Obamacare

In Shocking Development, Patients React Rationally to ObamaCare's New Rules

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This morning's Wall Street Journal has another item for ObamaCare watchers' Who-Could-Have-Predicted?! file:

Patients are demanding doctors' orders for over-the-counter products because of a provision in the health-care overhaul that slipped past nearly everyone's radar. It says people who want a tax break to buy such items with what's known as flexible-spending accounts need to get a prescription first.

The result is that Americans are visiting their doctors before making a trip to the drugstore, hoping their physician will help them out by writing the prescription. The new requirements create not only an added burden for doctors, but also new complications for retailers and pharmacies.

"It drives up the cost of health care as opposed to reducing it," says Dr. Chung, who rejected much of a 10-item request from a mother of four that included pain relievers and children's cold medicine.

As consequences go, this was probably unintended; later in the article, the Senate aide who proposed the policy says he believes it was "not the ideal solution." But it was also predictable, or at least should have been: If you tell people that they can stretch their tax-free spending accounts further with the permission of a doctor, then more people are going to seek the permission of a doctor to stretch their tax-free spending accounts further. For many individuals, it's worth it: All it costs them is a little bit of their time. But it also eats up doctors' relatively expensive time, and, consequently, drives up the overall cost of providing care.

As with the 1099-reporting provision, this was designed mostly as a small revenue raiser; accordin to the Journal, the bill's authors counted on generating about $5 billion over the next 10 years by tweaking the tax break associated with flexible spending accounts. But that fails to account for the trade-off, which is more physician time spent dealing with prescription requests for over the counter drugs. Essentially, the law is forcing the cost of the provision onto doctors, who will now spend more time dealing with a fairly trivial task that shouldn't—and didn't previously—require their attention. That may prove especially problematic given that many expect a significant shortage of primary care physicians in the next decade.

In the grand scheme of things, it's a small part of the law. And I don't think it's wise to act as if the rules governing flexible spending accounts should be set in stone; those accounts were created by government policy in the first place. But the story does suggest, once again, how difficult it is to attempt to micromanage something as complex as the health care sector, and how easy it is for policymakers, in attempting to patch the flaws in old policies, to cause new problems they didn't foresee.

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42 responses to “In Shocking Development, Patients React Rationally to ObamaCare's New Rules

  1. “It drives up the cost of health care as opposed to reducing it,” says Dr. Chung, who rejected much of a 10-item request from a mother of four that included pain relievers and children’s cold medicine.

    It certainly gave much more undue and unjustified POWER to doctors. Talk about unintended(*) (ahem!) consequences!

    (*) More likely very much intended!

    1. Uh, it gives no real additional powers to doctors. They can refuse the prescription, but all that does is mean you can’t apply the cost of the item to your FSA. You can still buy it over the counter.

      What this law was for was to make it harder to apply charges to your FSA. In the past, I used to routinely charge anything conceivable to my FSA–pretty much anything bought in a drug store that could possibly be thought of as “health care”, from prescriptions to toothpaste–and usually got away with it.

      They’re trying to stop that, for some chump change. And of course creating bigger problems.

      1. Re: Episiarch,

        They can refuse the prescription, but all that does is mean you can’t apply the cost of the item to your FSA. You can still buy it over the counter.

        That’s real money, Epi. REAL MONEY. If I cannot apply it on my FSA, I am levied REAL MONEY, MY FUCKING MONEY, on it. That makes the doctors’ refusal detrimental to my income – that’s POWER. Maybe most doctors did not intend or asked for that power, but POWER it is.

        1. Dude, don’t all caps me. Seriously.

          The amounts of FSAs tend to be small, so the monetary effect of this law is minor. Framing it as a money = power issue isn’t really useful here. It’s not that you’re wrong, it’s that the real issue is that once again we have:

          1. Government taxes, burdens people.
          2. To reduce burden, especially among the poor, government makes new rules instead of reducing burden.
          3. People figure out how to exploit new rules.
          4. Government tries to plug holes in old rules with new rules.
          5. Unintended consequences occur, including people once again figuring out how to exploit the new rules.

          1. Epi, I am pointing out one of the unintended consequences you mention: The fact that doctors have now MORE power over people’s purchasing decisions, all in the name of “plugging holes.” The rules could be tightened by simply mandating FSA managers not to accept anything beyond medicines, medical monitors, first aid items, prescription drugs and medical services for FSA reimbursement. Instead, what government did was to give doctors the power to DENY the possibility of reibursement of YOUR OWN MONEY whenever doctors feel like it! Isn’t that unduly giving doctors power over your money?

      2. You mean, before the law, doctors weren’t allowed to refuse to give prescriptions?

        1. Re: jacob,

          You mean, before the law, doctors weren’t allowed to refuse to give prescriptions?

