Actually, this healthcare reform plan will be a windfall for insurance companies. They are vastly expanding their guaranteed customer base, as employers will now have to provide coverage to more employees, while drastically reducing the costs they have to pay to healthcare providers.
My prediction is that we're going to see the emergence of a two-tiered system, in which the vast majority of customers are covered at the bare minimum required by law, with procedures now considered routine only being covered under premium plans (much like dental coverage is now). While I don't think that rationing will be written into the government regulations themselves, I think it will be the healthcare providers themselves who start rationing services. For example, there are no dentists in the La Crosse area who will take the state-sponsored dental insurance for anything except emergencies, because the payouts are so low that they don't even cover expenses, much less pay a profit. With the low payouts being proposed by this plan, I foresee the same thing happening with regular healthcare. Oh, sure, you'll be able to see a doctor at will, but the care you'll actually receive in any given visit will become increasingly minimalistic. Gone will be the days of trying to rule out brain tumors for chronic headaches -- you'll receive a bottle of ibuprofen and be sent home. If you want to receive anywhere close to the level of routine care you're accustomed to, you'll have to buy the premium rider, which will represent a significant out-of-pocket expense.
Another effect of a plan like this will be to darken the face of medicine. Already 70% of doctors taking the USMLE (medical licensing boards) in this country are foreign born, but a lot of those people complete their residencies here and then return to their homelands. With the inevitable suppression of healthcare provider salaries that will ensue from this plan, I think we're going to see a migration out of medicine, leaving a lot of openings for these foreign nationals who might otherwise have returned to their own countries.
Not that this is anything new, of course. Healthcare salaries have been steadily declining not only in real dollars but also in inflation-adjusted dollars for at least a decade and probably longer. A major driver behind this trend has been the massive Medicare/Medicaid reforms that Clinton pushed through Congress in 1998, which significantly reduced federal expenses and helped him to balance the budget. It's not a coincidence that the rise in healthcare costs in this country accelerated immediately after 1998. These reforms significantly reduced Medicare/Medicaid payouts to healthcare providers, forcing hospitals and clinics to drastically raise prices on everyone else to compensate.
Now, with almost everyone on the equivalent of Medicaid coverage, hospitals and clinics will have no alternative but to reduce services and further reduce salaries. When you compare the salaries of physicians today to the equivalent salaries in the 1960s, they're down by almost 50% (in absolute numbers) in many specialties. Now part of this is because specialties like cardiology have moved increasingly away from invasive procedures and thus cannot charge as much anymore, but the reduction in payouts has also played a major role. Many medical schools are now
paying people to go into specialties like neurology if students will contract to stay in the field a certain length of time, because there is currently such a mass exodus out of those fields. It's partly because of declining job satisfaction (long hours, little freedom), partly because of rising malpractice costs, and partly because of depressed salaries. In a lot of hospitals now, physicians are paid minimal salaries, with the majority of their pay coming from billable hours, which has lead to doctors being treated essentially like assembly lines, with patients hardly receiving any true face-to-face time with patients.
People like to say that doctors make too much, but how many of them are willing to put in the long years of schooling required, years in which you have virtually no life, years in which you skip meals just so you can get in enough study time to pass your weekly tests, years of working up to 100 hours/week as a resident for less pay than a construction worker? If salaries continue to decline, how many people will be willing to make the sacrifice required? Before anyone accuses me of being paranoid or sensationalistic, let me point out that doctors across Germany, which has a socialized system of medicine, are currently contemplating a mass strike because they believe their salaries are too low when compared to the rest of the world. If it can happen there, it can certainly happen here.
So yes, there may come a day when doctors no longer make those outlandish salaries so many Americans like to complain about, but it's probable that when that day comes, you'll hardly be able to understand a word those doctors say.
But hey, those insurance companies will be making more money than ever before -- only now they'll have a government-guaranteed income.