Despite
the recent partisan bickering in Washington that has become a hallmark of the
current administration, the Affordable Care Act continues to plow ahead like a
glacial behemoth. The debt debate was
cleverly spun out of control and in my estimation was allowed to reach a
conflagration by the White House in their sophomoric refusal to come to the
bargaining table, preferring to view their democrat majority as a public
mandate, and at times a simple monarchy.
The bigger the conflagration, the more attention was diverted from the
real disaster here: the rollout of Obamacare.
In a rare change of format for Conservative Slants, I have chosen to
interview an actual healthcare provider, someone actually in the trenches with
an insider’s view of how the Affordable Care Act will affect the delivery of
healthcare, what is the current state of healthcare, and what can we expect as
this monstrosity is forced on the American public.
TS: Welcome to
Conservative Slants.
DR: Thank you. It is a rare opportunity indeed to have the
media actually ask a doctor about the state of healthcare and the Affordable
Care Act. All too often we are left on
the sidelines while the future of healthcare is decided by the insurance
industry, politicians and bureaucrats.
TS: I get that same
impression. It always seems with this
administration that they cherry pick their sources and all too often, the actual
experts are left out of the discussion……from global warming to gun control.
DR: Don’t get me started.
I have always found it amusing that CO2 has been branded a pollutant by
the carbon police. It seems to me that
the best way to reduce the emission of that particular hot gas is to eliminate
politicians.
TS: (laughter) That
would be a start. Let’s talk about
healthcare in America. Without going
into too much detail, give me a short background of your career and why you
have some perspective.
DR: Sure. I have been practicing a surgical
sub-specialty for 25 years. I am a solo
practitioner with hospital affiliations but perform most of my surgery on an
outpatient basis in my own facility. So
in addition to practicing surgery, I am also a small business owner with a
staff of six employees.
TS: Ouch. The worst
of both worlds. Government intrusion
into healthcare and having to adhere to the myriad of regulations required to
run a small business. What kind of
environment do you practice in? Are you
in a big city?
DR: No, but I used to
be. I practiced for years on the East coast
just outside a major city. I had a midlife epiphany and moved inland to a more
rural small town America setting to escape not only urban sprawl but also to
escape the expanding control of the healthcare landscape by the insurance
industry and the fierce competition for an ever shrinking piece of the
healthcare pie.
TS: What do you mean
by that?
DR: Certain parts of
the country have evolved into insurance dominated environments where the
insurance companies have, in an effort to stay profitable, been reduced to only
a few players, allowing them to control the reimbursement profiles. To reduce their premiums and remain
competitive against each other, they have to cut costs somewhere, and the
easiest place to make those cuts is the reimbursement for services to the actual
providers.
TS: But can’t you
just refuse to accept the insurance reimbursement and not become one of their
network providers?
DR: Well, sure you
can. But these environments have also
become so saturated with providers, that the competition is fierce between them
for patients, so they have an extremely high rate of participation in the
plans. With patients seeking the best
bang for the buck, they will gravitate to a participating provider rather than
pay out of pocket for services covered by their insurance plan.
TS: Is there that
much of a difference? And wouldn’t the
patient gravitate towards the best doctor anyway?
DR: There usually
isn’t that much of a monetary difference, but the insurance company inserts all
sorts of punitive clauses into their contract that makes going out of network
financially unattractive. And patients
are not very loyal when it comes to money.
The insurance industry has done an effective job in treating us like a
commodity and the patients have bought into it.
All services are thought of like widgets, all the same product. That is why you see so many doctors trying to
differentiate themselves in the marketplace by offering all sorts of comfort
services like beverages in the waiting room, or massages, and swanky new
offices. All efforts to attract patients
by offering something that the other guy doesn’t.
TS: Marketing 101.
DR: Exactly. And that
is also why you have seen medicine evolve into big group practices. With more doctors under one roof, they can
share overhead and be more cost effective on the business side. If your reimbursement is low, then you have
to lower your expenses and be efficient in managing your overhead. Remember, the insurance industry is
essentially fixing your price so your income is stagnant.
TS: Or another option would be to increase your productivity.
DR: True, but you can
only go so fast before you become sloppy.
Mistakes are made and patient care will suffer. One of the biggest complaints doctors get
these days is that they do not spend enough time with their patients. Patients feel like numbers and fail to have
a relationship with their physician.
