As of February, 2010, there are at least four wells that have produced > 500,000 barrels of oil:
Behr 34: 500,725 bbls in 591 days
Austin 28: 504,554 bbls in 517 days
Austin 21: 514,353 bbls in 522 days
Chandler James: 500,234 bbls in 484 days
As a reminder, 500 days = 16 months; that's barely more than a year. Bakken wells will certainly produce for seven (7) years and I most will last much longer with pumps, work-overs, re-fracks, etc. BEXP says Bakken wells will be economical for 39 years (corporate presentation, August, 2010).
The Austin 28 is now producing over 1,000 bbls/day after getting a submersible pump in December, 2009. At $50/bbl, that's $1.5 million/month at the wellhead.
The Chandler James and the Behr well are still flowing according to the posting, referencing the NDIC website. Wow!
The PetroHunt USA 2D has produced 933,366 bbls and is still producing 586 bbls/day well into its third year of production. 1 million barrels = a minimum of $40 million at the wellhead.
A few points:
1. Oilmen are optimistic and always looking to the next well. I don't think they think much about wells that have already been drilled. They are only looking for cash flow to drill that next well, hoping for a game changer.
2. In the old days in North Dakota, I remember a lot of "dry" wells. I don't see many dry wells in the current boom. Even poor wells (not "uneconomic" and abandoned wells) produce some cash flow. Wells that are only producing 300 barrels/day (about $0.5 million at the wellhead) are reasons for yawning.
3. As one can see by the "monster wells" above, one well can pay for a lot of future drilling with one great well.
Williston Basin Pipeline Company (a subsidiary of MDU) announced today (May, 2010) plans to expand its existing natural gas pipeline capacity by approximately 33 percent in the Bakken production area in northwestern North Dakota. The proposed expansion would add up to 30 million cubic feet per day to existing volumes from the Bakken production area for delivery to Northern Border Pipeline. The expansion project is expected to begin November, 2011. (The URL suggests this link my break or point to another story in the future.)
The price of natural gas is very, very low, but yet I keep seeing many, many stories on activity in the natural gas arena.
It doesn't take a rocket scientist to see that there are some folks that think investing in natural gas "today" is going to pay off nicely in the future.
Some things to consider:
1. No matter how much folks talk about "green" power (wind and solar), the fact remains, both of these "renewable" sources will play a marginal role in energy production in the US for the next several decades.
2. That leaves two choices: carbon and nuclear. The carbon choices are coal, natural gas, and/or oil. Without political intervention, coal would remain the least expensive, but sooner or later, the odds are that coal will become more expensive. Oil is good for transportation but it's not going to be used to generate electricity. That leaves natural gas and nuclear energy to generate electricity.
3. The current administration backs increased nuclear power and there are big players advocating nuclear power. These big backers include Bill Gates and General Electric. So, one would think that the expansion of nuclear power is a no-brainer. But the American public is skittish and unpredictable. It's one thing for an oil rig in the Gulf of Mexico to implode/explode resulting in a catastrophic oil spill; it's another thing for a nuclear power plant to implode/explode resulting in a catastrophic nightmare. And that's the rub.
4. US electricity needs will continue to increase over the next decades, partly because of the electric cars about to hit the market. Something is going to be needed to generate that electricity, and there appear to be some folks who think it will eventually be natural gas.
On a completely different note regarding the increased natural gas activity in North Dakota. It has been common practice for oil companies to flare off natural gas in North Dakota. I believe I read somewhere a year or so ago, that North Dakota ranked #1 among states, and western nations, in flaring of natural gas. The state finally stepped in and mandated that oil companies limit their oil production from any well flaring natural gas, until the flaring was eliminated or minimized. Obviously this regulation requires that natural gas pipeline capacity be increased. Obviously the regulation plays a role, but I still think there is more going on in the natural gas arena than meets the eye.
