How Obamacare Tempts Doctors To Cut Corners
Paul Hsieh, MD, writes at Forbes:

ObamaCare ... creates new conflicts of interest for physicians. One of the primary goals of ObamaCare is to control health costs (i.e., "bend the cost curve downward"). Under ObamaCare, doctors will face increasing incentives for undertreatment rather than overtreatment.

For example, ObamaCare includes pilot programs to replace the current fee for service model with "bundled payments." Hospitals and doctors would receive a fixed sum for treating a patient's condition (e.g., pneumonia or stroke), regardless of what it costs the providers. If the hospital and doctors treat the patient for less than the bundle, they keep the excess. But if their costs exceed the bundled payment, they must absorb the loss. In theory, bundled payments eliminate incentives to overtreat patients. But they can also create dangerous incentives to undertreat.

A hospital administrator might ask a physician, "Does Mrs. Smith really need the stronger, more expensive antibiotic that covers 99% of the bacteria? Or can she get by with the cheaper drug that only covers 85%? We've already burned through her bundled payment for this hospital admission, so anything we do now comes out of our pockets!"

I'm a bit of an odd duck -- as a person and as a patient. I lost some cognitive abilities (suffering diminished memory, for example) for three weeks following the anesthesia for an endoscopy. Am I just going to be given the "standard" care for everybody? It would seem very possible.

Hsieh offers some protective measures patients can take:

Patients can ask their doctors if they have any incentives to limit their care (just as they can ask if their doctors have any incentives to favor particular treatments or tests).

Patients should also consider paying cash when appropriate. New federal regulations allow patients who pay cash to request that the details of their medical care not be sent to insurance companies. This frees your doctor to concentrate on doing what's best for you without worrying that his treatment decisions might skew his practice statistics.

Some patients may also benefit from "direct pay" or "concierge" practices outside the standard insurance system. This allows the doctor to work for the patient, without interference from the government or government-controlled insurers.

This sure wasn't the Obamacare we were promised -- the need to interrogate doctors to prevent our getting skeeved by them, the need to do tricks to preserve our privacy, and the need to go outside the system to get adequate care.

But it was absolutely to be expected. Anyone who is surprised about this is too naive to be voting.