Medicine has become procedure and
code driven where productivity comes from maximizing allowable procedures,
procedures all identified by universal codes that have to be paired with
diagnostic codes. Patients often
complain of unnecessary tests. These
tests serve two purposes: they cover the doctor’s backside in the event that
something could possibly be missed, but they also provide more billable
procedures. Unfortunately the doctor
becomes shackled to his keyboard and is rapidly becoming a data entry
clerk. Case notes, exam entries, test
results, correspondence with specialists, follow-up notes, contacting the
patient with results, referrals to other doctors, prescriptions, and the
inevitable battle with insurance companies over billing and denials………all that
takes time that could be spent in direct patient care.
TS: But isn’t that an argument in favor of government run
universal healthcare? You provide the
medicine and they do the rest.
DR: No, the
government would just be a different devil.
Seriously Mr. Swift, is there anything the government runs that isn’t a
colossal disaster? Why would we consider
allowing the government to run healthcare and control one-sixth of the economy?
TS: But the left will
proclaim that a single payer system is the ideal and will look to Canada and
the UK as examples of success.
DR: And when the
Canadian prime minister needed surgery where did he go?
TS: To the US of
course. I don’t see much traffic going
the other way, either.
DR: Because we have
the best healthcare in the world. You
just can’t make that comparison either. Everyone forgets just how big the
United States is. We have 313 million
people as compared to Canada’s 35 million and the UK’s 63 million. We intend to inject as many Medicaid
recipients into our system as Canada has people. And Canada doesn’t have the demographics we
do. They do not have Detroit, Houston, Los Angeles, Chicago…….big cities with
big city problems of crime, drug use, poverty….. unhealthy lifestyle choices of
that magnitude.
TS: But you often
hear from the liberals about Canada’s success with their single payer
system. I often hear quotes about more
successful treatment outcomes as compared to the US.
DR: It is a model
devoid of business incentives. Canadian private
practice doctors have salary caps established by the government where they are
told how much money they can make. When
they reach that number they have the choice to continue to serve their patients
for free or to go on vacation. I have a
colleague who capped in October and went fishing for two months. That hardly serves your patients and it
seriously affects access to care. There
is no incentive to work harder, a theme that appears to be recurrent in
socialism. And as far as the better
outcomes: I read that study that was
comparing breast cancer survivability in which Canada was superior. But on closer inspection, it appeared that it
was all about case selection and rationing.
From what I understand, patients were placed on waiting lists to receive
care. The more severe cases went
untreated because they died while waiting for treatment, thus only the cases
with a better prognosis were left and responded well, skewing the results
towards success. US doctors who took on
the more difficult cases naturally had higher rates of mortality because they
actually treated the more complex cases.
TS: So this was an
access to care issue. If you have to
wait for your surgery it is essentially a form of rationing.
DR: The democrats
made a big deal about Republican claims that the system would have “death
panels”. That may have been harsh,
headline grabbing terminology, but when care is rationed, whether it is because
of access to care or cost cutting measures, it may end up a death sentence for
some. I have a colleague with a mother who
lives in the Netherlands, where she required a hip replacement. She went on a waiting list. After two years of steady deterioration and
pain that affected her lifestyle, she hopped a plane to Belgium and paid for
the procedure out of pocket.
TS: The death panel concept is not too far of a stretch when
you hear some of the comments made by Rahm Emanuel’s brother.
DR: Yes, Ezekial Emanuel
is a former professor at Harvard Medical School and a medical ethicist for
those of you not familiar with him. He
has been called on by the White House and appointed Special Advisor For Health
Policy. I think a lot of his comments
were misconstrued by the conservatives as being policy when, as an “ethicist”,
he is delving into the realm of philosophy where he was making statements based
solely on the application of a finite set of resources.
TS: But his comments
regarding elder case and the Hippocratic Oath……
DR: Yes, I agree that
they were disturbingly Orwellian.
Brought to mind the level of societal engineering that you would see in
a science fiction movie. Some of you may
recall Charlton Heston in “Soylent Green”. It is not particularly wise to have your healthcare
advisor making these sorts of public statements. They are best left in the
classroom.
TS: (laughs) That is
a reference I may have to look up. Not
to belabor the point, but in particular that one statement about allocating resources…..
DR: I have it here
someplace. Ah, here it is. Emanuel essentially believes that “communitarianism”
should guide decisions on who gets care. He says medical care should be
reserved for the non-disabled, not given to those, and I quote: “who are
irreversibly prevented from being or becoming participating citizens … An
obvious example is not guaranteeing health services to patients with dementia”
(Hastings Center Report, Nov.-Dec. ’96). He also stated that “Savings will
require changing how doctors think about their patients: Doctors take the Hippocratic
Oath too seriously, as an imperative to do everything for the patient
regardless of the cost or effects on others” (Journal of the American Medical
Association, June 18, 2008).