Final comment: This really is a big deal. One starts to get used to all these press releases, it is easy to lose sight of the big picture. In this case, Williston Basin Pipeline/MDU says it currently transports 90 million cubic feet per day, and this expansion will be another 30 million cfpd. I can't deal in large numbers but if I had $90 to spend and someone said they would give me another $30 that's a huge amount. And it appears that this increase capacity should be accomplished with relatively little effort. I would assume most of the environmental impact statements and rights-of-way will be easy to complete.
The Components of ObamaCare [Initially posted September 27, 2013 as details started to become clear] There are three components of ObamaCare: employer mandates, individual mandates, and everything else (hidden taxes and fees) Employer mandates:
delayed for one year; delayed until 2015
cost-shifting began in late 2013; employers moving employees to exchanges
Individual mandates:
One can start to see how ObamaCare is going to turn out exactly like Solyndra.
1. The individual mandate -- the cornerstone of ObamaCare -- will be provided by the "on-line exchanges."
2.
None of the large, well-known health insurers will be participating in
these "on-line exchanges." Small, under-capitalized, unknown companies
will run these "on-line exchanges." Many of these companies will be
start-ups with minimal, if any, experience in health care insurance.
3.
These exchanges will offer very low premiums for insurance that meets
the minimum standards mandated by ObamaCare. My understanding is that
some premiums will be as low as $5.00/month (posted with link earlier).
Of course, these policies will have huge out-of-pocket expenses:
co-pays.
4. The large insurers say they will not support the
"on-line exchanges" because they will be inundated with applications
from those with pre-existing conditions and open-ended demands for
psychiatric care.
5. It is my understanding that ObamaCare does
not allow insurance companies to set an upper limit for lifetime claims.
If that is true, the under-capitalized, small companies are at risk for
large claims that won't be offset by the number of folks they would
need to sign up who have minimal claims.
6. It took two to five
years for the DOE-backed "Solyndra" companies ("the list of 38") to go
bankrupt. We will see the same thing with the "on-line exchanges." A
lot of federal money will be provided these small, under-capitalized
companies, but over time, they will run into financial difficulties, and
gradually disappear. [September 16, 2014: CNBC is reporting -- exactly what happened in Minnesota.
PreferredOne, the insurer that sold nearly 60 percent of all
private health plans on Minnesota's Obamacare exchange, on Tuesday said
it would leave that marketplace. PreferredOne's plans were the
lowest-cost options on that exchange, known as MNSure.
PreferredOne cited the costs of doing business on
MNSure as the reason for its surprising decision, saying that selling
plans is "not administratively and financially sustainable going
forward." In other words: bankrupt.
Health Exchanges
Those "health exchanges" we are hearing so much about? They are nothing more than "websites." Bloomberg says it's about time states get "on board." But yet, HHS hasn't even provided specific guidelines regarding the websites:
The exchanges will basically take the form of websites,
designed to lead people through the process of selecting an
insurance plan, based on price and coverage. In the process,
users will be able to determine whether they qualify for
subsidies or for Medicaid. (The existing Massachusetts Health
Connector is a model for what most exchanges are expected to
look like.) To design and plan such a website doesn’t require
knowing, as McDonnell demands, for example, how the federal
government will manage pools of high-risk patients. [Really?]
It’s true that HHS delayed until this week issuing guidance
on the benefits that insurance plans will be required to
provide. It’s also true that the department was a little slow to
come out with its rules on enrollment periods, rate increases,
catastrophic-care plans and the ways in which premiums can vary.
It’s eminently possible that these delays were attributable to
politics (that is, a presidential election). Yet this
information has arrived in plenty of time; the plain fact is
that states didn’t need it in order to decide whether to go
ahead with an exchange. [Really?]
At this point, a state that has done absolutely nothing to
prepare probably has too little time to create its own exchange
before October 2013, when HHS says it must be ready. Still,
there is time enough to join in partnership with HHS; the
deadline for deciding to do that is not until mid-February. In
such partnerships, the federal government could provide the
information technology, while the states would work with
insurance companies on plans and provide guidance for residents.
