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Columns

Obamacare Repeal vs. Reality

March 22, 2017 - 6:00am

The attempt by House Speaker Paul Ryan and other powerful Republicans to “repeal and replace” the Affordable Care Act (ACA or “Obamacare”) has run into a buzz saw of opposition from both sides. Most proponents of the American Health Care Act (AHCA) concede that the Act is “not perfect.” But there is “political reality” to consider—what can make it through the congressional sausage-making machine? Already Congress is telling us the most important consideration for them: staying in power. The 2018 election will be a “bloodbath” for Republicans if AHCA is not passed—or else if it is passed.

The outcome of the midterms supposedly depends on how unhappy the American people are. But the political reality is that the happiness of the donor class is far more important. Most of the donor class resides in the “Swamp.” Perhaps the best thing to say about AHCA is that it has the right enemies: the AMA, big hospitals, and some big insurers (who all favor ACA).

Leaving aside political reality and looking at actual reality, these are some facts:

It is very difficult to take away an entitlement, and Obamacare entitlements have had seven years to take root and spread. And while the media will be focusing on sad stories, the real losers with clout are not sick and dying individuals but the hospital/pharma/managed-care cartels. Coverage is not the same thing as care. Denizens of the Healthcare Swamp adroitly confuse the two. Coverage often blocks care, as with narrow networks, and inevitably drives up the cost. Government cannot provide care. Increasingly, it cannot even finance care, as governments at all levels are mired in deficit spending. Its programs forcibly redistribute a decreasing pool of assets. Guaranteed issue (no “discrimination” against people with pre-existing conditions) is not insurance. It destroys insurance; low-risk individuals will not buy it unless forced to do so.

Ohio Governor John Kasich said, “We cannot turn our backs on the most vulnerable. We can give them the coverage,… and make sure that we live in a country where people are going to say, ‘At least somebody is looking out for me.’”

In fact, Gov. Kasich, your congressman, the CEO of UnitedHeath Group, CareSource in Ohio (probably the chief beneficiary of Ohio’s Medicaid expansion), or the AMA are not looking out for you—but don’t mind using you to promote their own interests. The Medicaid expansion brought in far more new enrollees than the 5.5 million predicted, including 11.5 million able-bodied adults. Since resources for providing care were not expanded, funds are being diverted from the disabled and needy.

AHCA does not get rid of the basic flawed premises of ACA. Arguably, it cements them further. But is it a step in the right direction? The answer to that question ultimately depends on whether it permits a free market to develop outside the comprehensive managed third-party pre-payment NON-insurance model. If it has competition, that model will fail, and vast resources now diverted to the rapacious Healthcare Swamp will be freed up for actual care.

The question is not whether people will “lose coverage.” According to the Congressional Budget Office (CBO) analysis, most of the increase in the number of uninsured “would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

In other words, millions of Americans see ACA insurance as such a bad deal you have to force them to buy it. They would choose to reject it.

There are a few good features and many bad ones in AHCA. Tax “credits” are subsidies if people don’t owe taxes. But if credits refund payroll taxes, ending discrimination against people who buy their own coverage, that’s a step toward fairness and freedom. So is the liberalization of health savings accounts—especially if people have savings because they are freed from requirements to buy expensive comprehensive coverage, and to pay for people who decline to purchase insurance as long as they are healthy. The AHCA penalties for failure to maintain continuous coverage—like those in Medicare Part B—would help to discourage system gaming. However, any credits must go to patients, not third parties. And the government needs to stop dictating the terms of voluntary insurance contracts, including premiums.

Freedom is possible only if people are responsible. The worst feature of AHCA is perpetuating the myth that “non-discriminatory” coverage for pre-existings is insurance rather than a pipe dream.

We can hope that AHCA, if properly amended, might be a wedge of freedom rather than a way station on the road to a full crony capitalist/government takeover. The ultimate goal must still be the restoration of a free market. We need to get rid of the subsidies, mandates, and regulations that stand in the way, feeding the Swamp and propping up Obamacare. ACA needs to die. The unshackled free market needs to kill it, before or after Congress repeals every last word.

 Jane M. Orient, M.D.obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. She completed an internal medicine residency at Parkland Memorial Hospital and University of Arizona Affiliated Hospitals and then became an Instructor at the University of Arizona College of Medicine and a staff physician at the Tucson Veterans Administration Hospital. She has been in solo private practice since 1981 and has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989. She is currently president of Doctors for Disaster Preparedness. Since 1988, she has been chairman of the Public Health Committee of the Pima County (Arizona) Medical Society. She is the author of YOUR Doctor Is Not In: Healthy Skepticism about National Healthcare, and the second through fourth editions of Sapira's Art and Science of Bedside Diagnosis published by Lippincott, Williams & Wilkins. She authored books for schoolchildren, Professor Klugimkopf’s Old-Fashioned English Grammar and Professor Klugimkopf’s Spelling Method, published by Robinson Books, and coauthored two novels published as Kindle books, Neomorts and Moonshine. More than 100 of her papers have been published in the scientific and popular literature on a variety of subjects including risk assessment, natural and technological hazards and nonhazards, and medical economics and ethics. She is the editor of AAPS News, the Doctors for Disaster Preparedness Newsletter, and Civil Defense Perspectives, and is the managing editor of the Journal of American Physicians and Surgeons.

Comments

This doctor may have a degree from some unknown Med School but she is basically nuts and her little article here makes absolutely no sense! I don't have an hour to tear it apart...but I'll tell you one basic premise that's she is dead wrong on (and the Republicans are too) there is NO such thing as a "free market" in health insurance!! Period!! We tried that for the last 100 years and it doesn't work!!! Insurance companies are not charities...they are blood sucking businesses...and unless they are regulated...and your life and health are on the line...you'd better be damn sure that somebody (yes even the evil government) is looking out for you...because "deregulating" the insurance companies (there is that famous Republican word) to the "free market" (there is that other favorite Republican word) charge and do what the want...would only lead to your demise!!!! Don't be fooled by Trump, Ryan and all the other BS they are throwing at you!!!

The "free market", is just that, they're free to charge what they want, and it sure isn't free! I would agree with I C that businesses will NOT "save the day" nor will they even contribute towards that goal. Until, and unless the authorities actually, and properly crack down on the illegal behaviors of business, large & small, quite frankly no one will "save the day".

your point is well taken. People should not be forced to purchase insurance by the gov't. However, your belief that free market will somehow improve things is laughable. Insurance companies are like casinos. They exist solely to make money. They are inherently inefficient and deteriorating entities that exist and legislate only for that purpose. Now of course, some are better than others and want to provide a good service. Any free market system, unchecked, will resort to any means necessary, even criminal to keep the machine moving forward and making more and more money. It is largely "survival of the fittest". The free market system is actually one of the most inefficient means of production for these very facts. It ends up becoming more corrupt and actually towards the end of the life cycle self-defeating in efforts to continue to grow and consume more to make more. Don't take my word for this. Do your own research and you'll find the best, most efficient economies are balanced market economies with regulated free markets. Just look at the cable industry, housing and savings and loan crisis' for good examples, or read "Balance" or Nobel Prize winning "Perfect Economies". Politicians and party purists will have you believe that if everyone gets out of the way, businesses will save the day. Not so much...

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