TS: I don’t care if he was waxing philosophic or
not. That is scary stuff.
DR: Agreed. But again you have to look at it in
context as an argument against government run healthcare. He is saying that if we are all in the
government run pot together, with only so much in the way of resources, and you
can define resources in an access to care context with only so many providers
available, or in the economic context of only so many healthcare dollars
available, then the only logical solution is to ration healthcare. So essentially he just made the Republican
case that there is going to have to be “death panels”. Someone has to be sitting in the emperor’s
box giving a thumbs up or a thumbs down on treatment. And who is that going to be? Doctors, philosophers, statisticians or the
accountants?
TS: It is positively
frightening. But then again, his father was a pediatrician active in a Jewish
paramilitary organization and his mother was a psychiatric social worker who
was active in the civil rights movement including the Congress of Racial Equality. He comes from a rather radical background.
DR: It is
frighteningly radical thinking. Especially when you consider that it is
factoring in a person’s worth. You have
worked your whole life, played by the rules, and paid into the system. But in the end you have no more worth than
someone who didn’t pay into the system, never worked a day in their life and
didn’t abide by society’s rules. And to
suspect that someone will be the beneficiary of your labor merely based on the
fact that their parents had state sanctioned reproductive rights and are judged
to be participating citizens? Where do
you draw that line? And you can bet that our politicians will be a level up on
the worth scale as compared to the masses.
Who decides these things?
TS: Depressing
topic. Let’s move on. Back to the ACA. What about the implementation?
DR: The Obamacare rollout cost the taxpayers over 634
million dollars for a system that doesn’t work and no one seems to be
accountable. The website was
fundamentally flawed, and despite government claims that the system was simply
overwhelmed with traffic, it turns out that was just spin. The system is filled with bugs and errors and
is just not ready for prime time. The
government shut down got all the press.
Meanwhile the public’s attempt to sign up for insurance through the
exchanges was, and still is, a complete disaster.
TS: But today
Sebelius stated the system didn’t crash, it just wasn’t working. Hysterical.
DR: Just more spin
that will be followed by finger pointing. This administration loves to talk and
is intent on pushing their socialist agenda consequences be damned. But they are extraordinarily poor at
implementing anything. All we seem to
get is more partisan rhetoric and nothing gets accomplished. We have a President with no experience in the
private sector, surrounded by staff with no experience in healthcare delivery,
pushing a defective product that does not work, that they themselves will not
have to use. And if you don’t buy it,
you are penalized. You can’t make this
stuff up.
TS: Why wouldn’t they
have succumbed to Republican demands for a provision to delay Obamacare
implementation for a year? It seemed like the Republicans were offering them
a way out.
DR: Right, knowing
full well that the system was not ready for implementation, why wouldn’t they
have allowed another year to get it right?
They gave out exemptions to all of their campaign donors, big corporate
cronies and supporters like Halloween candy and even chose to exempt
themselves, but rammed a second rate system down the throat of every day
Americans.
TS: So I take it you’re not a big supporter of socialized
medicine?
DR: As far as I am
concerned, the government has already auditioned for universal healthcare and
failed miserably. Medicaid is perhaps
the most inefficiently run, financially draining, government run disaster ever
conceived. I assume you are aware of the
recent study that compared Medicaid patients to those that had no healthcare
whatsoever and found no statistical difference in health between the two
groups?
TS: Yes, incredibly sobering statistics.
DR: And even more
sobering is the fact that much of the Affordable Care Act is based on the
Medicaid model. It would be like basing
the design of all new cars on the Ford Pinto.
TS: Interesting
analogy………
DR: But
accurate. Why would you use a poorly
functioning model of healthcare as your template? Obamacare has expanded Medicaid into the middle
class and will inject upwards of 30 million more participants into a system
that functions poorly already.
TS: Many doctors currently
don’t accept Medicaid. Do you take it in
your practice and if so, what has been your experience?
DR: I accepted
Medicaid in my practice years ago, but it was financially unsustainable. An
analysis showed that we were actually losing money seeing Medicaid
patients. We could just not work fast
enough to make it profitable and the reimbursement is positively draconian. The fee profiles in Medicare are even worse.
TS: That bad?
DR: Some parts of the
country have not seen fee increases in decades. Some reimbursement profiles are
as low as 30% of the usual and customary fee.
In New York, last year Medicaid actually cut their reimbursement profile
retroactively during a budget
shortfall. So they cut the fee on
procedures that had already been done where doctors were awaiting payment.