If everything is so easy, and everything is so straightforward, a) why has HHS not published the guidelines; and, b) why are Illinois and Ohio partnering with the Federal government. An "exchange" is simply a webpage, according to Bloomberg.
Federal exchanges: due to time constraints (they need to be in place by October, 2013, less than a year from now), the industry will sort this out for the government. Federal exchanges will be folded into the DOD health care program, Tricare. Humana will be one of several huge winners. Posted November 28, 2012.
Only 15 states opt for state-run exchanges, December 13, 2012. Link to CNBC. Two less than reported November, 2012. This is going to be one huge mess. -- December 13, 2012. By the way, the "exchanges" are simply websites telling folks which insurance programs meet ObamaCare criteria. The federal government has not posted its own exchange as of this date. Four states will partner with the federal government, two more than in November, 2012.
Exchanges (as of November 12, 2012, with changes highlighted in bold)
State exchanges: California, Colorado, Connecticut, Hawaii, Idaho (see below, rejects Federal exchange), Iowa, Kentucky, Maryland,
Massachusetts, Minnesota, Mississippi, Nevada, New Mexico, New York,
Oregon, Rhode Island, Vermont and Washington. (as of November, 2012)
No-state exchanges (defer to the federal exchange): Alabama, Alaska, Georgia, Indiana, Kansas, Louisiana, Maine, Missouri,
Nebraska, New Jersey (see December 6, 2012, note below), North Dakota, Ohio (see below), Pennsylvania (see December 13, 2012 entry below); South Carolina, South Dakota, Texas,
Virginia, Wisconsin and Wyoming. (as of November, 2012) Partnership exchanges with the federal government: Illinois (as of November, 2012); Ohio (see November 16, 2012 entry below). Undecided about exchanges, state vs federal government: Arizona, Arkansas, Florida, Idaho (see below, rejects Federal exchange), Michigan, New Hampshire, Oklahoma, Pennsylvania (says "no'; see December 14, 2012 entry below), Tennessee, Utah and West Virginia (as of November, 2012)
Medicare gutted by ObamaCare:
Spin
It's such a great program, we're going to delay it for a year. -- July, 2013
It's not just UnitedHealth Group that is having very serious red ink problems over Obamacare.
Goldman Sachs
just reported that the thirty not-for-profit Blue Cross plans are
expected to lose money as a group for the first time since the
1980s—with the Obamacare exchanges being the key driver.
Already, 12 of the 23 Obamacare created
health insurance co-ops have become insolvent with almost all of the
rest losing money—100 percent of their business is Obamacare business.
The Obama administration itself has
reported that in its risk corridor reinsurance program, the carriers
losing money are doing so at a rate eight times larger than the few
carriers that are making money.
The head of California's Obamacare exchange says the U.S. Supreme Court
risks setting a "horrible moral precedent" if it strikes down health-law
subsidies across much of the country.
Peter Lee, executive director of Covered California and a former
Obama administration official, said a court ruling against the
Affordable Care Act "signals that subsidies don't matter."
"I
think it would set a horrible moral precedent if the Supreme Court was
to find that we can leave Americans without that financial leg up," Lee
said in an interview. "I think it’s a fundamental flaw to not understand
how every American needs a leg up."
A court ruling against the
Obama administration in the King vs. Burwell case would have no
immediate effect on Covered California and its 1.2 million consumers
receiving subsidies because it's a state-run marketplace.
June 10, 2015: the tea leaves are swirling. There are two questions with regard to the ObamaCare case before the Supreme Court: when and what. When will the court release its findings? What will the court say? My earlier posts have always been that the best outcome would be to throw the case back to Congress. Now, at 11:40 a.m. today we get this story from Fox News: SecHHS says the same thing: if the Supreme Court rules "against" ObamaCare, it's back to Congress to fix it. That story answers the two questions. The court will rule 6-3 against ObamaCare, and the Supreme Court will release its decision NLT Friday evening, 5:00 p.m. EDT, this week.
