By Thomas Mitchell

It’s not a bug. It’s a feature.

Yes, the website is a dud. Yes, people are losing their health insurance plans that they liked. Period. Yes, the prices of new individual policies are 41 percent higher on average nationally and 179 percent higher in Nevada, the highest increase in the nation.

In the first month of ObamaCare, only 513 Nevadans purchased insurance through the Silver State Health Insurance Exchange, while 25,000 had their individual health policies canceled.

So how do you think Barack Obama, Harry Reid and Nancy Pelosi will try to fix the problems? They’ve all said they favor a single payer plan — which eliminates insurance companies and their overhead and profit margins entirely and has the government make direct payments.

Take a hint from an Obama speech in August at a Syracuse, N.Y., high school: “So over the past four years, what we’ve done is to try to take some steps to make college more affordable. First thing we did — we enacted historic reforms to the student loan system.

What was happening was student loans were going through banks; banks were making billions of dollars. We said why don’t we just give the loans directly to the students, cut out the banks, then we can help more students.”
This is how they think: To save billions of dollars give the money directly to doctors, cut out the insurance companies, so you can help more patients. Profit is so vulgar.

According to the Office of the Actuary for the Centers for Medicare and Medicaid Services, doctors are reimbursed by Medicare, federal coverage for those over age 65, at a rate of about 80 percent of what private insurance pays, while Medicaid, federal and state coverage for the poor, pays doctors only about 58 percent of what private coverage does. In many cases that fails to cover the costs.

Some doctors are refusing to take on new Medicaid patients. Nationally, 30 percent of doctors refuse to see new Medicaid patients.

In Nevada, 25 percent of doctors currently refuse to accept new Medicaid patients. Some Democrats are already contemplating a law that would mandate doctors treat Medicare and Medicaid patients.

Medicare reimbursement is as high as it is only because Congress for every year since 2002 has voted for the “doc fix” to stop scheduled decreases in reimbursement. This next year a cut of 27 percent is on the books, unless Congress passes another “doc fix.”

Also, ObamaCare cuts $716 billion from Medicare. It is predicted those cuts will result in 15 percent of all hospitals becoming unprofitable within a decade and 40 percent unprofitable by 2050.

When doctors become basically federal government serfs who must live off whatever Congress and the president decides they are worth, how good will care be?

You might have government “insurance,” but where will you find a doctor?

According to the University of Nevada School of Medicine, 66.9 percent of Nevada’s rural population already lives in a designated Primary Care Health Professional Shortage Area.

While there are 182.2 physicians per 100,000 residents in urban areas of Nevada, there are only 76.5 physicians per 100,000 in rural areas — for a statewide ratio that is 48th worst in the nation.

With the governor’s decision to expand Medicaid, instead of Medicaid covering people up to 87 percent of the poverty level, those making 138 percent of the poverty level will be covered. Currently a family of three with income of $16,000 qualifies for Medicaid, but expanding the coverage qualifies such a family if it earns about $32,000 a year. Medicaid patients aren’t required to make a co-payment for doctor visits.

The state estimates there will 68,000 more people covered by Medicaid in the first six months of next year.
Do you have any doubts that politicians are capable of forcing doctors to take patients at reimbursement rates below what it costs for treatment?

A recent Investor’s Business Daily editorial put it thusly: “If doctors can be forced to participate in a government payment system they don’t want to be in, then doctors are owned by government. Their education, labor and intellects will have been seized by the state. They are no longer free agents — they are serfs, the bondsmen of legislators who will sweat them like galley slaves.”
It’s not a bug. It’s a feature.

Thomas Mitchell is a longtime Nevada newspaper columnist. You may email him at Read additional musings on his blog at