TS: That’s
unbelieveable. They can do that? What was the response?
DR: It’s the
government and yes, they can do that. A
lot of providers like myself abandoned the program, a lot of specialists. Many states have flirted with the idea of
tying licensure to a requirement to accept Medicaid, but fortunately I’m not
aware of any state where that has come to pass.
A Wall Street Journal poll of doctor’s
opinions showed that 56% are still evaluating or don’t know if they will
participate in the new plans offered by the exchanges, but 55% thought the
plans will have a negative impact on
their practices. So it appears that doctors
are waiting to see what the plans have to offer, whether they may have to
accept the plans to remain viable, but they do not have high hopes.
TS: But if
practitioners do not accept Medicaid, or the plans offered by the exchanges, where
do they go?
DR: Precisely. It then becomes an access to care issue. Now think about it. Medicaid is the model for Obamacare and we
are about to inject some 30 million more patients into the system. It has been estimated that we will need
another 42000 primary care doctors in this country to treat that influx of
patients. And many doctors are not going
to be willing to accept those patients.
We are already seeing doctors retire early, become salaried staff
members at hospitals or adopting a “concierge” style of practice that reduces
patient access to the few that can afford it.
TS: Based on the
miserable reimbursement?
DR: Not only that,
but we have to look at exactly who makes up the Medicaid population. Many of them are elderly. But a great deal of them are young, indigent,
unemployed, undereducated, disabled.
This is an extremely difficult patient population to treat.
TS: How so?
DR: Take my practice
for instance. My patient population is
approximately 30% state-run managed care.
Mostly lower income folks with jobs who make too much to qualify for
Medicaid, but have low incomes that qualify for state subsidized programs, much
like what we can expect from the sliding scale of Obamacare exchanges. As I said, I no longer accept Medicaid due to
its low reimbursement profiles. State
run plans reimburse better because they are currently managed more efficiently
by insurance companies, but they are taxpayer subsidized. They are the next rung up from Medicaid.
TS: So a very similar
socioeconomic group as compared to Medicaid recipients, but a better run program,
and a little better off.
DR: Exactly. In my
practice we have found that this demographic has some interesting
characteristics. These lower income patients are often less educated and less medically
astute, and therefore extremely apprehensive, so they wait until late in a
disease process to seek treatment. They
are more often smokers, more often substance abusers, more likely to have
complex medical histories, more allergies to medications, with higher drug
tolerances. In other words, a
significantly higher risk population to treat.
TS: For example?
DR: As an example, in
the ER this morning I saw an obese 24 year old woman, multiple tattoos,
complaining of shortness of breath, unemployed, single, with three children
aged 8, 6, and 2 with a history of sexually transmitted disease, asthma,
anxiety and chronic back pain. She was
taking Albuterol [author note: a
bronchodilator to prevent wheezing, difficulty breathing, chest tightness and
coughing caused by lung diseases such as asthma or COPD], Klonipin [author note:
sedative, hypnotic class drug used to treat anxiety and act as a muscle
relaxant], Lamictal [author note: an
ant-seizure medication also used to treat bipolar disorder] and round the
clock Hydrocodone [author note: a potent prescription narcotic pain reliever
found in Vicodin] She was a 2 pack
per day smoker with a history of multiple prescriptions for the narcotic pain
medication every two weeks for the last ten months. In the next bed was a 13 year old with a
facial infection caused by one of perhaps 12 decayed teeth. He had a history of an abusive home, a
pregnant 16 year old sister, and was in the custody of his grandmother. He had
a history of depression and was taking Prozac. He was unmanageable and
combative in the treatment room and had to be scheduled to be put to sleep in
the OR to address his dental problems. Both
of them were on state plans, both using the ER as their primary care physician. The Affordable Care Act will not change their
self-destructive behavior, but will have to pay for it.
TS: And higher risk patients
like this means more complications?
DR: Amongst other
things. Anesthetic cases are more
difficult to manage due to higher drug tolerances. Anesthetic complications are higher due to
the effects of smoking. Irritable
airways, COPD, asthma, bronchitis are all very high in this patient population.
Sometimes it seems like I’m trapped in an episode of Mad Men when I treat these
folks. They are more likely to call
after hours and require additional procedures and time to treat their
complications. All time and treatments
for which I am not compensated.
TS: So you work
harder for less money. And most of us that live in yuppie-land think smoking
has been largely irradicated. How can they afford that habit? Aren’t cigarettes up to 8 bucks a pack now?
