Narrowing the Networks
Although the Affordable Care Act (or ObamaCare, as it was also called) was expected to make health care more accessible for all citizens of the US, it has still brought some problems that needed to be solved. The first conflict between ethics and the healthcare reform is the prescribed narrowing of the networks. The providers are asked by the commercial insurances to grant a smaller charge because it will allow the insurances provide a “competitively priced product” (Hall & Lord, 2014). Providers that do not agree with such policy will be excluded from the networks offered by the insurance companies. Some of the patients may find out that the doctor they have been visiting for years is not on the list of their insurance company. Therefore, not only the patients will be limited in their choice but also the doctors might lose their resident patients and experience serious losses. Moreover, doctors are now dependent on the list of the networks, so if their current place of employment is not included, medical staff can be forced to leave the clinic and try to find a job in a facility that belongs to one of the narrow networks. However, it does not mean that doctors will get the same salary and career opportunities as they had in the previous hospital. The expansion of the narrow networks might lead to a severe competition among private and government insurance exchanges. The providers will have to offer significant discounts, even if they are not advantageous (Hall & Lord, 2014). Thus, the Affordable Care Act aimed to make health care affordable but has created certain limitations to the medical staff and health care providers.
Centralized Control of Medicine in ObamaCare
Another problem that arose after the Affordable Care Act was passed is the control of costs in the hospitals. The hospitals provide a standardized care that is limited to its cost. The doctors have to choose whether they are going to follow the limitations and prescribe a cheaper medicine or offer a more costly treatment that will be suitable for the patient but will not be covered by the ‘bundled payments’ of the Act (Huntoon, 2014). Patients assume that the doctor does the best he can to treat the disease, but in fact, he is limited by the bundled payment and offers only those options that will not force the hospital to pay. Before ObamaCare, the patients were at risk of overtreatment (e.g. when a physician promotes certain medical devices to the patients but has a profit from the sales of these devices); now they have to face undertreatment if the bundled payment is not enough to provide them with the best options (Huntoon, 2014). If a test can be helpful to a patient, but is too expensive to the hospital and is not covered by the bundled payment, the physician will most likely notice that such test is not necessary (Huntoon, 2014). Since most of the doctors are subordinate to the hospital system and not the patient, they may leave the patient under an ‘observation status’ because it allows the hospital charge high outpatient fees that patients have to pay out of their own pockets (Huntoon, 2014). The control of medicine was supposed to monitor the costs, but not force doctors to undertreatment.
References
Hall, M. A., & Lord, R. (2014). Obamacare: What the Affordable Care Act means for patients and physicians. The BMJ, 349(7), 1-10.
Huntoon, L. R. (2014). Obama Wonderland: Independent physicians excluded. Journal of American Physicians and Surgeons, 19(1), 2-4.