June 10, 2015: with regard to the ObamaCare before the Supreme Court right now, the court should call Congress' bluff -- send the law back to Congress saying they have six months to "fix those four words, make their intention clear, make the law clear" or the court will scuttle the federal exchanges. Give Congress six months to fix the law the way they want it. My hunch is the GOP would support Mr Obama.
June 10, 2015: knowing that the Supreme Court has already made their decision on whether the Federal exchange is legal based on four words in the ObamaCare law, we are seeing more and more articles trying to read the tea leaves to see how the Supreme Court will rule. I was almost ready to write a similar post as this WSJ op-ed that was posted today.
Does the White House think it is going to lose this year’s big
ObamaCare subsidy case at the Supreme Court? We’re beginning to wonder
given President Obama’s increasing show of pique when he talks about the law.
On Monday in Austria, Mr. Obama responded to a question about the looming decision in King v. Burwell by treating the Supreme Court like first-year law students for even considering the case.
“There is no reason why the existing exchanges should be overturned
through a court case. It has been well documented that those who passed
this legislation never intended for folks who were going through the
federal exchange not to have their citizens get subsidies,” Mr. Obama
averred. That conveniently ignores comments by ObamaCare architect Jonathan Gruber, but the President kept rolling.
October 17, 2013: 99.6% of those who visit, do not enroll. Of those who enroll, the vast majority will NOT purchase an insurance plan. Of those who do purchase an insurance, most will have cancer, AIDs, or AIDS-equivalent medical expenses. Of those who are healthy and do purchase an insurance program, most will drop out after two or three months because of high co-pays or high deductibles.
October 16, 2013: three insurers offer on-line ObamacCare enrollment in North Dakota. As of yesterday, only two have enrolled with one of the three insurers; none for the others. Insurers say they are not worried. It's early in the process.
October 4, 2013: there are a lot of story lines in this article about a man signing up for ObamaCare; he's 28, healthy; earns $20,000/year. The monthly premium: $214. Government pays $150; he pays about $65/month. Something tells me he won't pay the second premium and will drop out. The math, for him, doesn't add up. $20,000/12 = $1800/month. I'm not sure how he gets around LA without a car. If he is actually paying for rent in Los Angeles he must be living in a dump. But the good news is that $20,000 a young, healthy male with no family can survive.
September 18, 2013: seniors turn on ObamaCare. They want it repealed. Just remember that the organization that represents all seniors, the AARP insurance company, was a strong, strong supporter of O'BamaCare. AARP members might want to let AARP know how you really feel.
The predictions and fears of the Affordable Care Act’s adversaries
have begun to materialize, specifically fears that the law will
encourage employers to demote their employees to part-time positions in
order to evade federal health care requirements. Popular clothing
company Forever 21
is the first of what might be many companies to limit its
non-management workers’ hours to 29.5 a week, just below the 30-hour
minimum that the ACA deems full-time work.
Explaining that the company “recently audited its staffing levels,
staffing needs, and payroll in conjunction with reviewing its overall
operating budget,” Associate Director of Human Resources Carla Macias informed employees that effective August 31, they will no longer be full-time employees of Forever 21.
August 19, 2013: the president has essentially blown off O'BamaCare: waiving, delaying; and now it's reported that the White House has missed more than 50% of the law's deadlines. I don't know if this is how all presidents have worked, but it is clear that this president broke the code -- Presidents can do what they want; they won't be impeached for failing to uphold laws that the public doesn't like.
NBC News contacted around 20 small businesses and other entities for
this report and found that employee hours are being cut to 29 hours
because of Obamacare, despite the delay of the employer mandate. But the
White House, NBC News reports, says that there is no systematic
evidence that this is because of Obamacare and dismisses the report as
anecdotal.
Does not matter. This administration threw the truth under the bus a long time ago.
