For the first time ever, women will have access to even more life-saving preventive care free of charge.....
- Well-woman visits.
- Gestational diabetes screening that helps protect pregnant women from one of the most serious pregnancy-related diseases.
- Domestic and interpersonal violence screening and counseling.
- FDA-approved contraceptive methods, and contraceptive education and counseling.
- Breastfeeding support, supplies, and counseling.
- HPV DNA testing, for women 30 or older.
- Sexually transmitted infections counseling for sexually-active women.
- HIV screening and counseling for sexually-active women.
Now for the phrase "first time ever" one should note that all of the above have been available before just that there was some cost sharing. Cost sharing with the user. Now the user is spreading their costs over everyone, namely the 50% or so of men are paying for what was a cost sharing part before. Yet this is the same ACA which wants to stop PSAs and refuse surgery to men with prostate cancer allowing many to die a painful bone met death.
There are several issue here worth noting:
1. Nothing is free, and when we say it is free we open the door for abuse.
2. The tests mentioned above were always available to anyone, paying or clinic patient. By mandating them it is suspected to up the utilization , increase costs, yes there are costs, and yet not really improve any patient care.
3. HPV and HIV are sexually transmitted diseases. One causes cancer and the other lots of real nasty stuff. The problem is for a sexually active person, protection of some sort is sine qua non, yet testing could become a chronic problem being done periodically and at a significant cost.
4. Gestational diabetes is always a concern in pregnancy and the Oby will or should always be on the look out. Also the expecting mother should be made aware of the signs and respond accordingly. The difference here one supposes is that now it is mandated to be paid for 100% by the insurer.
5. Frankly the real question is what does free mean. Free means that the woman does not pay, but pay what? If the Government or Insurer will pay a physician a fixed amount for ll of the mandated service then will the woman be denied service by a physician because the "free" service payment is less than the costs?
To see what could happen just look at yesterday's CBO release on Medicare. They state:
Medicare’s payment rates for physicians’ services are scheduled to be
reduced by 27 percent in 2013, CBO estimates, under the provisions of
law known as Medicare’s Sustainable Growth Rate (SGR) mechanism. The SGR
mechanism consists of expenditure targets, which are established by
applying a growth rate (calculated by formula) to spending for
physicians’ services and certain related services in a base period, and
annual adjustments to the payment rates, which are designed to bring
spending in line with the expenditure targets over time. In each of the past several years, legislation has been enacted to
override the SGR and to either maintain or increase those payment rates
when they were otherwise scheduled to decrease.
The Medicare payments are estimated to drop by 27% in January 2013. That means that almost all Medicare physicians will be compensated well below costs. Just think of all those additional staff to handle the Electronic Healthcare Record systems. Who will now be paying for them. Mandates for free are increasing while allowed payments decrease.
Frightfully one could see in a generation that medicine will turn into what Public School Teachers are today, overpaid and under-educated. It would then be better to go off to another country, like Canada even!
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