          I don’t think you understand the point, jacob – and neither does Epi, it seems.

          If you were made to go to a doctor to receive a note to buy a CAR, and the doctor can REFUSE to write you a prescription for a CAR, would you still say “Oh, the law previously allowed them to refuse prescriptions”? Or would you agree that, all of a sudden, doctors have now MORE control over what you BUY?

      3. Epi, there’s a much easier fix. My FSA requires me to fill out a line-item claim, and to provide a copy of the receipt. My pharmacist obliges this with a simple soft-ware change in their system. It flags anything on the receipt that is FSA elegible.

        1. Now if you can find your way to ignoring my grammatical and punctuation errors, we’re all set…

  2. And I don’t think it’s wise to act as if the rules governing flexible spending accounts should be set in stone; those accounts were created by government policy in the first place.

    They were created to keep a bit more of OUR GODDAMNED FUCKING MONEY in our pockets, Mr. Suderman.

  3. You only get 5 grand tax free though. But it is a 2-way shelter so I guess every little bit counts.

  4. As with the 1099-reporting provision, this was designed mostly as a small revenue raiser; accordin to the Journal, the bill’s authors counted on generating about $5 billion over the next 10 years by tweaking the tax break associated with flexible spending accounts[.]

    “Daddy, daddy, what’s the difference between in theory and in practice?”
    “Well, to illustrate it, ask your mother and sister if they would sleep with George Clooney if he offered them a million dollars each.”
    “Sis, sis! Would you sleep with George Clooney if he offered you a million dollars?”
    “Well, he’s kind of old and stuff, but I would do it!”
    “Mommy, mommy! Would you sleep with George Clooney if he offered you a million dollars?”
    “Why, of course! George Clooney, are you kidding? I would!”
    “Daddy, daddy! Mommy and sis said that they would!”
    “Well, son, in theory, we have ourselves 2 million dollars. In practice, we have ourselves a couple of whores in the house!”

    Same with this “we counted on” shit.

    1. cute story, but aren’t they whores in theory since they didn’t do it?

      1. I would say they are unsuccessful whores. They apparently are offering their services for money, but just haven’t found any takers. Yet.

  5. The cost isn’t just the doctor’s time. The docs are going to bill that as an office visit, so the cost of health care goes up, and premiums will go up, as a result of this asinine rule. Remember:

    Foreseeable consequences are not unintended.

    Seriously, how stupid would you have to be to miss this one? When I saw the new rule, the very first thing I said was “Well, that’s going to be a hell of a lot of doctor visits for no good reason.”

    1. ^THIS^.

  6. We obviously need to institute price controls on pharmacy items that aren’t covered by prescription to ensure their affordability.

  7. But the story does suggest, once again, how difficult it is to attempt to micromanage something as complex as the health care sector

    You understand this, I understand this, everyone here except Tony understands this. But the reality of the situation is that the vast voting public wants the government to micromanage the healthcare sector. The difference between Democrat, Republican and independent voters is merely over who gets to do the micromanaging.

    1. I doubt the voting public wants to the government to micromanage the health sector as much as they want someone else to pay for their healthcare.

  8. Threadjack: In other shocking news, Del Toro’s movie version of At The Mountains of Madness just got cancelled by Universal. Universal felt a PG-13 version would be more appropriate for a big-screen version of the H.P. Lovecraft novella. http://www.salon.com/entertain…..index.html

    PG-13 and Lovecraft. I have no words…

    1. Ooo, I wonder if they’ll add a wisecracking computer animated sidekick too…

    2. FUUUUUUUUUUUU…..

  9. “But it was also predictable, or at least should have been: If you tell people that they can stretch their tax-free spending accounts further with the permission of a doctor, then more people are going to seek the permission of a doctor to stretch their tax-free spending accounts further.”

    I see it from the other direction–I didn’t think they were letting people save money by using their tax free spending accounts…

    I thought they were trying to stop people from using their tax free spending accounts for medication that’s available without a prescription.

    1. I thought they were trying to stop people from using their tax free spending accounts for medication that’s available without a prescription.

      But sometimes you can treat the same condition either with OTC medicine or prescription medication. The government has now created an incentive for people to waste doctors’ times and to prefer more expensive prescription medication rather than use just as good OTC medicine.

      More expensive for everybody else, but cheaper for the individual. That’s bad regulation.

      It doesn’t matter what they were “trying to do.” You would have to be an idiot not to foresee this consequence happening.

      1. Not to mention that when prescription medications go off patent, suddenly they’re safe to use in low doses without a prescription!

        In anti-acids alone, I’ve seen several that used to only be available with a prescription become available in the drug store aisle without one–once they came off patent.

