Wednesday, April 09, 2014

America's health system: will it survive under Obamacare

America’s health system: will it survive under Obamacare

Mark Davis, M.D.


     America’s system of health care delivery is one of the best in the World. Tens of millions seek medical services yearly, most of whom are successfully treated for their ills. Yet a small percentage of this group fails to achieve a similar success story. Consequently, a harsh reality encumbers a segment of society in their search for the healing process. This failure is the substance of an indictment brought to bear by an overreaching government that seeks equity in a system that in the end is an unrealistic goal. Present day medical services offer an array of choices from basic care to sophisticated diagnostics and therapeutics. Costs associated with these variant levels of care move along a similar spectrum with the latter end out of reach except for the wealthiest amongst us. Present population demographics indicate the nation’s inhabitants number more than 317 million. In order to manage the medical services for this vast number of people 900 thousand physicians are licensed to perform the task. Of this group approximately 80% perform direct patient services. The rest are embedded in administrative roles through government entities or private functions. Nearly three million nurses, nurse practitioners and physicians assistants supplement the services of their physician colleagues. Day to day medical miracles are performed in 5,800 registered hospitals, thousands of clinics, innumerable physicians’ offices and a variety of other health outlets that complete the circle of this expansive system. During the early days of the 111th Congress the Democrat majority, in both houses, quietly began the foundations of a piece of legislation we now know as Obamacare. As it was nearing completion in 2010 a heightened level of negative rhetoric was heard against the prevailing system. Insurance companies, the pharmaceutical and health industries found themselves harshly demonized by a government which was planning to literally nationalize the medical system. On March 23rd 2010 a several thousand page legislative effort, written end to end by lawyers and passed by both houses of Congress on the slimmest of margins, was signed into law. With the swipe of a pen one sixth of the U.S. economy and  control of America’s health system was usurped by  federal bureaucrats who forgot one small point, no one knew its contents.


     Designated as a cure-all for the ills of a system that had a minor cold the Patient Protection and Affordability Care Act (PPACA) may be a historic first. Nearly every voting member in the House of Representatives and its Senatorial counterpart were ill-knowledgeable of the Trojan horse they had passed into law. Several thousand pages of legislative confusion was about to be inflicted on a nation whose greatest majority were already covered by health plans. Promises of eternal access to high quality medical care with cost affordability in mind were splashed throughout receptive media channels in an effort to convince Americans a new day has dawned in American health care. Pre-existing condition coverage was an absolute within the structure of the legislation. All this and more without increasing the federal budget was the fantasy repeated over and over again by Obama’s friends in the media. Then a few people began to look under the hood of this new health vehicle and found something else. Written in legalese its authors deliberately confounded the wording making it difficult if not impossible to decipher. Those who were able to break the code found there were more sanctions and penalties than health initiatives in this disturbing law. Few initiated in health care management had contributed to this expansive edict which was designed to eventually place every aspect of medical services under the watchful eye of Uncle Sam. Left out of the conversation was the fact that traditional insurance was less expensive, offered more services and allowed better access to the health system. Those who led the charge to pass PPACA were unavailable for comment during the early days of the law’s incipience. They were vacationing in Antarctica. Nevertheless reality has a way of surfacing and the more people knew about Obamacare the less affinity they had for it.


     Media friendly to the Obama Administration brought in their usual list of hacks to bless this new burden on our society. Politicians, economists, Harvard professorial consultants and other faces you have seen many times were among them. This crowd read from the same talking points noting how the left’s pinnacle achievement would save America from its unfair and decaying medical system. Referencing a few key elements their diatribes were almost believable. Yet scratching the surface of Obamacare’s cheer leadership a pervasive credibility gap opened which still defines the hazards of this legislation. Promising to bring tens of millions into the fold, who had a paucity of health services in the past, these spokesmen for the Administration could not quite explain the machinery to bring this about. Analyzing the Romneycare experiment in Massachusetts, a program that influenced PPACA legislation, a cold chill comes over the reader as he sees the parallels between the two laws. Increased demand for services in the Bay State taxed the medical infrastructure to a point causing many physicians to close their practices to new patients. Prices of services rose through the natural progression of cost inflation, yet government officials blocked many requests for elevation of fees. Massachusetts government officials artificially kept reimbursements low by denying legitimate requests for increases. Inundated with lawsuits over their micro-version of Obamacare, Massachusetts elevated many lawyers to the level of administrative judgeships then quickly dispensed with these cases.  The fix was in, similar to the courts for Obamacare. Autocratic methodologies, convoluted judicial opinions and heavy financial penalties are the fulcrums used to squash any resistance to a health plan few desired and less were willing to pay for. Romney jumped ship before his legacy plan was implemented. Do you blame him?


