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.