        It’s absurd to me that a medication without any psychoactive component isn’t available over the counter. Make the pharmacist go over the warnings if they must–but if zantac wasn’t safe enough to be used without a prescription before, why is it okay now?

        1. Last year I went on a trek in the hill country of northern Thailand. I had a small accident that resulted in lacerations on my shin. Despite first aid, a few days later, when I got back to Chiang Rai, the wound was swollen with a nasty infection.

          To fix this up, all I had to do was go to the pharmacy to get the medicine that was obviously necessary. I showed the wound to the pharmacist, and she recommended an oral antibiotic and a local antibiotic ointment. Total cost: about $12. Time elapsed: about 30 minutes, including travel time.

          Compare with the US. First one has to go to a doc-in-a-box. Cost: about $150. Time elapsed: probably about 2 hours, about 3 minutes with a MD, 5 minutes with nurse getting blood pressure checked, etc., an hour or so in the waiting room and 30 minutes in travel time.

          Then, it’s off to the pharmacy. Cost: around $50, maybe less. Time elapsed: about an hour in waiting for the fill and travel time.

          So, in the US it would take about $200 and three hours of patient time to accomplish what in Thailand takes about $12 and 30 minutes.

          But it gets worse. The poor soul that can’t pay up at a doc-in-the-box goes to the hospital emergency room instead. He doesn’t pay for anything, but I get the pleasure of paying his astronomically expensive ER services on April 15. Even though he’s not paying, the ER derelict will probably have to wait several hours in triage before seeing a doctor. Which is the level of service, of course, we can all expect in the brave new world of ObamaCare.

          Oh, by the way, the Thai pharmacist did ask about allergies and caution regarding side effects as well or better than any US MD I’ve ever encountered.

          1. To dogpile onto your comment Cato, it’s the same way for veterinary care in the U.S. I need a prescription in order to purchase antibiotics for my pet. My pet. IOW, personal property. If they’re worried about me using the stuff on myself or other people, get me to sign a release of liability, but forcing me to get a script is absolutely asinine.

            Of course, the tort environment in Thailand is probably considerably different than it is in the States…

    2. Given the general hostility of health policy people and government to these types of accounts, I also read those comments this way.

      1. Yeah, that was part of their solution…

        We have to find ways to make people pay more for prescriptions–so that others can get them for less!

        It’s a shell-game, and it’s all of us that were being conned.

    3. I thought they were trying to stop people from using their tax free spending accounts for medication that’s available without a prescription.

      They were, but they botched it, and created an incentive to have more (expensive) doctor visits, instead. Morons.

  10. But the reality of the situation is that the vast voting public wants the government to micromanage the healthcare sector.

    I’m not so sure. Outside of the policy hacks playing for Team Red or Team Blue, I would guess the average person just wants to do know that they’ll be able to get decent, affordable care when they need it. I would also guess the average person is pretty skeptical of the government’s ability to take that over without massively fucking it up.

  11. Of most note is the fact that random congressional aides can just think up stuff and enact it into law without even going to the trouble of getting a friendly think tank to gin up a ridiculously biased study.

    Of course there was never any chance that the People’s House might have consulted the people or that the World’s Greatest Deliberative Body might have actually deliberated on this issue.

    1. I am surprised this wasn’t commented on sooner.

      Perhaps it should be required for all laws to be handwritten on the house floor by the bill’s sponsor? At least that way we wouldn’t end up with 2000 page bills that no one know can explain the contents of.

  12. I’m not sure this is rational. Even the doctor I would use costs nearly $50/visit, and with a 10% copay would still be more than the tax savings on the over the counter drugs.

    The smart thing would be just to pay the tax and deem oneself to be healthy.

    This seems just like a particular case of irrationality.

    1. you aren’t wrong, but the next time I really do need to go to the doctor, you can bet your sweat butt I’m bringing a list of things I want him to write a script for.

  13. We couldn’t have known that was in there.

    I am serious, we literally couldn’t have known.

    We hadn’t passed it yet.

    Seriously.

    1. Shut up, hag.

    2. Then, how did you know whether the bill was Constitutional?

      Seriously.

  14. Dan, no one goes to see the doctor, they call the office and the assistant has the doc sign scripts for them. Then the patient goes and just picks up the script. It’s not a full 30 minute appointment, but maybe 5 minutes of the docs time. But that is 5 minutes for almost each patient at this point.

    A friend’s doctor gave her a script for time release tylenol since she has rheumatoid arthritis.

  15. Fuckin’ retards, the whole lot of them.

  16. Dan, no one goes to see the doctor, they call the office and the assistant has the doc sign scripts for them.

    That depends on the doctor. Many doctors won’t write any kind of script without a patient encounter.

  17. Aw shucks, call me anytime.

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