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25 or so – Unintended Consequences of Healthcare Reform

Protean, Pervasive, Prolonged and Painful

By Dr. David Edward Marcinko; MBA, CMP™


Definition of the Term

Much like the physical laws of nature, action begets consequences, which are usually known, unknown or disregarded by human foibles.

According to Robert Norton, the law of unintended consequences, often cited but rarely defined, is that actions of people—and especially of government—always have effects that are unanticipated or unintended. Economists and other social scientists have heeded its power for centuries; for just as long, politicians and popular opinion have largely ignored it.

My List

And so, regardless of your political affiliation or opinion on healthcare reform in America, passed on March 21 2010 [Patient Protection and Affordable Care Act], there is a plethora of unintended consequences with the [any] new law. So, please indulge me in a bit of healthcare administration prescience:

  1. Healthcare costs will be shifted to doctors in the form of lower reimbursement with higher practice overhead costs for private physicians, and with fewer office employees and more ancillary business and service line extensions.
  2. Hospital based physicians like pathologists, radiologists, anesthesiologists, emergency department doctors and hospitalists will demand, and receive, higher salaries.
  3. Fewer [under populated] primary care physicians with more [over populated] PAs, nurse practitioners and DNPs; with a blunted medical establishment oligopoly.
  4. Higher health insurance costs for employers and most patients, especially young adults without a commensurate increase in aggregate risk.
  5. Medical care access impediments for most Americans, but improvements for those previously uninsured.
  6. Health 2.0 electronic connectivity for the masses with medical data “internet-neutrality”.
  7. Continued rise of evidence based medicine and crowd-sourced healthcare information.
  8. Higher costs for DME, instruments and drugs; particularly in the filed of human genomics and personalized pharmaceuticals.
  9. Increased acceptance of MSAs, HSAs, concierge medicine, private-pay and other direct cash payment methods for medical care.
  10. Realization that eMRs do not improve patient care or reduce costs as “meaningful use” is diluted.
  11. An enterprise wide health data breach of epic proportions, with in-numerable smaller security breaches despite the HIPAA laws.
  12. Long term macro-economically induced national inflation with weakness in the US dollar
  13. Poor quality digital manipulation of medical information with eMR specific inflation due to ARRA and HI-TECH.
  14. Increased national unemployment with widespread underemployment for some Americans.
  15. Modified value added taxation in addition to increased federal tax brackets, rates and related others.
  16. Promotion of outcomes reimbursement models, values based healthcare [episodes of care] and various micro-capitation derivatives.
  17. Many more community hospitals, which lost 12 cents/dollar spent on Medicare and 35 cents/dollar on Medicaid patients last year, will close.
  18. Medicare will become the defacto health insurance, much like public housing, food stamps, the USPS and public transportation. 
  19. There will be fewer viable alternatives to commercial health insurance, other than Medicare and Medicaid, since the antitrust exemption for health insurers was not repealed.
  20. The impact of changing to ICD-10 for medical records coding and billing, will be as significant across the industry, as was Y2K and will push many other HIT projects to lower priority.
  21. New HIPAA 5010 requirements will present substantial changes in the content of the data submitted with claims as well as the data available in response to electronic inquiries.
  22. The Obama health insurance “police” program will be a policy failure, but a  job creator.
  23. Medical practices, often a doctor’s largest financial asset, will go down in value jeopardizing personal retirement plans.
  24. Medicine’s lost professional status will become complete as healthcare becomes commoditized and future grass-roots caregivers are neutered.
  25. Your 2 cents here.

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In order to be politically correct – not a known trait for me – I will adopt a scientist’s perspective and omit any value judgment regarding the above [positive or negative] unintended consequences.



And so, your thoughts and comments on this ME-P are appreciated. 25 consequences not listed? Add your 2 cents. What else can you think of? Am I correct, or not, and how do you feel about the above?

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