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"What do you think of 'Obamacare'?"

September 2015
We don't usually talk religion or politics in the exam room, but we are frequently asked by patients..."What do you think of 'Obamacare'?" I think they just want to see how high my own blood pressure can rise. To save some exam room time, I will tell you all what I think. 

Healthcare in this country IS a mess. A logical, but devastating to the economy change would be full left-wing, single payer, government-take-over-and-run-it-like-Amtrak program. Rationing, price controls, uninhibited demand vs. a dwindling ability to deliver would follow. But at least it would be a consistent logical "solution" from a command economy view point. A right-wing, free market approach, would put patients back in control with mandatory tax-favored health savings accounts (self, employer, government funded), together with only catastrophic insurance (yes, maybe even government provided). When patients get to keep as retirement monies amounts not spent earlier (maybe only a portion if the government funded the account), they will be highly motivated to practice money-saving prudent lifestyle choices and demand of their physicians "why" anything expensive is necessary and "where" they can get the best deal. Both unnecessary demand and the prices fall. Dramatically. A good description of that kind of system was in the Atlantic magazine. Read it here: http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father-7617/. We got neither left-wing or right-wing reform. We got the same mess we have now with just a bunch more layers of bureaucracy, rule making, expense and frustration. While there were a few nice things (i.e. stay on parents insurance till age 26) in the big picture it won't work for ANYBODY and is very, very bad for the country. And it did not address the growing plague of lawyer driven litigation (across all industries) at all (best estimate of savings simply from "tort reform?" - about 20% - more than enough to just buy the uninsured commercial policies). For me? For a few years, I will probably make more money and enjoy doing so less - then they really tighten the screws. What follows is a good article on what will happen. RLF

Justice Roberts Is Right: The Plan Won't Work
Peter Schiff - Euro Pacific Capital
Monday, July 30, 2012

Now that the Supreme Court has given its narrow blessing to the Affordable Care Act, the big question is whether it will deliver the benefits that its proponents promise. Unfortunately, as it is now constructed, the plan will backfire causing fewer healthy people to buy insurance, raise premiums for those who do, destroy employment opportunities, cripple the health insurance industry, and weaken the economy.

In order to guarantee insurance to all, regardless of health or pre-existing conditions, the framers of the plan concede that it is essential that the young and healthy (who are less likely to be heavy users of health care) pay into the insurance pool. The surplus generated from their premiums compensates for the money lost to those receiving more in services than they pay in premiums (e.g. older people and those with medical conditions). But the ACA has given these healthy people a "Get out of Jail Free" card that many of them are sure to play. (continued here)

July 2016 - A good summary of the real problem in health care:

by Doug Farrago, MD
April 26, 2016

I have spoken about my catastrophic insurance plan for a long time. Here is the highlights from my Sept 2015 entry:

They are all trying to re-imagine healthcare by leaving the insurance industry and the government in the equation. That problem is unsolvable because they are the problem! Now remove the insurance industry. Remove the government. Let's say everyone has some catastrophic plan that is reasonable in cost. You can't tell me this is impossible to do. And let's say that for a cheap monthly fee the only thing that is covered is after you pay $5,000 of your own money (and maybe that is less depending on income). Let me repeat that. NOTHING IS COVERED! Guess what would happen? Patients would shop around. Doctors would be paid in cash and the prices would come down because there is no more coding, no more billing no more accounts receivable. Since overhead is less, the cost is less. If doctors don't lower their cost, patients will go elsewhere. Also, patients would only get prescriptions that are reasonable in cost. The cost for diagnostic studies and MRIs come down. This is capitalism and it works.

Americans are the best shoppers in the world. They are on the internet all day getting things on Amazon, etc. (continued here)

September 2016 - The previous Obamacare articles were largely predictive. The promise of MORE care, for MORE people, at LESS MONEY and NO MORE physicians AND the mandatory flattening of premiums (less difference between highest and lowest) should have been obvious to all as impossible. Yet  nevertheless, the American people bought into this scam. The article below suggests how well that has worked out......


