacare is behind the problem.
The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.
Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.
That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.
The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.
The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.
A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.
So if we're looking for reduced quality of care, reduced access to care, and longer wait times, we're right on track.