DR: When the government entitlement programs pick up the tab
for all your necessities: rent subsidy,
heat subsidy, SNAP (food stamps), WIC, cell phones, transportation to and from your
doctors appointments, not to mention earned income tax credits………that frees up
a lot of cash for booze, drugs and cigarettes.
TS: That always
infuriates me. The recent government
glitch in Mississippi where they failed to put a limit on their SNAP, WIC and
EBT cards…….
DR: ……and they went wild at the local WalMart and cleared
the shelves? When management realized
what was happening and shut it down, they rioted.
TS: Welcome to the Entitlement States of America……
DR: It is just
amazing that the Affordable Care Act has been touting monthly premiums less
than your cell phone bill. If you are
that broke, you shouldn’t have a cell phone, and you sure shouldn’t be smoking. A colleague of mine once told me that nothing
is more infuriating to him than accepting a Medicaid patient only to find him
in your waiting room streaming video on his iPhone.
TS: That’s awful. Since
when did a cell phone become a necessity? We have all heard the stories about
Obamaphones. Yet another entitlement.
DR: I recently heard
an interview on NPR where a woman and her husband supposedly made less than
twenty thousand dollars per year, but sailed through the exchange and emerged
with government subsidized healthcare for $60 a month. And she proclaimed it
was just like Obama said: less than her
cell phone bill. Now from my experience,
it is likely she has children and more than likely she is a smoker. If you and your husband have a two pack a day
habit, then you are spending in excess of $900 per month on cigarettes in
addition to a $60 per month cell phone bill.
And you can’t afford healthcare?
TS: And from what
I’ve heard about access to the government website, NPR must have found the only
woman in the country who managed to sign up.
DR: That truly is
some feat of investigative reporting.
Despite claims that 40000 people signed up for healthcare through the
New York exchange, it was determined that after day three precisely zero had
actually acquired a healthcare plan. And
New York has their own exchange, not the federal exchange.
TS: I read the same
thing. After the first three days, only
one signed up in North Carolina, none in New York. As of day 18 reports had Maryland at just
over 1000 enrollees and Colorado at 226.
Most states, naturally, are not releasing data. It has been reported
that nationally, despite 3.72 million people who entered the registration
section of the website, only one million registered successfully and only 36000
actually completed enrollment.
DR: Not very
encouraging statistics. But what I find
infuriating is the fact that this is nothing more than another massive
redistribution of wealth. Why was Obama
against any form of income verification?
Who exactly is going to pay for a system where there is no premium bias
for pre-existing conditions?
TS: I assume you are
being rhetorical as we all know where the money is coming from.
DR: Yes we do. We are going to be subjected to massive
premium increases to fund the currently uninsured. I read that in the first year they expect 7
million people to sign up, with the requirement that 2.3 million of them have
to be young and healthy to subsidize the program.
TS: And according to Sebelius, after three weeks of the
exchanges being open, she cannot give us an accounting of what the ratio of
sign-ups has been thus far. In fact, she
wouldn’t even reveal any figures regarding the number of people that have
signed up through the exchanges at all. She kept repeating that the results
will not be available until mid-November.
DR: More stalling.
You know they have the numbers. The youth of America, those healthy
individuals who probably would go without healthcare, are going to be forced to
foot the bill by paying for healthcare that statistically they are unlikely to
need. And Seniors…….I just don’t
understand why there hasn’t been a massive gray-haired revolt……have been sold
down the river by this administration and the AARP, who backed this
debacle. 716 billion dollars cut from
Medicare to fund the 30 million newly insured.
Good Lord.
TS: Just when we need
it. It won’t be there. Or at least not
what we have now. According to a report in Investor’s Business Daily (October
10, 2012), within the ACA there exists a point system to award points to
hospitals for reducing spending specifically on seniors. They call the parameter “Medicare spending
per beneficiary”.
DR: They are attempting to reduce the cost by eliminating expensive
senior procedures like knee or hip replacements. They even punish hospitals for care that is
consumed 30 days after a patient is discharged, such as the physical therapy
required after a hip or knee replacement.
TS: How short is the
public’s memory? In 2009 at a town hall
meeting, Obama actually told a senior “maybe you are better off not having the
surgery and taking the painkiller”. So
now he is an expert in orthopedics when the body of medical evidence clearly
shows the benefits of these procedures for seniors.