Authentic Medicine Gazette
August 31, 2016

This really should be no surprise to anyone. You were told prior to 2012 that Obamacare was just making a bad situation, our healthcare costs, worse. You were told that this was just wealth distribution, where much of the population was being heavily taxed to cover the costs of others. Sure, they made it seem that the ultra-rich would be the target but that is the same trick they use every time for new taxes and this was one of the biggest tax increases for people in history.  In a recent WSJ article it was pointed out that:
  • Overall, health-care spending across the economy reached 18.2% of gross domestic product as of June, up from 13.3% in 2000, according to Altarum Institute, ad health research group. (continued here)

Spring 2017

Patients are asking: "What did you think about TrumpCare?" -- in short I thought it was an equal disaster for the country as is/was ObamaCare. As long as we have the inane necessity of sending bills for $100.00 worth of Primary Care services across the country to be assessed, adjudicated, chopped and diced by people who have never seen the patient nor bear any responsibility for their care - only to have it delayed, denied, or reduced for payment followed by the expectation that the practice must turn around and bill the patient for the "authorized" amount of their co-pay or deductible ($7.00? 20.00?whatever? it is hardly worth the expense of billing 3-4 months after service) we will have excess waste and excess games playing by patients, payers, and providers.

It is ridiculous for each physician on average to support two people in the insurance industry and another 1-2 in their own office just to get paid.

The same patients who are horrified if asked to pay their bill directly ("I have insurance!") think of nothing of dropping $300.00 for groceries and sundries at Costco, or paying their cell phone or cable bill directly. The cost of care will only be controlled when patients have their own cash in the game, paying directly to their providers up to some (perhaps slowly increasing) catastrophic level ($3000.00? $5000.00?) yearly. The marketplace will work just fine without the government or giant insurance companies distorting it. Tax favored Health Savings Accounts encourage that. Couple that with rarely used and thus cheap catastrophic only insurance sold to a national market and we have real reform. As an international traveler, I bought worldwide catastrophic coverage ($20,000 deductible) for only a few hundred dollars per year

Anything else is window dressing and special interest pandering. The country cannot afford what we have, and less so any of the "reforms" thus far offered. John Stossel says it well in the article below.

Free Market Health Care 
Government involvement in health care drives prices up.
John Stossel  March 29,  2017

President Trump and Paul Ryan tried to improve Obamacare. They failed.

Trump then tweeted, "ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!"

But I do worry.

Trump is right when he says that Obamacare will explode. (continued here)

A. Barton Hinkle
May 10, 2017

Democrats need to get their story straight.

First they tell us the GOP replacement for the Affordable Care Act is going to doom Republicans at the polls. Democrats in Congress were so confident on the point they even taunted Republicans with the "hey-hey, goodbye" chant.

Then Barak Obama urged lawmakers to summon the "courage" not to repeal Obamacare in remarks he made after receiving the John F. Kennedy Profile in Courage Award.

"Courage does not always mean doing what is politically expedient," Obama said at the JFK Library Foundation, "but what they believe deep in their hearts is right."

That is certainly how political courage is usually defined. But wait a sec - if the GOP health - care bill is so widely reviled, and therefore so politically toxic, then Republicans showed much bravery in passing it. Since they're going to get trounced at the polls for doing so, they must be men of great conviction. Why didn't they get a prize for courage? (continued here)

May 15, 2017 

Tough Choices
by Pat Conrad, MD
May 15, 2017

From the Blog of Doug Farrago

Note: This blog is directed at physicians.  It tells the truth. The truth is not pleasant.   RLF  

The hilariously named Affordable Care Act is working exactly as intended. It is collapsing, leaving an even worse sinkhole into which a fearful public, hyperventilated celebrity/media class, and gullible Republicans are diving. We are - and I really hope I'm wrong - accelerating toward the dreamed of/dreaded "single-payer" system. I'm not wrong.

We couldn't afford the ACA. We can't afford the replacement AHCA even if it gets passed. The states cannot afford Medicaid and its ever-expanding rolls. We never could afford Medicare, even before the Baby Boomers began to belly up to the trough.

When sitting around with family, friends, or coworkers and this topic comes up, someone will often bring up single-payer, and how wonderful it was in this or that country the lived in for a couple of years. I hear plenty of arguments that health care is a right, and that if you the taxpayer don't     
provide a basic level of  care, then there will be "people dying in the  streets, " which is to say, you killed them. I'm told that I can't disallow this person, or that, 
for respectively good reasons. So we don't say"no" to anyone? (continued here)   

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