Dr. Nick Riviera Explains Obamacare

Dr. Nick Riviera From ‘The Simpsons’ Explains Obamacare

He graduated from Hollywood Upstairs Medical College, thinks “choc-o-tastic” qualifies as a food group, and has a strange habit of jumping out of windows when called to the coroner’s office. He’s also an animated character, for what it’s worth. So what does Dr. Nick Riviera, Springfield’s resident quack on “The Simpsons,” have to do with Obamacare?

As it happens, plenty. Dr. Nick provides a humorous example of what may happen in future years, as cascading reductions in reimbursements due to Obamacare wreak havoc on our health care system—and could make “doctors” like Dr. Nick the only access option for some patients.

Productivity Adjustments Ahead

Most economists consider health care a superior good. That is, as income rises, people want more of it. Moreover, in many cases patients equate price with quality. People generally want the most, and best, health care money can buy, even if the most expensive care does not always equate to the best care. In Springfield, that high-cost care gets provided by giggling physician Dr. Julius Hibbert.

Obamacare included several major changes to reimbursement systems that attempted to change this drive for more, and more expensive, care, but also included arbitrary payment reductions that will lead to abysmally low payment levels. Most notably, the law included so-called “productivity adjustments” to the Medicare formula for hospitals and other providers, reducing the growth of their payments every year.

The CEO of a major hospital trade association admitted back in 2010 that this trade-off—a one-time increase in insured patients for hospitals in exchange for lower payments from Medicare forever—probably didn’t amount to a great deal for his industry in the longer term. Nonpartisan budget experts agree.

The Congressional Budget Office in September 2016 released an analysis showing the Obamacare productivity adjustments could more than double the number of unprofitable hospitals nationwide by 2025. In the longer term, the independent Medicare actuary believes that the productivity adjustments will become unsustainable. As Medicare payment levels keep dropping relative to private insurance, they will make 70 percent of skilled nursing facilities and 80 percent of home health agencies unprofitable, “raising the prospect of access and quality-of-care issues for Medicare beneficiaries.”

Although set by another formula—one created in 2015 rather than in Obamacare itself—Medicare physician payment rates face the same dilemma, as simulations also project payments to decline substantially over time when compared to other forms of coverage.

‘You’ve Tried the Best—Now Try the Rest!’

Into this payment breach steps none other than Dr. Nick Riviera. In season three of “The Simpsons,” the title family had to rely on Dr. Nick to perform open-heart surgery on Homer. Because Homer’s insurance wouldn’t cover the operation, the family turned to Dr. Nick upon seeing his television ad, in which he pledged to undertake any surgery for the ridiculously low price of $129.95. (“Call 1-600-DOCTORB—The B is for bargain!”)

The following scenes show an inept Dr. Nick attempting to learn bypass surgery on the fly. Only a well-timed intervention from smarty-pants daughter Lisa allows Dr. Nick to complete the surgery successfully, resulting in a happy ending for the Simpson clan.

Coming to a Hospital Near You?

Liberals might argue that this episode makes the case for Obamacare, by preventing the kind of care denials that led Homer to Dr. Nick in the first place. But in reality, Obamacare insurance plans currently provide increasingly narrow provider networks that could impede access to care. Moreover, the law’s productivity adjustments, by making hospitals and other providers unprofitable, will increasingly limit access to care for seniors in Medicare over time.

Democrats claim Obamacare made no changes to Medicare, and that reducing reimbursement levels amounts to no more than cutting “waste” out of the system. “Your guaranteed benefits won’t change,” House Minority Leader Nancy Pelosi argues.

That argument only holds merit to the extent that providers will accept lower and lower reimbursement levels in perpetuity. Medicare could lower payments for all surgeries to $129.95, but I doubt anyone other than our good friend Dr. Nick will perform them at that price.

So the next time Democrats try to argue that Obamacare didn’t harm Medicare, or will have a positive effect on our health-care system, think of Dr. Nick. In less time than you expect, his real-life equivalent could be coming to a doctor’s office or hospital near you.

This post was originally published at The Federalist.