DR: It irks me to no
end that when I will need Medicare to be there, after working my entire life, I
will be unable to find a doctor, will be subjected to long waits to see a
doctor, or more likely a nurse practitioner or some other mid-level provider,
and then I may not be allowed to have the procedure at all. Or perhaps we will
have to pay out of pocket in a fee-for-service practice as the healthcare
system evolves into a two-tier system like England, where agonizingly long
waiting lists for cheap national healthcare exist side-by-side with no wait,
but expensive, private fee-for service medicine. Meanwhile the political elites are basking in
their boutique medical plans that they reserved for themselves by exempting our
elected officials and their staff from the Affordable Care Act.
TS: That’s
depressing.
DR: It is. But it is simply unsustainable. Where will the money come from? We are sacrificing the best healthcare in the
world on the altar of socialism.
TS: That’s good, let
me write that down.
DR: It’s true. It has been estimated that the Affordable Care
Act will cost three to four times the original estimate. And that comes from the Congressional Budget
Office, not some partisan think tank.
This administration is lying to us.
Already it has been estimated that premiums for males will increase on
average 99% and for females 62%. And
with figures just released that report only 63.2% of Americans participate in
the labor force, the lowest rate since the 1970’s, how is this sustainable?
Costs have to be contained and there are only so many ways to do it. Remember the Medicaid model: you can reduce the reimbursement to
providers, you can increase the premiums, or you can cut the services
offered. With so many participants not
working, and so many participants with serious health issues injected into the
system, that group is hardly a revenue source.
You can continue to cut the reimbursement to doctors, but that too will
reach a point of diminishing return.
TS: How so?
DR: With no future in
medicine, the best and brightest will look to Wall Street or technical fields
as a source for accumulating wealth.
Medical School already produces young graduates who average debt loads
in the vicinity of $300000 after spending their entire twenties in school. They
emerge to face long hours of internship and residency at abysmal pay scales,
only to face servitude as an associate or a hospital employee or perhaps an
exorbitant buy-in for a private practice.
And the Affordable Care Act never addressed tort reform, so medical
malpractice remains a daunting beast with high insurance premiums and
astronomical awards.
TS: No one ever
mentions that. How high are malpractice
premiums?
DR: It depends on
where you practice and what you do. Internists generally are at the low end of
the scale paying $6000 per year on average but it can be as high as $50000 in
some states like Florida. General surgeons average about $22000 to $34000 per
year. OB/GYN suffers the most with
premiums that can be as high as $200000 per year in some states.
TS: But surely the
reward is high in the form of salary.
DR: Sure, it is in
some cases of the surgical specialties.
But your average pediatrician or general practitioner, those guys who
will bear the brunt of the Affordable Care Act, those guys are looking at average
starting salaries in the low to mid 100,000 dollar range.
TS: Good money, but not much of a return on investment.
DR: No, not at all.
Especially if you consider that doctors in private practice medicine have to
self fund their own benefits and retirement contributions.
TS: Are you pushing
your kids into a career in medicine?
DR: Hell no. The generation before me was in the golden
years of medicine. Respected in the
community, low insurance penetration, and even when it existed, good
reimbursement. High degree of patient
compliance, low overhead, low malpractice, less government regulations. Those days are over. None of my colleagues have advised their kids
to go into medicine. And that too will
lead to physician shortages. Medicine is
just not sexy anymore.
TS: How about your
own personal experience with insurance plans and Mr. Obama’s claim that “if you
like your current plan you can keep it”?
He also stated that your plan would remain affordable or that you would
even save money under the ACA.
DR: Bullshit. The Affordable Care Act’s parameters for
plans to satisfy those guidelines are so stringent that it has been shown that
51% of current plans cannot meet the qualifications to continue to operate
under ACA mandates. And we all know what will happen. Those people that lose their plans will not
lose coverage, but will be herded into other plans that are either more
expensive for the same benefits or are similarly priced with lesser
benefits. My personal family plan was
cancelled last year and I was moved into a vehicle of similar cost, but with a
higher deductible and less benefits. And
this from a plan that in eight years has nearly doubled in cost.
TS: Yes, the Wall Street Journal reported that more people
may actually lose their current coverage than those that gain it through the
exchanges. Let me see here (reading from
the WSJ October 22, 2013)…….Florida Blue has already terminated 80% of
individual policies in the state, Kaiser in California has put 160000
subscribers on notice and Blue Cross of Philadelphia ha dropped 45% of its
customers.
DR: And as you said,
this behemoth continues to plow ahead.
TS: But some
conspiracy theorists think it’s all part of a larger plan.
DR: It does make you
wonder. Remember, our President is on
record saying that he “is a proponent of a single payer system”. The suspicion is that requirements that
insurance companies adhere to a set of ACA minimum guidelines is so demanding
that they will be forced to cancel current plans and offer ACA compliant
alternatives at a higher premium. This
will cause widespread revolt and the insurance industry will implode as they
are unable to be profitable given the mandates for taking on pre-existing
conditions and poor health risk patients without premium bias. The only thing left to do is turn to the
government and voila….Obama has his single payer system that he wanted all
along.