July 28, 2013: about 25% of those who access to health care through their employers turn it down. Why? too expensive.
Commenting on Obamacare and the administration's move to delay the
employer mandate for a year, Schoen said warned that if the
administration is forced to delay the individual mandate as well, "that
would effectively kill" the healthcare reform law that the president
invested the first two years of his presidency in.
July 23, 2013: they won't shut down government this autumn, but they will delay ObamaCare. Everyone knows a recession is all but guaranteed going into the 2014 elections if ObamaCare's last leg -- the individual mandate -- is implemented. ObamaCare is dead. Like the Keystone XL, it will wither on the vine. No drama, O'Bama. States won't play along. Unions denouncing it. Young, healthy adults will simply opt out and pay the $95 penalty. The health insurers will continue "pulling out." If not delayed, the largest social disobedience movement in US history -- except maybe Prohibition. And the first profession.
July 22, 2013:this is no longer about cost; it's about the constitution -- ex-HHS; now running for US Senate. It will be interesting to see what the House does this autumn when the government runs out of money -- whether they will fund/de-fund ObamaCare
The White House is working to get back on offense in the debate over
ObamaCare, after a surprise delay in part of the implementation knocked
its message off course.
July 7, 2013: Just
16 states and the District of Columbia have elected to operate their
own marketplace. Another seven states are partnering with the U.S.
Department of Health and Human Services (HHS) to run their exchanges.
And 27 states have abandoned the option of running their own
marketplace, and instead are letting HHS run those exchanges within
their states.
From
the comments at the linked article, it's obvious Americans can see
through this. And folks wonder why "we" migrate to Fox and to Drudge,
and NBC ratings keep dropping.
July 7, 2013: Just 16 states and the District of Columbia have elected
to operate their own marketplace. Another seven states are partnering
with the U.S. Department of Health and Human Services (HHS) to run their
exchanges. And 27 states have abandoned the option of running their own
marketplace, and instead are letting HHS run those exchanges within
their states.
July 2, 2013:the "corporate mandate" is delayed one year; this is the guts of the law; probably illegal for the president to do this without Congressional consent; Dems applaud the move; some suggest this is the beginning of the unraveling of the act; risk of social disobedience on a grand scale; at best provides a one-year delay; at worse, doesn't stop the Train Wreck.
May 31, 2013: Health care premiums in California will go up 150% due to ObamaCare. Whatever you now pay, double it and then increased the original price by an additional fifty percent. $500/month will now go to $1,250. I guess that's affordable. Cue up Connie Francis.
April 3, 2013: a lot of ObamaCare stories today. When the Time Magazine story broke (see below), I e-mailed a friend, suggesting that ObamaCare would be delayed a year. Now, just moments ago (about 4:30 pm CST) a story broke on Fox News that a key provision of ObamaCare will indeed be delayed a year. It's very, very bad news for small business but it will result in ObamaCare, in general, being delayed a year. All those states that signed up to expand Medicaid are now in limbo, I assume, wondering what's in effect, what's not, what is the state liable for. What happens if the state expanded Medicaid, but the federal government now delays ObamaCare?From Fox News:
Parts of ObamaCare are starting to fray, even before full implementation.
The Obama administration now says a special system of exchanges
designed to make it easier for small businesses to provide insurance
will be delayed an entire year -- to 2015.
"Lots of small businesses struggle with providing insurance for their
workers so this was supposed to facilitate it and make it easier for
small business to do this," said Jim Capretta of the Ethics and Public
Policy Center. "It was a huge portion of the sale job.
When they passed
the law in 2010 there were many senators and members of Congress who
were saying 'I am doing this because it's going to help small
businesses.'"
April 3, 2013: Cancer clinics turning away Medicare patients; clinics can't survive financially on Medicare reimbursement under ObamaCare.This is not particarly new; it's only going to get worse under ObamaCare.
April 3, 2013: ObamaCare incompetence. -- Time Magazine. If they are only starting to plan for ObamaCare, they are way too late.