Coming Attractions: Obamacare Goes Hollywood!

Over the weekend, the New York Times reported on California’s attempts to implement Obamacare.  Among other things, the state is looking to build support for the law by hiring a PR firm to engage in some old-fashioned Hollywood propaganda:

Realizing that much of the battle will be in the public relations realm, the exchange has poured significant resources into a detailed marketing plan — developed not by state health bureaucrats but by the global marketing powerhouse Ogilvy Public Relations Worldwide, which has an initial $900,000 contract with the exchange….

And Hollywood, an industry whose major players have been supportive of President Obama and his agenda, will be tapped.  Plans are being discussed to pitch a reality television show about “the trials and tribulations of families living without medical coverage,” according to the Ogilvy plan.  The exchange will also seek to have prime-time television shows, like “Modern Family,” “Grey’s Anatomy” and Univision telenovelas, weave the health care law into their plots.  “I’d like to see 10 of the major TV shows, or telenovelas, have people talking about ‘that health insurance thing,’ ” said Peter V. Lee, the exchange’s executive director.  “There are good story lines here.”

Indeed, there are many good story lines – and television show ideas – from Obamacare.  We have several we’d like to suggest:

“The Office:”  Kathleen Sebelius and federal bureaucrats channel Dwight Schrute in the famous “Health Care” episode, deciding which treatments and diseases will, and will not, be covered under Obamacare.  No word yet on whether Count Choculitis will in fact be considered a covered benefit under the law.

“Lost:”  Instead of being trapped on an island, participants in this series will instead be marooned in a vast federal bureaucracy including 159 new boards, bureaucracies, and programs, along with over 12,800 pages of regulations.  In the pilot episode, thousands of small businesses found that Obamacare’s complex small business tax credit left them stranded and confused amidst a complicated array of paperwork that bogged down their firms – and saw many businesses not qualify for a credit at all.

Nick Riviera, M.D.:”  The networks originally proposed a revival of the popular “Marcus Welby” series.  Unfortunately, due to Obamacare’s unsustainable reductions in Medicare reimbursement rates, Dr. Welby – along with many other medical providers – will soon stop practicing medicine.  As a result, the networks resorted to “The Simpsons’” most famous graduate of Hollywood Upstairs Medical College.  Expect to see members of the medical review board as recurring characters in this show…

“Unhappy Days:”  In this show, Tom Bosley is forced to shrink his hardware store business, as Obamacare’s employer mandate will discourage new employment.  Rather than pay tens of thousands of dollars in penalties, he stops hiring new workers and converts his full-time employees to part-time status.  His workers respond with a single despondent reaction: “Whoa!

Coming soon to a small screen near you!

Obamacare’s Mandate: Worst. Policy. EVER!

So perhaps the title is a slight exaggeration, but nevertheless a recent article by Paul Starr justifies the reference to the catchphrase made popular by Jeff Albertson.  As background, Starr is a prominent liberal who worked in the Clinton White House on the ill-fated Hillarycare proposal (so he knows unpopular and ill-fated policy whereof he speaks).

Starr notes Obamacare’s mandate is 1) politically unpopular, 2) likely to be so weak as to invite non-compliance, and 3) placing the entire statute in danger of being struck down by the Supreme Court.  He calls the mandate “a political as well as a legal miscalculation,” one that “put at unnecessary risk [Democrats’] most significant domestic achievement of the past three years.”  Starr adds that “No other provision could have provided as effective a basis for both the legal challenges to the law and the political campaigns against it.…Public opinion [has been] focused on the least popular aspect of [Obamacare], dragging down overall support and maintaining the high-intensity opposition to the law on the right.”  His ultimate conclusion:

Democrats managed to get themselves the worst possible result: a law that enflames the opposition on the basis of overreaching federal power but may not work in practice because there is no real power behind it.  Whether or not the Court strikes it down, the individual mandate has been one of the most serious political and policy mistakes of recent decades.

Two years ago, former Speaker Pelosi famously said we had to pass the bill to find out what’s in it.  This latest article highlights how even liberals are finding out what’s in the bill, and discovering that they don’t like it either.