     Students of Romneycare see the obvious parallels between the poorly designed national plan and the Bay State’s experiment. In both cases a heavy reliance on the legal system has been introduced to enforce these two tragedies on less than receptive audiences. For lawyers and judges Obamacare is a legal fantasyland given to them as payback for supporting the President. Tentacles of this leviathan reach into every aspect of our society. When compliance is questionable the briefcase crowd along with their black robed friends will be called in to save the day. Tort reform was deliberately left out of this beast. Instead battalions of attorneys were given a license to lead the charge against those who would rather make their own decisions on health care. Lawsuits will have a new flavor. In addition to the thousands of malpractice suits filed yearly Obamacare lawsuits, in equal numbers, will join them. Rules to implement this behemoth are still being formulated by the Department of Health and Human Services. When fully released, thousands of pages of regulatory structure will be added on top of Obama’s grand Ponzi scheme to cure America. Treatment plans, diagnostics, choices of drugs, lengths of hospital stays and more will be controlled by central “authorities.” Stepping away from government protocols will not be an option for physicians and individuals. Physicians become indentured servants paid and controlled by a blind bureaucracy whose only goal is to keep the beast alive at any cost. Doctors out of compliance with the monotone tenets of Obamacare will find themselves looking for other work or even jailed. Lawyers will be bathed in money because they have been given the “right” to sue on behalf of the government at the national and state levels. Designers of this egregious legislation placed a smile on their public faces as they discussed Obamacare. In the dark halls of Congress most knew this legislation would bring on dissent once everyone was made aware of it contents.


     Checked your tax and insurance bills lately, you may be surprised. Over a dozen taxes and levies were brought to bear to support this new health scheme. Contrary to the President’s multiple statements that taxes will not increase for those earning 250,000 dollars or less, the antithesis is true. Many of the new charges affect people across the economic spectrum. Surcharges on investment income, increases in the Medicare payroll tax, mandated taxes on employees and employers, a tax on health insurers, excise taxes on so-called Cadillac insurance plans, taxes on medical device manufacturers, elevated threshold to deduct medical expenses on income taxes and many more are a direct result of government’s interference in the health system. Originally conceived as a program which would save hundreds of billions for its participants, economists’ worst nightmare has come true. Costs will not be contained in the manner as Congressional Budget Office officials originally stated. Trillion dollar deficits are perceived in the next few years. Even more detrimental those who decide to retain traditional insurance will find premiums exponentially higher.  Fiscally unsound algorithms are driving costs skyward resulting in millions of jobs vanishing from view and a health system placed in chaos.


     Obamacare is an indictment of the traditional medical system. Irrational as it sounds, the legal profession along with their legislative counterparts brought into law a legislation that condemns prior efforts to assure health care for all. Paradoxically Obamacare degrades the health system with erroneous formulas and algorithms to refabricate a medical industry that needed a tune up not an overhaul.  More than three years have passed since the inauguration of the Patient Protection and Affordability Care Act. From the public’s perspective none of the promises envisioned by its engineers have come into existence. Alternatively Obamacare introduces a system struggling for an identity. A system that is so profoundly flawed that logic dictates it was never intended to fulfill the health needs of our expanding population.  Instead the Affordable Care Act has purposely caused; insurance rates to rise exponentially, reduction in provider access and dismembers traditional insurance pathways. My own Maryland Blue Cross policy has seen its renewal rate increase by 82.5% a month for the same limited coverage. Sticker shock is being realized throughout the country. Millions are being forced off their plans because of excessive costs or the plans cease to exist. Enter the Exchanges as a means to move us closer to a one payer system.


     October 1st 2013 was a momentous day for Obamacare. On this day the full incompetence of the Affordable Care Act’s legislative mandate made its debut. Federal and state insurance Exchanges came on line for the first time or did they?  From their incipience technical flaws surfaced which hindered most from applying. Billions were spent to provide a seamless experience applying for health insurance in cyberspace.  Those who tried found glitch after glitch as the system mined them for irrelevant information. Nearly six months have passed since phase one of ACA began with elements of the system still being hidden from the public. A few facts have surfaced. More than 5 million have registered on various online sites, yet the government has not been transparent who these applicants are. Media reps have pressed government officials for the answers, specifically requesting whether these people have been moved from one subsidized program to another, essentially inflating the number of applicants. Answers to this question are still pending. Ezekiel Emanuel, one of the architects of Obamacare, tragically admitted in order for this legislation to succeed millions of young people need to sign up. To this date that goal has not been achieved because there are built-in incentives for the youth of America not to apply. A small fine, with no teeth for collection, is awaiting those who go sans insurance. Obamacare is an obsolete mode of medical care delivery whose cost/benefits are low compared to the system it is attempting to replace.


     Patient Protection and Affordability Care Act is essentially an accusatory instrument denigrating the traditional system of health care delivery. This legislation’s breath taking scope enumerates multiple flaws in the system which it intends to correct. Written end to end by lawyers and peppered with a few tidbits from the medical community, failure was the ultimate end point of its designers’ intentions to lead the nation into a one payer system. Obamacare victimizes individuals and businesses by forcibly ensnaring them into purchasing a product in markets created by government entities. Refusal to obtain insurance can bring the wrath of an IRS agent to your front door. Ultimately the judge and jury of this abomination are the end-users, the public, who will discover that promises made are not promises kept. America’s health system will survive despite Obamacare’s brief interlude on the scene. This medical nightmare is unraveling. Its demise is imminent. The only unknown is when.


Mark Davis, MD is an author, journalist, media advisor and physician who has been intricately involved in the health care delivery system at many levels. As President of Heathnets Review Services and Davis Book Reviews he works with many authors to bring current health and political issues to a wide audience. Dr. Davis’ latest book is Obamacare: Dead on Arrival, A Prescription for Disaster. To contact him for consultation, seminars or interviews please use the following sites.

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