I am frequently asked about my opinion regarding Obamacare. There has been lots and lots of excellent pieces written on the subject by others, but here are some of my thoughts.
This thing was never going to work. They took the worst aspects of insurance medicine and the worst aspects of government paid/controlled medicine, lumped them together and called it a wonderful plan. Only in government does that make sense.
The government cannot do anything efficiently. It is true that the military kills people and breaks things with excellence (not skills most people look for in their doctor), but anyone who has been in the military knows the military does not do things efficiently, nor economically. Whether it be the post office, IRS, immigration services, TSA, DMV or myriads of other government agencies, none of them do things with the level of excellence expected of our private health care system and all are incredibly wasteful of money. We already have a government run health care system in the Veteran’s Administration. Not a single person will argue that the VA provides services on par with the private health care system. It is beyond my comprehension, how anyone thought the government, through the “Affordable Care Act” could create a well functioning health care system, much less make health care cheaper.
Politicians who voted for the Affordable Care Act, did so because they could not resist the temptation to vote for something that had the hope of giving people something for free. They assumed giving people “free” health care would buy them votes. They did not even read the bill, much less think about the long term implications of the bill. (Doctors are committing malpractice when they do that type of thing.)
Hospitals, professional medical organizaitons and insurance companies supported this thing because they could not resist the promise of more money and increased control over the delivery of health care. Some well-meaning people accepted the false rhetoric of the selling points. For the few entities that might have resisted getting on board with the government, there was fear that the government would come after them and cause them great harm. Even though it is becoming increasingly clear this thing was a mistake, you will notice no medical or insurance organization is speaking up. I suspect that is because they believe that for all of its problems it is going to be maintained in one way or the other and they are afraid of the repercussions from the government if they should speak out against it.
While it was clear that Obamacare could not work, I was absolutely astounded that the government is so incompetent as to not even be able to get a simple web site correct. Obviously, these are not actually simple websites, but there are scores of similar commerce websites and in comparison to the complexity of taking care of patients and running an entire health care system, they are child’s play. If they are having this much difficulty with a web site, what kind of problems are going to arise as the real thing starts?
It also needs to be pointed out that the claimed reason we had to have the Affordable Care Act is because it was unacceptable that there should be uninsured people in the United States. The irony is that as a result of the regulations in the Affordable Care Act, we will have more uninsured after the act is implemented, than we had before it was passed. Only arrogant politicians could rationalize how making health insurance more expensive and then mandating that it be bought is going to make people and employers who already could not afford to buy health insurance now able to buy it. Of course, they are increasing those covered by Medicaid and throwing a lot of subsidies out as the answer to this question. The problem is that the subsidies and increased Medicaid will not come close to making up for the increased expense of insurance and the loss of employer provided insurance. The biggest problem with this approach is that an already bankrupt government is going to take more in taxes and print more monopoly money to cover those increased expenses. Sooner or later that will have a devastating impact on the economy as a whole.
January 1st started the use of Obamacare as an insurance policy. Up until this time all of the focus has been on the dysfunctional web site. Though still a challenge, it seems over a million people nationwide have been able to sign up for a policy. Now what happens?
The government equates having health insurance with receiving health care. Therefore, they assumed that if people get health insurance they will have health care. This assumption is very problematic. Just as their web site was non-functional, so is the very complicated means of administering these health plans. People have plugged in all of their information and been told they have insurance, but then nothing further happened. This means when they go to obtain health care they are in a worse position than those who have no insurance in the first place.
We as a practice have been given zero information on how this system will work. Blue Cross forced us to sign up with their exchange product by telling us, if we did not sign up for an exchange our regular Blue Cross fee schedule would be penalized. Since then nothing else has happened. We have no way to check eligibility. We have no idea of the fee schedule. We have no idea of the process for billing. All of this means that people will maybe get an insurance card and then have difficulty finding providers who accept that insurance coverage.
The fact that neither the government, nor health care organizations, understands is that health care is delivered by individuals to individuals. It is not delivered by the government or even hospital systems or Accountable Care Organizations. It all comes down to an interaction between two individuals. The pressures being added to those providing the health care on top of the pressures already present is going to produce an increasingly dysfunctional health care system for all because individuals on both sides of the stethoscope will be negatively impacted by these pressures.
What is going to happen now? Obamacare will muddle on for awhile with the problems piling up. Those problems will be ever increasing costs to the Amrerican public in insurance premiums and taxes. The health care itself will become less available and less pleasant when obtained. There will be all kinds of difficulties and stresses for both patients and health care providers. The government will blame the problems on the insurance companies, doctors and hospitals (and George Bush). It may eventually get repealed, but so much damage will have been done to the health care system that the result will be unacceptable and there will be a big push for a single payer system. There is no question that the health care system prior to Obamacare was very problematic. Unfortunately, the Affordable Care Act, did nothing to fix those problems, but has compounded them greatly.
Hold on, it is going to be a very unpleasant ride.