TS: It’s
frightening. So in summary, what is your
take on this? Can the ACA survive? What can be done to make government
healthcare in this age affordable?
DR: Well, Mr. Swift,
we both know that this isn’t about healthcare.
This is about socialism, government control and power of you and the
economy. Mostly this is about the
democrat pipedream of universal healthcare……a lovely ideal, mind you, but
economically impractical to implement in this format. This is a redistribution-of -wealth scheme of
massive proportions. And what is truly
frightening is that this administration continues to mislead the public, punish
the producers, punish business, punish the elderly and now in a strange
turnaround, has actually hit youth in the pocketbook , the very demographic
that supported them. Obamacare is being
funded on the premise that they can get healthy young people to buy premiums
that they statistically do not need, in conjunction with a reappropriation of
funds from Medicare, all to fund a program that will provide entitlements for a
non-productive demographic that will disproportionately suck up a huge share of
resources. Our elderly and our healthy
young people will bear the burden of the Affordable Care Act.
TS: Do you think it
can be fixed?
DR: No, I don’t. Like most government programs that have been
proven by hard data to be non-productive or at the least poorly functioning,
the government will continue to throw money at it until it becomes entrenched. The ACA will morph into another form, perhaps
a single payer system, but I think we’re stuck with it. The public will just get used to a new poorly
functioning version of healthcare. The
only way to make a program work is the same way it would work in the private
sector: make it profitable, or in the
government’s case, where they are spending someone else’s money, make it less
of a debacle. The usual response will be
to cut costs by providing less services, lower reimbursement to doctors, and
inject more money into it with higher taxes on the wealthy, which everyone
knows means people with jobs. I logged
into healthcare.gov and was met with a line that said, in summary, if you make
less than $46000 as an individual and $96000 as a four person family, your
premiums will be less than those indicated.
In other words, if you make more, expect to have a radical increase in
your costs to fund those folks. That was
two days ago. Interestingly, that
statement was gone when I logged in today.
TS: What would you do
to make the system functional?
DR: We have
essentially given a blank check to the most irresponsible members of
society. Now don’t get me wrong,
Medicaid is a necessity to act as a safety net to catch those unfortunates that
cannot provide for themselves: the elderly, the disabled, the handicapped and
to act as a short-term crutch for the jobless.
It is not, nor was it ever meant to be a permanent way of life for the
physically able-bodied. The average
welfare recipient in this country has been in the system for three
generations. If the American public is
going to pay for your health care, then a contract of sorts has to be devised,
just as if you were an employee. There
are certain things that you should not be allowed to do if it will take
resources away from the program….resources that could be better spent. Zeke Emanual should be all over that concept.
Pregnancy is one of them. Why do we
allow unchecked reproduction when pregnancy avoidance can be easily
implemented. There has to be a carrot
and stick form of incentive here. If you
maintain your health in certain parameters, you will be rewarded with
benefits. Not the other way around.
TS: So you propose
standards of preventative care that must be met to receive your benefits?
DR: Exactly. No pregnancy allowed and adherence to a
contraception regimen. I don’t want any
more kids and I shouldn’t have to pay for someone else to have them
either. And in this patient population
with high incidence of smoking and substance abuse, poor health habits and diet
choices, we are going to get premature babies in need of neonatal care. An expensive, and avoidable proposition.
TS: But the liberal
argument is that government cannot dictate the reproductive rights of the
people.
DR: No it can’t. But it can dictate the rights of the
taxpayer. I don’t have ten kids because
I am responsible and I know that I cannot afford that luxury. Medicaid recipients shouldn’t have ten kids
because they cannot afford them either.
If you want to have a child then have at it. But know that you will not be rewarded with
an increase in your benefit package.
That premise is moronic.
TS: And other health
guidelines……
DR: Smoking. You do not smoke on my dime. Period.
Children of smokers suffer higher rates of asthma and childhood illness,
and smokers are more likely to suffer more upper respiratory tract illness and
eventually chronic obstructive pulmonary disease. Bronchitis, Emphysema, not to mention risk of
cancer. All preventive and all expensive
drains on the healthcare system. Money
going towards a destructive habit is better served in supplementing your
healthcare premiums.
TS: and……..?
