As Republicans contemplate repealing the Affordable Care Act (ACA or “Obamacare”) -- seriously, not just as a political gesture -- alarms are sounding about millions of individuals losing coverage.
So soon we have forgotten about the millions who lost coverage they had had for years because Obamacare outlawed it.
Obamacare resulted in perhaps five times as many losers as winners -- even counting just those who ended up with more expensive or less desirable coverage. If you count the taxpayers, the tally of losers is much higher. But with government largesse, the losers -- the ones who have their earnings taken away -- are “forgotten men.”
Anyone who has government-funded benefits taken away, on the other hand, becomes a victim.
The best poster children are cancer victims. They face a premature, particularly nasty death. Who would deny someone’s mother or 4-year-old daughter the chance of a cure, even if the chemotherapy costs more than $100,000?
Obamacare would. Exchange plans have excluded the best cancer hospitals from their narrow networks. Medicaid would. It might call the treatment “experimental” or “not cost-effective.” Medicare would, possibly just because the patient is “too old” or “too young.” Unless the particular victim can be featured in a PR campaign to “save Obamacare,” she might be “better off with the pain pill,” as President Obama put it.
And let’s not forget how the FDA has driven the costs of drug approval sky-high, suppresses therapies that have no prospect of turning billion-dollar profits, and protects manufacturers against competition when the drug is about to go off patent. The anti-leukemia drug Gleevec, for example, cost $26,000 per year in 2001, a price called “high but fair,” considering the cost of research and the need for profits. It is $146,000 a year today, but the introduction of cheaper generics in the U.S. is being delayed.
Why can such prices be sustained? Because third parties sometimes pay them. One Obamacare plan reportedly pays $10,488 per month for Gleevec, from a pharmacy with which it apparently has an arrangement, although it might be available from Walgreen’s for $4,400, and from other pharmacies for still less. What would the hapless patient do if her Exchange plan went out of business (maybe because Republicans took away its subsidies or maybe because it just failed)? One option would be to go to India and buy a year’s supply of a generic version of Gleevec for $400. (The cost of manufacture is $159.) In fact, the manufacturer might well give her the drug to buff up its image. But drug companies really love the third-party payment schemes, just like big hospitals do.
Do the designers of ACA -- which would be more aptly named the Unaffordable Care Act -- really care about cancer patients? Such patients may be useful props for lobbying, but they don’t help achieve the reformers’ stated goal of maximizing “population health.” Prolonging the lives of sick people reduces the average health score. Money spent on Gleevec is diverted from reducing disparities, achieving “quality” quotas, and paying for the information technology and administrators to “document” all that (and sell the data).
The current “healthcare delivery” system, including entitlement programs (e.g. Medicare and Medicaid), is about the redistribution of wealth and the control of medical care, which enables control of the population. The idea of comprehensive third-party payment for all medical care (all that is allowed) destroys medicine—the care of the sick—while placing unsustainable burdens on the economy.
The people who are terrified about losing their Obamacare “coverage” are the very ones at greatest risk of losing their lives if Obamacare is perpetuated.
Real reform would put patients back at the center and demote insurance companies to their proper function of reimbursing subscribers for the costs of unexpected catastrophes. Costs would plummet, and innovation would soar.
While the free market is building much better facilities, some patients will be caught in the transition. But we should be concerned about their actual care, not their coverage. They can be helped in many ways, without destroying arrangements that work for the 99 percent. Perhaps a dollar-for-dollar tax credit for those helping to pay for their treatment?
What if we said that those who like their government medicine can keep it? Just let the rest of us go.
Jane M. Orient, M.D.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.