One thing is clear: Obamacare will fail if he doesn’t start paying
more attention to the details of implementation, if he doesn’t start
demanding action. And, in a larger sense, the notion of activist
government will be in peril—despite the demographics flowing the
Democrats’ way—if institutions like the VA and Obamacare don’t deliver
the goods. Sooner or later, the Republican party may come to understand
that its best argument isn’t about tearing down the government we have,
but making it run more efficiently.
Sooner or later, the Democrats may come to understand that making it run efficiently is the prerequisite for maintaining power.
March 17, 2013: it's personal now. An older couple, husband-wife, both blue collar, older (50's), and relatives (that's why it's personal); both in long-term jobs; he was cut back to 30 hours; she was laid off. Being cut back to 30 hours is interesting isn't it? That's the ObamaCare cutoff. I told my wife this is just the beginning. My hunch is that Congress will start seeing the debacle develop this summer, but by the time they try to postpone implementation of ObamaCare, it will be too late. Once companies lay off workers, or cut back on their hours, the companies learn to do more (or as much) with less (and they will be helped through technology and automation). Once these companies learn to do more (or as much) with less, they won't be hiring folks they laid off.
It appears that's exactly what's happening in Massachusetts, which
passed its own Obamacare-like reform with an individual mandate in
2006.
Last year Charles Baker, former CEO of Harvard Pilgrim Health Care,
one of Massachusetts's largest health plans, noticed some health
insurance brokers posting comments on his widely read blog. They
expressed suspicions that people were applying for health coverage
after a medical condition developed, got the care they needed, and then
dropped the coverage.
Coverage for an individual, noted Mr. Baker, now a Republican
candidate for governor, might be $2,000 to $3,000 a year, whereas the
penalty was only about $900. He asked his finance people to see whether
they could find any discernible patterns.
Boy, did they.
Between April 2008 and March 2009, 40 percent of the individuals who
applied to Harvard Pilgrim stayed covered for less than five months.
Yet claims were averaging about $2,400 a month, about six times what
one would expect.
a) will not add any more restaurants until they get clarity on the impact of ObamaCare
b) they will pass on the costs of ObamaCare to their customers
c) they are looking at ways to lay off employees; hire fewer employees in the future
February 22, 2013: Gallup poll on US health care. February 18, 2013: a Financial Times article on ObamaCare as it starts to hit businesses. They started complaining too later. Cue up Connie Francis. The interesting thing: the writer of this story does not "get it." The employer does not determine the number of "full-time" employees; the IRS determines the number of "full-time" employees by dividing total number of employee-hours worked, divided by 120 (as in 120 hours/month). So, if one has 100 "part-time" employees, each working 20 hours/week (well below the 30-hour threshold), the employer may think he/she has 100 "part-time" employees for which health insurance coverage is not required. In fact, 100 x 20 = 2000 hours x 4 weeks = 8,000. Divide by 120 = 67 "full-time" employees for which the company is required to provide health coverage, at $2,000/full-time, or in this case, $2,000 x 67. Very, very clever, how the law was written.
Texas, Florida, South Carolina, Wisconsin, Mississippi and Louisiana have rejected the two key provisions of the law, according to
americanhealthline.com.
"Our company, CKE Restaurants Inc., employs about 21,000 people (our franchisees employ 49,000 more) in Carl’s Jr. and Hardee’s restaurants. For months, we have been working with Mercer Health & Benefits LLC, our health-care consultant, to identify Obamacare’s potential financial impact on CKE. Mercer estimated that when the law is fully implemented our health-care costs will increase about $18 million a year. That would put our total health-care costs at $29.8 million, a 150 percent increase from the roughly $12 million we spent last year.
July 21, 2011: An inconvenient truth -- the real jobs killer -- ObamaCare. I don't think folks understand that majority of jobs in this country are provided by small business. As long as they stay under 50 employees and do not engage in interstate commerce, they are not affected by Federal law (at least in general). Businesses close to 50 employees will do all they can to stay under that "magic" number.