DR: Testing for
illicit drug use and alcohol. In my
rural locale, meth is running rampant. Heroin
is also making a comeback. Addiction and
alcoholism is treatable and the health risks associated with addiction are
frightening. Why would be possibly allow
these wards of the state healthcare system to engage in recreational drug
use? It’s preposterous. You want a check? Test clean.
TS: And other healthy lifestyle choices?
DR: How many times
have you been in the supermarket and have seen the two cart technique? One cart full of food covered by the state
welfare plan: chips, Mountain Dew,
twinkies…….hardly healthy choices. And
the other cart full of beer and cigarettes.
It’s absurd. In this age of the
bar code scanner we can know what the welfare recipients are buying and can
have an effect on their purchases. NPR
actually did a report that concluded that giving people free money makes them
happy. Their conclusion was that
charitable organizations should reconsider spending money on programs and
instead just give people money. That’s
what the states are doing now with benefit cards. Credit cards that the recipients can spend
freely as they wish. The result is that these
cards are being sold for cash and being used in strip joints and amusement
parks. I don’t think that is what the
public wants their hard earned tax dollars to go towards.
TS: But once again,
the liberals will argue that you cannot infringe on their right to eat junk
food or drink beer.
DR: And again I have
to agree with you. I have absolutely no
intention of telling my fellow Americans whether or not they should smoke, eat
junk, consume illicit drugs or engage in other risky behavior. I tend to lean libertarian in this case. I will happily advise you on what you should
do to maintain optimum health. But I
draw the line when the taxpayer has to pay for your indiscretions. If I have to pay for your healthcare
benefits, which amounts to me paying for the consequences of your poor
lifestyle decisions, then you have essentially given up your right to make your
own health choices and I will make them for you. And that should be a contractual
agreement.
TS: Rather than
stretch the healthcare dollar and be fiscally responsible, the liberals just
want more of our dollars.
DR: It is amazing
that they are willing to cut the amount they pay doctors and hospitals, hobble
the medical device manufacturers with innovation-killing taxation, cause
premiums to rise for the currently insured, and even consider rationing
healthcare, yet they will not address the preventative measures that can be
taken to reduce consumption of medical services by the those that are not
paying their own way. And I’m not
talking about pre-existing conditions.
I’m talking about lifestyle choices that result in serious medical
conditions that are entirely preventable.
TS: It will be interesting to see if after Obama administration
debacles that include Benghazi, the IRS targeting of conservative groups, the
Syria embarrassment, the NSA spying on our allies, the quantitative easing
money pit, the poor handling of the economy, the shakedown of JP Morgan, the
exemptions of Congress and their political cronies from the ACA, the wasted
green energy investments…..and the list goes on……..if finally the American
public will see in Obama’s signature piece of legislation the incompetence and
idealistic march towards America’s demise that are the hallmarks of this failed
Presidency.
DR: Never, ever
underestimate the stupidity of the American public. Especially if they continue to think that
they are getting something for free.
TS: It has been a pleasure speaking with you. I’m sure this interview will ruffle some
liberal feathers. Any final words?
DR: Thank you for
letting me voice my opinions. Let me be
clear. As a physician I do believe in
healthcare for all, but not necessarily the same healthcare for all. No one should be without access to healthcare
and it should not bankrupt your family. And as a civilized society we have an
obligation to care for the aged, the handicapped, the sick and infirmed. But we
have to be smart and manage the health of that other segment of the market that
is heavily subsidized, those that will disproportionately utilize more
resources relative to the amount that they put in. This can’t be another
entitlement that is written with a blank check by the taxpayer. Being a good
Samaritan is one thing, but exorbitant, punitive, progressive redistribution of
wealth is another. And if this plan is so American, so special, let’s stop the
exemptions for the politicians and the politically well connected. Let them have some skin in the game. This class warfare and class envy has to end.
This administration is all about fairness and equality. But fairness does not
necessarily mean that you should be forced to enroll in a healthcare plan with
benefits that you do not need, just to pay for benefits needed by someone
else. Healthcare is not a one size fits
all proposition. You should be rewarded
for healthy lifestyle choices, not forced to pay for the indiscretions of
someone who has chosen to ignore those choices. We all may be born equal, but
I’m sorry to say, if you are able bodied and able to work and choose not to,
choose to game the system, choose not to work as hard as your brother to better
yourself, then you are not his equal and do not deserve to enjoy the same benefits. There are just too few horses pulling the
wagon. Healthcare for all shouldn’t mean mediocre healthcare for all, and
especially not at the expense of our seniors.
Let’s be smart and end this entitlement era. Fairness should not mean entitlement, it
should mean getting what you deserve.
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