re: CBO: GOP health plan would cut deficit $337 Billion

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Contrary to goals, ER visits rise under Obamacare.

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And the main reason for this was not enough primary care physicians, not ACA. Another stubborn fact is that the trend you cite above will only get a lot worse under the Republican plan, since within ten years, 24 million fewer people will have health insurance and therefore will have to use the emergency rooms.

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And why aren't there enough primary care physicians? Specifically enough primary care physicians that take Medicaid?

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That can't be blamed on the ACA. That was a long-existing problem. Healthcare is a complicated issue which Trump is unbelievably just now finding out. So you seem to be okay with emergency room visits likely rising and increasing the costs of healthcare under the Republican plan. Why is that?

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So you seem to be okay with emergency room visits likely rising and increasing the costs of healthcare under the Republican plan. Why is that?

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GOP is not trying to solve the real underlying issues. nothing they are talking about in this bill is about reducing cost of treatment.


and for sure, the 8 or 20 million (something like that) uninsured will go to ER and cost us all a lot more than the ACA does. Penny wise, pound foolish. that's the GOP way.
they are all about appearances.

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A major reason that hasn't happened is there simply aren't enough primary care physicians to handle all the newly insured patients

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There is more to it than simply not enough primary care physicians. Prior to the ACA there was more primary care capacity. The obamacare role out enabled and even encouraged shady ACA carrier activity targeting provider networks with unnegotiated, unannounced rate cuts.

Primary care docs were left in a precarious situation d/t falling reimbursement rates. Falling rates were coupled with overhead practice pressure including ObamaAdmin EMR forcing.

Under the ACA, facilities did much better. Facilities and healthcare systems had long angled to buy up as many primary care practices as possible. Control of PCPs enables direction of referrals to facility assets. As an aside, control of PCPs obviously entails system self-referral, healthcare system monopolies, and higher costs.

The combination of pressured PCP practices with healthcare systems' desire to acquire them, led to a wave of PCPs fleeing risk of private practice ownership, to the shelter of facility employment, and guaranteed salary.

With that change went incentive to see as many patients as possible. In private practice, increased patient volume would have resulted in significant expansion of work weeks, clinic efficiencies, and relative income. The same incentives don't apply to salaried employee MDs. In the employed setting, work weeks not only did not expand, efficiencies waned. Fewer patients were seen. Capacity declined.

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However make no mistake, the main reason for a rise in ED visits is medicaid expansion. There is little medicaid incentive to seek care IAW cost. It shows. Another problem is obamacare policyholders often exhibit behavior identical to the uninsured. Unfortunately obamacare's high deductibles leave folks de facto uninsured. Their behavior matches.

What is the ratio of primary care physicians that nc thinks is sufficient. Certainly not status quo. Your retort is unsupported and unlikely.