July 8, 2013 - Politics

The original version of this blog was posted a year ago. I have had many questions recently about medicine and the current situation with Obama Care. Since writing this article last year, many things have changed, so I felt it would be prudent to make modifications where appropriate and repost. This is the updated version with some corrections in gray, but additional text has been added as well.  

I am not a political analyst—So why am I blogging about politics?

obama-face on

The Supreme Court upheld the Obama Health Care Law. I encountered unexpected hostility soon thereafter.

Dr. Sanjay Gupta, the chief medical correspondent for CNN, for whom I have a great deal of respect (Sanjay—not CNN), skillfully answered questions about this cumbersome bill for hours. I don’t agree with everything he said, but I do respect his views.

Not long after the announcement from the Supreme Court last year, I posted several comments and opinions on select sites, regarding the passing of the bill as well as on the statements issued by Jeremy Lazarus, President of the American Medical Association.

I was speaking, or so I thought, primarily to my physician colleagues who were instrumental in promoting this bill and currently support it.

Most of my comments were followed by a surprising number of people accusing me of acting shamefully, not caring about America, hating women, and of being greedy and stupid.

I realize that I may offend someone when addressing this emotionally charged topic in this blog, but please hear me out and then talk to me—I will listen and respect your point of view.

I want to make a few things clear—if you want to speak as an expert without reading the 2700 page law or a pertinent summary, I find that to be ignorant. That doesn’t include everyone—just those who claim to fully understand the bill and tell me what it says without ever actually seeing it.

I use the word ignorant, because if they are arguing their point without knowing how this law will affect others, it’s not a fair discussion.

When I make a point, it is interesting how many times the person arguing with me states, “no, you can’t talk about that. This is about you!” This happened to me several times today as well as yesterday when corresponding directly with John Fugelsang from CNN.

But here are some talking points:

  • Does the bill benefit anyone?
    • Absolutely it does. Reform is needed to help those truly in need of medical care and insurance coverage—this is without question. But is this the best way? What are some of the repercussions of the current plan?
      • Those who do not have insurance now and can afford it will have to buy it.
        • Although that seems fair, who decides if you can afford it or not? If you think you can’t afford it, that really doesn’t matter—the government will tell you if you can. If you still fail to obtain insurance, you will be fined a percentage of your income (regardless of your expenses in life) in a manner shrouded from truth by calling it a tax. It is actually a tax and a fine for not participating in government-run medicine, by those who have not run anything in the medical field before, nor have any ideas how it should be run, or how it should look when it is working. As a business owner with 200 employees, I know this is not a good plan. If I approached my bank with a request for a loan with that practice pro forma, they would throw me out–and rightly so.
        • Even though you may currently have good, affordable coverage from your employment, according to Forbes, employer paid health insurance will become a thing of the past for 7-20 million Americans because of perverse incentives under the program http://onforb.es/165qC2y.
      • Those who truly can’t afford insurance will be covered.
        • This is indeed a needed benefit. But keep in mind that it is in part due to increasing enrollment in Medicaid by 30 million people (since last year, this number has inflated to 60 million), at a time we should be trying to decrease enrollment by providing jobs. The price tag on this part of the bill is estimated to be $2.3 trillion through 2020 http://bit.ly/LU2MiJ Since last year, an additional $716 billion will be needed in Medicare cuts, $414 billion coming directly from physicians — your physician.The $2.3 trillion price tag has also increased exponentially, but the number is meaningless until the target stops moving.
      • Those who have pre-existing conditions will be covered.
        • This is a needed benefit, no argument. The question is should we do it this way? Does it justify the millions spent in other aspects of the health care bill?
        • Although the current regime in America is currently democratic, according to Forbes, even the democratic party CBO admits that after ten years of implementation, Obama Care will still leave over 30 million Americans uninsured  http://onforb.es/165qC2y .
  • Does it hurt anyone?
    • Those who have money will be covering those who don’t—simple. That is the opposite of what the Obama camp is saying, but it’s true.
      • According to Forbes http://onforb.es/NH6UkT in 2009 Obama stated that the health care bill would “bend the cost curve,” promising that it (the law) would “bring down premiums by $2,500 for the typical family.” The new IRS estimate for the Cheapest plan under Obama Care will be $20,000 per year in 2016 http://bit.ly/16Oq8QH . 
      • Again according to Forbes, in 2012, Jonathan Gruber, a key economist in the Obama camp stated that his calculations that arrived at the 2009 estimates were flawed, and that there would actually be a premium increase of 19-30% by 2016. That could push the cost per household up to $32,000 annually.
    • Let’s not pretend that this bill is not a liberal move toward socialized medicine. The money must come from somewhere. But where?
      • The government?
        • Uncle Sam will contribute only a portion of the price tag. This will increase our national debt by an estimated additional $1.76 trillion to $2 trillion over the next 10 years http://bit.ly/NH6F9m . Since official budget forecasts did not factor in the cost of insuring many employee’s spouses and children, true costs are expected to be $50 billion per year higher than predicted according to the National Bureau of Economic Research http://thedc.com/L5d7vJ
          • That’s a nice way of saying it comes from our kids, grandkids, and us.
      • Decreased reimbursements to doctors and hospitals
        • According to Chapin White from the Center for Studying Health System Change, the Medicaid expansion may actually reduce access to health care. Some physicians will refuse to see Medicaid patients if it becomes a losing proposition http://bit.ly/MEjul3 .
        • Doctors and hospitals are running businesses that need to turn a profit to stay afloat. This isn’t easy in today’s financial environment. What happens when Obama Care reduces reimbursement further? Doctors leave their practices because they can’t afford to keep them open.This is simple economics, and it’s real.
      • Controlling the flow of health care, which may be the most concerning. Do you qualify to receive medical care now? Will you qualify in ten years?
      • From tax hikes outside of the ‘non-compliance’ fines.
        • This has been hinted at, and accusations made, but the ground is far from solid on this.
      • From those who are paying insurance premiums. In other words, the cost will be spread around in a Robin Hood manner.

But how does this bill affect us in the realm of free enterprise and commerce? New drugs are continually being developed and new procedures perfected based on free enterprise.

If pharmaceutical companies have no way of recouping their research and development costs, will they continue the costly process of creating new products? It will actually be impossible to do so, since the reimbursements will be diluted.

I have read arguments against this view in Forbes that you may want to read yourself at http://onforb.es/MZ9WSf to form your own opinion.

This is the same for problems hospitals will face. If they can’t keep their doors open, they can’t keep their doors open. Argument number 5 on http://onforb.es/MZ9WSf indicates that when hospital volumes increase, the profits increase as well. This is flawed thinking since revenues do not translate directly into profits in the medical industry.

The impact of this new healthcare bill is far-reaching and yet unknown. But one thing is certain—this country cannot afford it without dramatically changing the delivery of medical care. Are we ready for that? We have seen that the original promises were not true or valid. We are already paying more than predicted (2-300 percent more by some estimates), and from a very real perspective as a physician, doctors are getting out. The shortage of medical providers forecast for 2016 will be here in 2014. No joke, no doomsday talk, just the truth. Why are they leaving? They can’t afford to see patients when each visit costs them money.

Remember, be careful what you ask for—you may get it.

Please comment, agree or disagree, or ask questions below—but play nice. If I am proven wrong, I will admit it. If I upset you, tell me. If I have totally missed an important point or been insensitive to your circumstances, I am open to discussion.

The reason for these ground rules is because of the heated responses I have had on other sites regarding the Health Care Law.

I will delete comments that are snarky or offensive to others, but not because you disagree with me. I appreciate your understanding.