By Brian Bearden
Texas Insider Report: AUSTIN Texas There is a train wreck coming you are going to be witness to some dramatic changes. Not in Obamacare itself per se but what it will lead to. The real reform here is the end of the typical fee-for-service convenience Dr. John F. McCracken a clinical professor of healthcare management at the University of Texas at Dallas recently told the Rotary Club of McKinney.
Going to a doctor or hospital for medical care will change dramatically in the next few years says McCracken of the Affordable Care Act nicknamed Obamacare.
Change in the Workplace: McCracken said employers will have a change in attitude toward employees as health care becomes more of a taxing subsidy program instead of a voluntary benefit offered to retain employees.
This is the revolution payment reform. Obamacare simply brings the reforms faster he said. Fee-for-service is in its twilight years. Doctors and patients will have to change to a new type of payment program and patients and the practices of doctors could be lost in the shakeup McCracken said.
The UTD teacher predicts bundled episode-based payments will take the place of fee-for-service.
Everyone has been to the hospital and received six or seven bills he said. Bundled episode-based 
payments are coming and coming very rapidly. That will create the organizational reform. That is going to be horribly disruptive to doctors.
Delaying the Outcome: Professor McCracken said he expects Congress to stop a meltdown by turning to its usual way of handling problems just before it is too late.
When you get to the end of the road Congress brings out the graders and extends the road he said.
McCracken said the problem patients have now is much like buying a car.
In medicine the parts are great he said. The problem is as a patient that you have to assemble them in the garage. Thats the reason 5 percent of the population consumes 50 percent of the money spent on health care each year.
McCracken said health care payments will become more like buying a car too. Car buyer makes one payment and the money finds its way back to the people who developed manufactured and sold the vehicle.
Surprises ahead: The fit 70-year-old professor said that many Americans now believe health care will be free with Obamacare.
It is not he said. Most people have no idea it is coming.
More Medicaid? McCracken who teaches courses on the American Healthcare System and Managerial Economics said the government plan calls for more Americans to receive health care through Medicaid.
He said trying to obtain health care through Medicaid can be defeating for a patient adding thats why many fall into the 19 percent without insurance.
He said half the population spends less than $800 a year on health care. Five percent spends half the money each year on health care.
It is one of the most difficult programs to get and it is one of the more obtuse programs.
He forecasted that doctors face a situation where they wont be paid enough to keep their practices open. Patients face a shortage in doctors.
While the median income for Americans has risen by $22900 in recent years that growth in income has been absorbed by taxes and non-health care inflation. That leaves $1140 out of the $22900 available for discretionary incomes.
Obamacare only helps the 19 of the population without health insurance now McCracken said which creates a big problem ahead.
As Medicaid grows the costs will outrun the money brought in by taxes. In 2010 employees paid $899 on average toward the cost of single coverage in an employer plan and $3997 for a family of four. The poverty level in 2011 was $22350 for a family of four.
Get covered or pay a penalty: Under the Affordable Care Act people are required to obtain coverage or pay a penalty.
Most people have no idea they will have to buy health insurance he said.
Growing Concern: In a few years all tax revenues are consumed by entitlements and interest on the debt McCracken said adding that Obamacare offers:
- An individual mandate
- An employer penalty
- Health insurance exchanges and
- Medicaid expansion
Management Education asked. Employers are like birds on a wire he said. They are waiting for someone to fly off the wire and then see which way they go.
McCracken holds a bachelors degree in economics from Southern Methodist University in Dallas a masters in economics from the London School of Economics and a doctorate in finance from the Wharton School of the University of Pennsylvania.
McCracken said that Obamacare (Affordable Care Act) would speed up a crash that leaves patients and doctors in a state of confusion sooner than later.
Obamacare is an insurance bill McCracken said. It is not a health care bill. It only deals with this 19 percent.
The former professor at the Columbia University Graduate School of Business has experience serving on the boards of hospitals physician-hospital organizations and managed care organizations and advisor to several large physician group practices.
Problems in the Act: He told the McKinney audience that the Affordable Care Act regulations are full of 
mistakes.
McCrackens Alliance for Medical Management Education serves as a strategic partnership between the UTD School of Management and The University of Texas Southwestern Medical Center at Dallas.
He said Americans will go from employment with voluntary benefits to a system that can be viewed as a taxing subsidy program.
Because this is highly partisan and highly divisive no one wants to go back and open the law he said. There are a lot of mistakes in it.
McCracken said that Medicaid is the biggest line item inmany state budgets and that many states cant afford an increase in spending.
The American Way: Much of the money spent on health care comes in the final years of a patients life.
America is the only country that spends that much on end of life care McCracken said adding that taking care of people is an American value while other countries dont devote medical resources in the same way to end-of-life medical needs.
For MORE INFORMATION visit the Texas Medicaid Program and the Affordable Care Act timeline.
Brian Bearden is a contributing writer for the TownSquareBuzz.com of McKinney Texas. He is a former managing editor of the McKinney Courier-Gazette Celina Record Frisco Enterprise Little Elm Journal Mesquite News & Rowlett Lakeshore Times.