April 13, 2011: Support for ObamaCare has now dropped below 35 percent; first time support among seniors dropped below 30 percent. Comment: ObamaCare will unravel in 2011/2012. Romney, whose Massachusetts RomneyCare was a model for ObamaCare, will have to finesse his "RomneyCare fits Massachusetts but doesn't fit the nation" theme.
March 23, 2011: One of the administration's strongest advocates of ObamaCare is now considering a waiver to release New York City from ObamaCare. I cannot make this stuff up. I assume it's a no-brainer to guess NYC will get the waiver if the city applies.
The federal government Tuesday granted Maine a waiver of a key provision in President Barack Obama's health care overhaul, citing the likelihood that enforcement could destabilize the state's market for individual health insurance. [This is becoming a joke. Any state that wants to opt out will simply "boiler-plate" Maine's waiver application.]
March 6, 2011: Waivers for ObamaCare now exceeds 1,000. On Friday, March 4, 2011, 261 new waivers were granted. This is truly obscene. The HHS web page has not been updated.
November 18, 2010: Twenty percent of Americans with mental illness last year -- and that's why ObamaCare is doomed to fail. I was one of the twenty percent: hypermanic about the Bakken. My insurance covers that malady but I refused electroshock therapy.
This has nothing to do with oil industry in North Dakota.
This posting will disappear within a day or two and will be filed elsewhere, so don't despair.
The Wall Street Journal posted a nice op-ed piece yesterday (May 18,2010) by Scott Gottlieb, a practicing internist, a partner in a health-care investment company, and a former official at the Centers for Medicare and Medicaid Services. I doubt he has anything to worry about with regard to his health care. But the rest of us have plenty to worry about.
With regard to ObamaCare, the short term concern: increasing difficulty to access medical care, especially if you are retired, or depend on Medicare.
The long term concern: ObamaCare "bankrupts" the US economy.
1. The new program now mandates everyone have health insurance, which the "man on the street" interprets as meaning "we all have access to medical care." Of course, everyone had access to medical care before the new health care plan but that's a story for another day.
2. There will be a learning curve for those new to the bureaucracy of medicine. It is human nature not to schedule an appointment until a condition becomes urgent or emergent. Even for those who want to schedule an appointment, it is a steep learning curve to learn how.
3. Physicians are opting out of Medicare program at an increasing rate: a) overwhelming bureaucratic paperwork; b) mandates for unfunded information technology upgrades; c) mandates for unfunded training for office staff using that technology; d) risk of violating Federal crime for misunderstanding rules (if one thinks malpractice is a physician's biggest concern, going to prison for Federal crime probably ranks a bit higher); and, e) all the while, decreasing Medicare reimbursements.
4. The act mandated that "we all have access to medical care," but did not mandate that there be enough providers. It is painfully obvious that medical schools cannot ramp up to meet this new need. And even if they could, the new physicians will become specialists, not generalists, and will not necessarily practice where the need is greatest.
5. Short term, the emergency rooms will be overwhelmed. They already are, but the situation will get acutely worse. And if one is already on Medicare, I doubt it will be easy to find a specialist. If one is newly eligible for Medicare, good luck in finding a physician willing to take new Medicare patients.
More to follow. I have to go explore Boston.
Update: We had a great day in Boston. With regard to the above, those are my thoughts only. As JRR Tolkien says, "we all have our myths" and once we have our myths, it is very difficult for us to change our beliefs. The above is my myth and JRR Tolkien's comments about myths could not be truer. Others will disagree with me and that's fine with me. We won't know how this will all work out for several years, and even then, folks will interpret the data through their own lenses. As for me, I am thrilled that there was an attempt to address the health care challenges facing this country. I just feel very strongly that the growing pains will be great, as they always are with major change. The financial risks to the country are not inconsequential.
