Audits and investigations into the effects of ObamaCare from congressional committees, government auditors, advocacy groups, and others.

“In 2012, Obamacare will create the ‘Value-Based Purchasing Program’ in Medicare. Using a pay-for-performance scheme, the program will reimburse hospitals and other health care providers at different rates based on how they score on performance measures chosen by the Secretary of Health and Human Services. Proponents of pay-for-performance see it as a way to use financial incentives to streamline and improve the quality of health care while attempting to reduce costs. But the fact is that standardization of the practice of medicine costs patients and physicians tremendously, and evidence shows it does very little to improve health outcomes.”

“It is an occupational hazard for politicians to think that they and their ilk know best, and by all indications Mr. Obama rather likes centralization. In my professional lifetime in the centralized British health-care system, however, I have seen a hundred schemes of cost reduction, but I have never seen any reduction in costs, or at least any that lasted more than a few months. I can’t remember a single health minister who did not promise more efficiency at less cost, or a single one who actually managed to achieve it.”

“The time has come for a long-overdue, honest discussion on not just the impact that government will have on patients, doctors, and the practice of medicine, but the impact it already has had over the past forty-five years. The importance cannot be undersold as the Patient Protection and Affordable Care Act is indeed bad for doctors, but it is always the patient that suffers the most.”

“The Patient Protection and Affordable Care Act (PPACA) creates federal ‘accountable care organizations’ (ACOs). In theory, ACOs provide financial incentives to health care organizations to reduce costs and improve quality. In reality, given the complexity of the existing system, ACOs will not only fail; they will most likely exacerbate the very problems they set out to fix. ACOs will concentrate more and more power in fewer and fewer organizations, allowing them to become ‘too large to fail.’ Such a system undermines competition and entrepreneurship—the bedrock of innovation and job growth in this country.”

“Mr. Obama wants to expand the power of the 15-member panel, which was created by the new health care law, to rein in Medicare costs.
But not only do Republicans and some Democrats oppose increasing the power of the board, they also want to eliminate it altogether. Opponents fear that the panel, known as the Independent Payment Advisory Board, would usurp Congressional spending power over one of the government’s most important and expensive social programs.”

“The fact of the matter is that IPAB won’t make the notoriously inefficient Medicare program any more efficient. Through arbitrary reductions on payments to providers, it will simply reduce the supply of care. Even before the advent of a new, more powerful IPAB and a new, tougher limit on spending, Medicare’s chief actuary warned that ObamaCare will drive providers out of the program. If you love Medicaid, you’ll adore the new IPAB version of Medicare.”

“The Department of Health and Human Services has released draft rule that governs Accountable Care Organizations. ACOs are groupings of health care providers who join together under specific rules in order to create shared savings. The idea is to bundle a single payment for a patient so that providers do not have incentives to prescribe additional services that generate additional fees. This sounds like a relatively simple concept, and it is worth exploring different ideas for needed payment reform. But the truth is, changing payment systems is far from simple. The devil is in the details about the ‘specific rules’ that define an ACO’s structure.”

“Obamacare is already exacerbating some of the current trends in American medicine that work against the interests of patients. Paramount among them is an erosion in the quality of the nation’s doctors. If unaddressed, America’s heyday as the world leader in the practice of medicine could draw to a close.”

“In 2009, using a PPACA-adjusted MLR
definition, we estimated that 29% of insurer-state
observations in the individual market would have
MLRs below the 80% minimum, corresponding to
32% of total enrollment. Nine states would have
at least one-half of their health insurers below the
threshold. If insurers below the MLR threshold
exit the market, major coverage disruption could
occur for those in poor health; we estimated
the range to be between 104,624 and 158,736
member-years.”

“Every year, thousands of people make a deal with their doctor: I’ll pay you a fixed annual fee, whether or not I need your services, and in return you’ll see me the day I call, remember who I am and what ails me, and give me your undivided attention. But this arrangement potentially poses a big threat to Medicare and to the new world of medical care envisioned under President Barack Obama’s health overhaul.”