I'd like you to meet my doctor: John Nuschke, M.D., FACP, or Dr. Jack for short. He's here today because I'm still a bit Obaffled by how Obamacare will affect you and me. I tried reading the actual bill, but it doesn't exactly move along like a Dan Brown novel. So I decided to get this suspicious growth checked by my primary-care physician, who's been practicing medicine in southeastern Pennsylvania for nearly three decades. This bill is going to be his new operating system, so to speak â€" Healthcare 102.0, or whatever we're up to by now.
But even Dr. Jack admits to being no expert. It's not like he's a Toyota mechanic who received a fax from headquarters diagramming exactly how this problem will be fixed and what to say to customers. Unfortunately, doctors have pretty much been left to figure it out for themselves, just like the rest of us.
Nonetheless, Dr. Jack says I (and you) may eventually notice four changes when it's time for a checkup in the not-too distant future:
It may be harder to get an appointment. According to the latest figures from the Centers for Disease Control (CDC), approximately 44 million Americans are without health insurance. Although it's impossible to say how many of them will start showing up in doctors' offices once they're insured, Dr. Jack points out that there are only so many primary-care docs to go around. Despite what you may think, they're not wandering around the golf course in their Izods, waiting to be paged. In fact, a 2009 CDC report concluded: "the time required to deliver recommended primary care is almost 3 times what is available per physician" and "there are not enough primary-care physicians to meet the recommended care guidelines." Which leads us to the second potential change--
You may not actually get to see your doctor. Instead you may meet with a physician's assistant (PA) or a nurse practitioner (NP). Although Dr. Jack has resisted using them in his practice, it's an accelerating trend. In fact, if you've visited any of the new retail or urgent-care clinics, a PA or NP has probably treated you. Although highly trained and competent, they're not MDs and, as a result, the traditional patient-doctor relationship may erode. I may become more of a file than a face.
It'll probably end up costing you more. No surprise here. As Dr. Jack points out, someone has to pay for covering the previously uninsured, and it'll most likely be those who have insurance now. "I suspect you'll eventually end up paying more either through increased premiums, increased deductibles, decreased benefits, or even lower salaries and raises," he says. However, this may be partially offset by the wider use and lower cost of generic drugs. Plus, starting later this year, if your insurance meets certain stipulations (check with your carrier) you may be entitled to free preventive health services, such as immunizations and disease screenings. "That's one of the most positive aspects of this bill," says Dr. Jack. "We have to develop a society that values prevention. The potential savings from that is huge, and it's ultimately the way to fund universal health care."
You may still be paying for your kids' care even when they're adults. Under the new bill, dependent children are now eligible to remain under their parents' policy until age 26. That means college graduation no long marks the celebratory, dance-naked-in-the-street end of a parents' financial responsibility. Starting this fall, the youngsters can boomerang back in an entirely new way. If my 24-year-old son loses his job and returns home--If my 21-year-old daughter doesn't get hired after graduating college-- How do the rappers put it? Who's your daddy?
All of which makes me shake my head and round my shoulders even more. The dump trucks just keep backing up to unload it on the hard-working middle class. But until my lumbago starts to act up, and I actually need to call Dr. Jack for an appointment, I'm going to try to remain open-minded and, yes, compassionate.
"Prior to this bill being passed, if a patient couldn't afford to see me, I would see her anyway," says Dr. Jack. "But I'm a relatively small part of the overall medical system. I'd try to do what I could but if the patient needed even routine testing or lab work, my hands were essentially tied. Now I can order that mammogram or those labs without having to worry about it. That's a big advantage, and something we should keep in perspective."