Doctors are recognizing trends in the health care market that don't bode well for patient care or patient costs.   The middle class and upper middle class, those Americans who actually foot the bill for the rest of us by paying inflated insurance premiums, are under-utilizing services because of the comparatively extraordinary costs of their deductibles.  Yet even with these people intentionally avoiding care, the costs are skyrocketing.  If Obamacare did nothing else, it seems to have taken away affordability for the insured, cornered the Republicans into an unwinnable situation with the ACA's collapse, and made otherwise sane people seriously consider single-payer, government-run options.

Doctors fortunate enough to work in population centers that have a strong mix of middle- and upper-middle-class patients have noticed a dramatic decrease in the utilization of elective surgery, specialty services, and even doctor visits, the costs being prohibitive, given patients' high-deductible insurance choices.  Americans are famous for living beyond their means, and an unplanned $8K to $10K bill to pay the deductible for their hernia surgery might not be worth pulling their child out of that new private school, replacing that old car, or paying the mortgage.  So they work around the problems posed by that hernia, or that recurrent sinus condition, or those painful knees.  Anything but forking out money they don't have or that is not easily available for a surgery that pre-Affordable Care Act might have had a tenth of the up-front costs.

With the insured not using their insurance because of money struggles, you would think these would be halcyon days for insurance companies.  In many ways, they are, but mainly because for the past few years, the government has essentially covered all their bad debt incurred from becoming part of the health insurance exchanges.  Unfortunately for them, the Affordable Health care Act didn't plan to cover losses by the insurance companies past this year.  The unspoken truth was that as soon as Hillary was elected, and Obamacare's support of insurance losses made the system fall apart, there would be a default toward single-payer insurance run by the government.  But Hillary lost, and the Republicans now get to own the health care crisis as it swirls around the commode, with the only people who can pay for insurance so scared by the costs that they are in near panic mode when they get sick.

Insurance companies were profiteering these years, with the government wiping away risk, and must have thought they could figure things out after the fact with the ACA's collapse, possibly hoping they could redefine themselves when it was gone.  An insurance company can't actually be a real entity without actuarial science, and the government's promise to take away pre-existing conditions as a means to set rates means they are no longer an insurance company, but a middle man in another government Ponzi scheme.  The government-run "insurance" eventually wouldn't want to share its power with anyone else.  So where would that leave insurance companies?  For now, they are pleasing their shareholders, making money however they can, strolling around in their own graveyard.

With Trump's victory, the future of private insurance should ideally be untied to government.  They should be on board with traditional, historically profitable but different free-market options.  But they are going away kicking and screaming, because they like having their risks covered.  They want to keep the eggs from the government golden goose as long as they can.  Why do you think the CEO of Kaiser Health care is screaming so loudly about losing subsidies, wanting the ACA to remain? 

Insurance companies, with their strange new bedfellows, the mainstream media, are now able to try to extend their government subsidies by attacking Trump and the Republicans.  They blame them for the paucity of insurance providers left after this subsidizing of failure ends, knowing that the media will play along if it makes the current administration look bad.  The MSM just want Trump gone and are willing to sleep with whomever they can to achieve their desired goal.  Any acknowledgement by the media that the pre-existing ACA game plan is really responsible for the subsidy phase-out is never heard.

The crony capitalist false markets of Obamacare, with big rewards also given by the government to hospital corporations, have forced many doctors suffering under poor financial reimbursement to sell their practices.   As doctors lose their businesses and are now owned by hospital corporations, the corporations dictate doctors' referral patterns.  Costs increase, personal care becomes less personal, and quality suffers.  Rarely is the hospital sleep study center, infusion center, outpatient surgery center, or outpatient radiology facility as patient-centered and responsive to referring physicians as is the one owned by a doctor.  And they often can't or won't charge as much as hospitals while sometimes giving special rates to those who cannot afford care that a hospital might not give.

The reason why hospital corporations can purchase doctors' businesses is that they can bill more when filing charges for the exact same services.  A cardiac catheterization, a C.T. scan, a tonsillectomy, or a colonoscopy can have remarkably higher costs when a hospital charges the patient instead of the doctor.  A lot of this differential is explained away as being necessary because the hospital must take care of the uninsured, and somebody must pay.  Insurance companies, ultimately the rates paid by the purchasers of insurance, have therefore been integral in these cost-shifting schemes for a long time.  Generous employers who previously had been subsidizing employees' insurance had hidden the real costs for many of us for a long time as well. 

It makes sense that if doctors' charges increase, because they now are filed with a higher-cost hospital code, prices will go up.  It is an easy, logical consequence of ACA cronyism.  It is why the costs of health care are going ever higher even with the insured utilizing their insurance less often because their deductibles are so high.

On top of this, becoming part of  "the Borg" of the ever enlarging hospital corporation seems to place patients lower on the chain of priority.  The bureaucracy seems to put electronic medical records goals and government-inspired social engineering ahead of the actual care of the patient.  Bonuses are contingent on things like government-recommended counseling of patients regarding their obesity, regardless of whether you stopped their nosebleed successfully in that office visit, an emergency that interrupted your day, delayed care for those who made appointments, and made you perform your hospital rounds later in the evening.  You might also have an E.R. call that made finishing your records that evening impossible to do, with the resulting delay in EMR completion tagging you as a potential "slacker" as a result, labeling you lower in the pecking order of  Borg, who may need a "review" that could have "financial consequences."

Doctors are famous for working long hours and running behind.  Record-keeping has always been an issue.  This is nothing new.  But having an administrator grading a doctor's computer record, with an administrator grading that administrator whom you barely know, and being told to redefine priorities to make the paperwork look good to the government overseers is not patient-centered, but bureaucracy-centered.  Sure, these hospital corporations want happy patients, and part of their review of a doctor's excellence revolves around patient satisfaction scores, but these ratings are victims of the same thing that makes bureaucratic decisions so imprecise in the first place.  If you see 200 people over a period of time and 18 take time out to fill out a satisfaction questionnaire, do you think this might skew toward the dissatisfied?

The real problem is that costs in health care are too high, having become that way because of multiple factors, and free-market reforms are scary to Americans because there has not been a marketplace in health care in our lifetime.  Dr. Tom Price, our current HHS secretary, introduced sane and guaranteed-to-help potential reforms back in 2006 when he was in the minority in Congress.  But these ideas never made it out of the Democrat-controlled committees at the time, nor have they been given any chance since the Republicans gained control.  They included insurance pooling, shopping for insurance across state lines, tort reform, and support of health care savings accounts.

Imagine that you are a 28-year-old single waitress with Crohn's disease in today's market.  You would have to go on an unaffordable Obamacare exchange, with federal subsidies helping but costs still imposing.  Under Dr. Price's idealized reform, you would have pre-tax monies in your accrued health care savings account helping with deductibles.  You might be part of an insurance pool of "Waitresses of America" that Aetna of Wyoming thought was worth the risk of insuring, at a much lower cost than your previously single option of Blue Cross of Alabama.  And you could choose your doctor by price, as one doctor could charge less because he is better at managing his overhead, or he could have lower insurance premiums because of tort reform.

But Republicans are too scared of the mainstream media to even put their foot in the water of sane reforms.  The media is all in for expanded government power and will do anything to demonize these options.  Patients just want insurance costs that are not more than their mortgages, and they are sick of the opaque billing, ridiculous prices, and worsening care offered by the current system.

We are at a tipping point in America, and if the Republicans won't do what they were elected to do, Americans will put the socialists back in power.  And if you think things are spiraling down the drain now, wait until we see the costs and the effects on our system incurred with "free health care."