The President and Democrats have spent the last three and a half years selling ‘Obamacare,’ the Patient Protection and Affordable Care Act of 2010, with a carefully planned campaign of laudatory speeches, comments, and editorials.
On June 15, 2009, President Obama made this promise to all Americans: “No matter how we reform healthcare, we will keep this promise: if you like your doctor, you will be able to keep your doctor. Period. If you like your healthcare plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.” The President and his allies have repeated such statements many times since.
Such non-ambiguous rhetoric was used to shape the public’s understanding of Obamacare. Now, we are reaching mandatory enforcement timelines. Millions of Americans are learning that they will lose their physicians, their hospitals, and their health care plans. This calamity has resulted in a furor that has finally registered with the media. It is clear that the promises of the president and many Democrats were simply untrue.
The president finally responded by stating: “I am sorry that they are finding themselves in this situation based on assurances they got from me”. Unfortunately, this does not seem much of an apology.
Further revelations show that the promises of reduced insurance costs, no new taxes, simple comparison-shopping and enrollment processes, reduction of the national debt and others were also untrue.
The endless campaign to sell Obamacare was based upon on the oldest and most successful technique of the flim-flam man. That is: the best way to sell a worthless product is to convince people that is something other than what it is. Then make the sale long before the buyer can learn the truth.
The reality check that Americans are now facing is that Obamacare is not at all what was promised, and never was. The silver lining to this charade is that the false promises did accurately reflect the reforms that Americans really want. Any replacement for Obamacare must address three basic necessities – choice, control, and cost: the 3 C’s.
Choice
Healthcare involves intensely personal interactions. The cornerstone is the patient-physician relationship, one based upon mutual trust. We must demand the right to choose the physicians, practitioners, and hospitals to whom we entrust our care.
Choice of the health care insurance plan is important. For some, a Health Savings Account coupled with a catastrophic insurance plan is an excellent solution, whereas PPOs, or HMOs may be best for others.
The disingenuous way by which Obamacare has been sold has been a wakeup call about the importance of trust when our health care is involved. Do we really want to entrust our health and lives to remote unknown bureaucrats who cannot be trusted even to be truthful? An essential ingredient of leadership is integrity.
Control
Control of important medical decisions is also an imperative. Physicians for at least the last 50 years have led a transition from “consent” to “informed consent,” consent after adequate disclosure, for medical treatment decisions. Doctors make certain that patients are carefully instructed about their disease, the various treatments that are available, and the risks and probabilities of cure. The physician usually recommends a specific treatment and the reasons for that recommendation. However, the patient retains control over the final treatment decision.
We must not cede this control to an aggressive government bureaucrat focused entirely upon the lowest cost treatment. Obamacare shifts control of all medical decisions from patients, physicians, medical organizations, insurers, and states to the federal government. A spectacularly inept bureaucracy will ultimately control all medical decisions.
Cost
Another broken promise was that Obamacare would lower costs. It is now obvious that is not going to happen. The Independent Payment Advisory Board (IPAB), an unelected panel, will have sweeping powers to enact price controls on every aspect of healthcare. This panel is not answerable to the Congress and Congress can only act with a supermajority in a limited time. The IPAB will have immunity from any legal action. We will be forced to accept their rulings without recourse.
There is a mountain of evidence on the impact of government imposed price controls, and it is all bad. The inevitable results are shortages, interminable waiting times, and ultimately, increased costs. This is unacceptable for anyone with a medical care need. The right of patients and physicians to negotiate any outstanding treatment costs beyond insurance payment is important. This occurs in Australia with their government program.
The administration has focused talk about insurance cost reductions upon monthly premiums for those who receive government subsidies. Subsidies do not reduce the cost of insurance, but shift the responsibility for payment to others. Actually, Obamacare increases all costs.
Another shell game aimed at the uninformed involves co-pays, co-insurance, deductibles, and out-of-pocket maximums. Under Obamacare, deductibles and out-of-pocket maximums have soared. This will have catastrophic impact upon many persons who naively expect Obamacare to cover life-saving treatments. They will learn the truth only when they are presented with massive bills for care after it has been rendered.
Another sleight of hand in the law is the transfer of over 700 billion dollars from the Medicare program to fund the massive expansion of Medicaid. So much for the “locked box” description of our Medicare contributions. This comes at a time of explosive growth in the number of patients eligible for Medicare – 10,000 per day every day for the next 20 years due to the aging of the baby boomers. These massive funding transfers will result in decreased payments for care of Medicare patients. As physician and hospital payments decrease to Medicaid levels, this will compound the inevitable shortages of physicians and hospitals that will accept Medicare patients.
Liability reform is another issue glaringly omitted from Obamacare. Reform of our outrageous medical liability system is generally accepted to be an absolute necessity in the fight to control costs.
Those insured through their employer receive their insurance tax-free. This is not so in the individual market. This inequity is grossly unfair and must be changed. For the system to be fair to all, any subsidies should be applied the same way, no matter what choice the beneficiary makes.
Another simple and very effective reform is to allow the sale of health care insurance across state lines. Can you imagine Amazon being limited to sales in a single state?
Finally, costs inevitably rise when the recipient of the product has “no skin in the game.” This does not preclude assisting those truly in need. Health savings accounts employing this principle have a clear record of success.
Attention to the three C’s offers a proven path to health care insurance reform that the public really wants. They do not turn our most valuable asset – our health – over to faceless bureaucrats, and they do not involve an unsecure billion-dollar web site that is an unmitigated failure.
The president promised health care reform that guaranteed every American choice, control and reduced costs. Obamacare does not provide any of these critical basic necessities. We do not need a bitter battle over repeal. Obamacare will collapse on its own because of its flawed design and its supporters’ broken promises. The sooner this occurs, the sooner we can proceed with proven solutions.
The authors were presidents of the American Medical Association. Dr. Plested from 2006-2007, Dr. Palmisano, 2003-2004, and Dr. Johnson 1996-1997.