Dr. Marc Siegal explains some of the problems with a more strict regulatory environment here:
Will the best and the brightest continue to choose medicine as a career? Medical school admissions are down by 6% at a time when the Association of American Medical Colleges predicts a shortage of 160,000 by 2025. And the effective shortage of doctors who will work with Obamacare is far greater. Doctors who are already in practice will drop out of insurances, move to hospitals to work for a salary, or accept cash only. This trend will create a two-tiered system of health care and could be a knife in the back of Obamacare, which relies on physician participation with insurances and its expanded patient load to survive.
Dr. Siegal places blame fairly on both insurance companies and on the government reimbursement scheme. He also explains that Medicaid pays only 56% of what private insurance does, and that Medicare pays 81%.
Query: where are physicians to make cuts? Do we expect them to cut the salaries and benefits of their receptionists, billing staff, and nurses by 19% to 44%? (Is that really a socially desirable outcome?) Will their landlords give them a 19% cut in rent?
Right now, we have a medical system wherein most of the middle class has access to outstanding medical care with very little wait. Anyone who has (as but one example) Harvard Vanguard health insurance can go into MGH and get treated by the same physicians that Adele the British pop singer was treated by — but she’s one of the few Brits wealthy enough to get that quality of care.
The problem with the PPACA is that the care currently available to the middle class will be restricted to the very wealthy. That fits no rational definition of “social justice” (or any kind of justice, unless you’re really into Darwinism).