Of Humpty Dumpty and Obamacare

A friend of mine is a metallurgist who studies structural failures. Buildings that fall, and airplanes that crash, share similar pathways to catastrophe. Small defects, caused by continued stresses, coalesce and eventually lead to total collapse.

Like the Jenga game, the analogy is not perfect, but our healthcare system is in danger of a similar outcome. Continued stress, in the form of financial cutbacks, bureaucratic mandates, government ineptitude, and widespread greed, have caused extensive damage to our healthcare infrastructure.

We are perilously close to the transition point at which our system fails totally. As much as I dislike predictions, a potential scenario is outlined below. Medical care is delivered locally, so I will concentrate on the Los Angeles area. Beware, it could happen in your town.

Jan 2014: Twenty five million Americans are added to the Medicaid roles under Obamacare. Millions of previously uninsured Angelenos, possessing this new Medicaid insurance, swamp doctors and hospitals. California battered by the continued recession, is unable to increase Medicaid funding.

Feb 2014: Faced with a 50 billion budget shortfall, and unprecedented new medical charges, California slashes Medicaid reimbursement to doctors and hospitals. Furthermore the claims overwhelm the outdated computer systems, meaning even these payments are delayed.

March 2014: Surgeons, Oncologists, Obstetricians, and other specialists, faced with draconian fee cuts, and absent or delayed payments, refuse to see Medicaid patients. In response, these patients swamp local and regional emergency rooms, displacing scheduled surgeries and elective hospital procedures on insured patients.

April 2014. Tenant and other private hospital chains, facing the crush of new Medicaid patients and losing money rapidly, close many of their Los Angeles hospitals. County USC, the only remaining emergency room in downtown LA, is soon inundated, wait times go from hours to days. The impact spreads from Santa Barbara to San Diego. Private hospitals are forced to close their emergency rooms, unable to handle the load.

June 2014. The panicked California legislature mandates that all physicians must treat Medicaid patients. In response, large number of doctors retire, and many others go "bare", dropping hospital affiliations and refusing to take insurance, insisting on cash for services. Many doctors open clinics in Mexico, or move offshore to "hospital boats", treating only paying patients. Kaiser and other HMO systems, forced to take Medicaid patients, close all new enrollments. Other private insurance companies, unable to secure contracts with hospitals, stop writing policies in California, forcing more people into Medicaid programs.

July 2014: ER wait times in the remaining hospitals approach days, or even weeks for minor problems. "Tent cities" spring up around emergency rooms, with patient waiting to be seen. Heart and stroke patients routinely die attempting to find an open emergency room

August 2014: Medicare drug price controls have sent drug companies overseas. Many non-generic drugs become scarce or impossible to find. Patients die from treatable infections and cancer due to inability to purchase drugs.

Sept. 2014: Doctor shortages become unprecedented. Wait times for appointments for Medicaid patients are now many months, or years for specialists. Legal challenges prevent the importation of foreign doctors.

Nov 2014: During the flu season, thousands of people, unable to be treated, literally "die in the streets'. Cuba and China offer emergency assistance.

Dec 2014. Obamacare is repealed, but no money is available to start new hospitals. Attempts to increase medical school enrollment are stymied by shortages of teaching hospitals and physicians. Congressional investigations are begun into the passage of Obamacare, alleging fraud on the part of White House staff, my blog readership increases.

All the king's horses and all the king's men Couldn't put Humpty together again.