Diagnosis for Democracy
Insights into the State of Our Union
A Blog by Rob Tenery, MD


October 11, 2013: Is This All Just About Obamacare?

By Rob Tenery, MD on October 11, 2013

“If you read Saul Alinsky’s book, Rules for Radicals, it talks about the need to ridicule. It also talks about never having a real conversation with your adversary, because that humanizes them and your job is to dehumanize them. Therefore, we see people coming out and saying about those who oppose Obamacare. For instance, that they want older people to die and they want kids to be deprived of food and all these things are just straight out of the text.

What’s really interesting that is Vladimir Lenin, one of the founders of socialism and communism, said that socialized medicine is the keystone of the arch to the socialist state. In other words, you’ve got socialized medicine as the foundation because it gives you control of the people. Once you have control of them, you can do whatever you want.

What’s really surprising, and is very serious, and is being missed in this whole discussion is that the fundamental relationship between the people and the government is shifting, and has shifted, with the implementation of the Affordable Care Act. It puts the government now at the pinnacle of the power structure. So we are now government centric as opposed to people centric.

I don’t think the average person understands what’s going on. This is very serious.

Benjamin Carson, M.D., live interview on The Kelly File, October 9, 2013.

 

The President went to selected members of the Congress who were ‘on the fence’ with his plan and cut deals to influence their vote. He made promises, many that he probably knew he couldn’t keep, in order to garner the support of influential groups, such as the American Medical Association, the American Association of Retired Persons and the pharmaceutical industry. With most of the medical community on his side, or, at least relegated to the sidelines, and with a majority of both houses of Congress aligned with his party, the controversial legislation still barely squeaked through.

The majority of members of both houses of Congress, who did not fully read or understand all the implications of the 2000+ page proposed legislation voted for its passage anyway. Chief Justice Roberts, apparently concerned that a rejection of the new law would be interpreted as ruling from the bench, led a majority of the Supreme Court to rule that the new law was constitutional, not on the original premise that it was a mandate, but a tax.

What does this controversial legislation mean to this country? It means that over 30 million of our citizens will not have to worry about going without health care, or face financial ruin, because of illness or injury. It means that millions of patients will not be rated-up or denied coverage because of pre-existing medical conditions. It means that doctors and hospitals will receive billions of dollars in funding that previously went uncompensated.

It also means that hundreds of billions of dollars previously designated to care for our elderly are to be shifted out of the Medicare program to fund these newly insured in an expanded Medicaid program. It means that a 15-member board of Presidential appointees will determine who is eligible for what care and who isn’t. It means an increase in taxes on investment income, the Medicare payroll tax, a 10% tax on medical devices and a 40% excise tax on the more expensive health care plans starting in 2018. It means raising the ceiling for medical expense deductions, lowering the cap on flexible spending accounts and making the pharmaceutical companies anti-up more to pay for closing the ‘donut-hole’ in the Medicare part D program.

It means that many employers will hire fewer new employees, or cut back existing ones to part-time, rather than be forced into paying the increased costs of providing health care coverage for them. It means that untold numbers of individuals will be tracked down and fined if they have not obtained health care coverage for themselves and the dependent members of their families. It means that the private practice of medicine will ultimately be available only to the wealthy (or those selected few who are granted waivers), while the majority of the population will probably end up being relegated to federally supervised health care delivery systems called Accountable Care Organizations (Exchanges).

And for what? It is now predicted by some experts that, even when the ACA is fully enacted, there may be as many as 30 million individuals who still have no health care coverage. Reports from states such as California point out that instead of rates for health care coverage going down as promised, they are projected to increase by over 160%. It is already a given that as many individuals lose access to their own physicians, they will be forced to wait in long lines to see a primary physician, as demonstrated by Romneycare in Massachusetts. Company after company is reporting changes to their hiring policies, in an attempt to avoid the punitive dictates for the required health care funding.

There are lessons to be learned here. Lessons about recognizing a problem--- the  over 40 million people in this country with no health care coverage--- and resolving a problem. Give our President credit on the first part. Recognizing that President Clinton had failed in his attempt to address this issue, and being aware that President George W. Bush and his Republican majority had only given lip service to meaningful change in the health care delivery system when they had their turn, President Obama decided to make health care reform the issue that would define his presidency. He enlisted his trusted advisers, his medical confidents and representatives from the SEIU, to draw up a plan.

President Obama recognized that Clinton’s plan, which was very similar to the one he would propose, failed because Mrs. Clinton and Ira Magaziner essentially excluded the parties that would be affected in putting together their plan. Deciding to do them one better, the President first went after support from influential sectors of the health care industry by making them promises that would favor each sector’s own agenda. He didn’t encounter much resistance from the hospital sector for his plan because, with potentially more millions of paying patients, these institutions’ losses in uncompensated care would be reduced significantly, under the dictates of the ACA. Additionally, recognizing the current trend of increasing physician employment by large hospital-owned corporations, the Accountable Care Organization model, proposed by the ACA, gave hospitals direct control over even more of the revenue stream.  The hospital community even agreed to phase out the ‘disproportionate share’ distribution that they received from the government to partially cover their losses from uncompensated care. However, with the rounds of new regulations being heaped on them, such as the ‘productivity adjustments’ that are designed to control the escalating expenditures in the government funded programs, and the projected increasing cuts in Medicare reimbursements, the hospitals are now having second thoughts in their decision.

The passage of time may be the only determinant as to whether President Obama’s vision and his political prowess were in this country’s best interest. Change usually takes adjustments and sacrifices. Some efforts succeed and some fail.  As the legacy of our President crystallizes in the future, will it be one that he gave our ‘disadvantaged’ a level of health care coverage that they deserve and one that society can afford, or will it be that he buried the best health care delivery system in the world with an avalanche of paralyzing regulations, new taxes and unprecedented federal control?




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