Obamacare’s cruel paradox: Acquiescence to mediocrity for all but the rich

Instead of elevating the level of medical care for the vast majority of Americans, Obamacare merely diminishes the overall quality of care for those within its grasp. Photo: Washington Times

SAN DIEGO, January 7, 2012 - Proponents and Opponents of the ‘Affordable Care Act’ (aka PPACA or Obamacare) both manage to take the same set of statistics and twist them to shape their uniquely partisan vision for health care reform in America. It seems obvious to anyone today, however, that the 21-month old, multi-year phase-in for the ‘Act’ will cost more than originally projected, will ultimately lead to restricted choices for patients and physicians, and will remain an enigma to the vast majority of medical consumers in the United States.

Even the casual political observer can appreciate the brewing battle between the left-leaning federalists and the right-leaning libertarians when it comes to the ‘Act’. The ‘left’ is looking to the government to control, save, and manage medical care, whereas the ‘right’ believes the smartest, safest, and most efficient health system is that which is driven by market forces primarily.

The term “essential benefits” is actually used in the PPACA legislation, and is put there for a reason. The purpose was to define, circumscribe, design, and (let’s be honest) limit the services which patients can access in medical facilities. The new law seeks to create parameters for the payment of medical services—specifically, what percentage patients will pay, under what circumstances, and up to what limit. These details may seem tedious at first glance, but make no mistake about it: these are the very details which determine whether treatment and pharmaceutical options will be realistically available to health care consumers.

‘Essential benefits’ for patients should allow for continued access to treatments—even expensive ones! They should not be designed to exclude options which could be life-saving. They should not be mandated in such a fashion where patients find their co-payment or co-insurance to be so prohibitive that they stop using the prescribed services or products, causing manufacturers to eventually stop producing certain products and/or providers to stop prescribing them.

Why? Because, as European ‘nationalized’ medical systems so clearly demonstrate, the rich will just pay out of pocket to ‘private’ doctors and ‘private’ facilities to get the care they need and want, regardless of what insurance they are allowed. Alternative medical care options available for the American poor (and most of the middle class) will be essentially non-existent.

A little known secret of health care financing is that you can negatively influence consumer choice and access through the subtle manipulation of patient co-payments. With regard to medications, most patients will be unaware of potentially different therapeutic efficacies of certain generic and brand-name drugs. Most patients will be fooled into thinking that within a ‘class’ of drugs all of the choices are therapeutically equal. Likewise, the downstream implications for wholesale de-selection of more expensive, newer medicines could dissuade corporate investments in research and development, with long-term disastrous consequences for all of society.

Most consumers of pharmaceuticals, for instance, do not understand that a mandated ‘tier system’ for certain drugs, combined with the use of the more expensive ‘co-insurance’ clause (instead of mere $25 or $35 a prescription ‘co-payments’, for instance), can literally drive a particular drug out of the market altogether.

Add to this the 2009 Stimulus Bill and Obamacare provisions for ‘academic detailing’ (a practice that requires the Department of Health and Human Services to promulgate regulations aimed at “preventing conflicts of interest and ensuring the accuracy of the pharmaceutical company educational materials”), and you have an Orwellian nightmare of epic proportions. Herein, the federal government—in pure, unregulated hypocrisy—will espouse medical guidelines for essentially political purposes. Unlike the drug companies they are purporting to counter, the government in this context will not have to obtain FDA approval or double-blinded studies to back up their positions against certain medications or treatments. They will need merely the impetus for cost-effectiveness to drive their version of the federally-funded ‘truth machine’.

The implied purpose of the ‘Affordable Care Act’ was not just to make health care affordable, but also to more effectively make the miracle of American medicine available and accessible to millions of more Americans—and thisshould mean translating the same outcomes, benefits, and services to all patients.

In a 2007 study in the Journal of the American Medical Association (JAMA), for each 10 percent rise in patient cost sharing, medicine use fell between 2 percent and 6 percent. And, in a 2004 JAMA article, it was shown that doubling co-payments could lead to a 17 percent increase in emergency room visits and a 10 percent increase in hospitalizations among patients with diabetes, asthma, and acid reflux disease.

If the purpose of the new health care law is to restrict care, ration services, and deceive consumers with classic bait and switch tactics, then we should not be arguing at all about the merits of the law itself, but rather about the implementation of socialized medicine in the United States. In this case, the political left would logically argue for simply giving medical students a free education, paying doctors like employees, and perhaps even mandating a two-year post-residency period of ‘national medical service’ for all doctors so that a renewable pool of ‘medical peace workers’ can fill all of the gaps in our nation’s medical needs wherever they may exist. This does not appear to be what the majority of Americans want at this point, but it seems only prudent to mention this option if the Obamacare train can never truly be stopped. Some would say we may as well just get the whole socialized thing over with in short order.

If, on the other hand, the proponents of this law are serious champions of maintaining the superior nature of American medical care, we must give credence to the Obamacare opponents (seemingly a majority) and allow the opportunity to re-do the PPACA’s sloppy 2,700 pages—some of which are specifically designed to micro-manage, restrict, and curtail patient choice and patient treatment options.

With great change comes great responsibility. Mastering the science of health care reform means not only reading legislation before we pass it, but also understanding the real-world dynamic of health care economics at the level of the board room and the bedside.

In a cruel misconstruction of fate, Obamacare will serve to further ostracize mainstream Americans from the privileged upper echelons of America’s top docs and top medical institutions.

Most know that the AMA represents a slim minority of practicing physicians and yet proffered to speak for all of them in support of the PPACA law. Most also know that the AMA receives tens of million of dollars annually (72 million in 2010 alone) from a federally-sanctioned copyright royalty on all medical billing codes.

It is ironic then, that the AMA’s own 2010 ‘Code of Conduct’ manual—a well-written document designed to protect the rights of patients (and even, frankly, to safeguard the independent practice of medicine by physicians)—contradicts the very health care reform legislation which they helped get passed.

Note Section 5, bullet # 4 of the AMA’s “Health Insurer Code of Conduct Principles — Standards for health insurers’ administrative and clinical processes”:

“No care may be denied on the grounds it is not ‘medically necessary’ except by a physician qualified by education, training and expertise to evaluate the specific clinical issues.”

To understand this concept, one only has to consider these facts: Obamacare does not save money; Obamacaredoes not sideline abusive trial attorneys; Obamacare does not increase the role of medical doctors; Obamacare does not simplify the essential and sacred doctor-patient relationship; and, Obamacare wastes billions of dollars building dubious governmental oversight and unnecessary new agencies. What the ‘Affordable Care Act’ does do is create layers of bureaucracy and red tape, serving only to fritter away dwindling resources and grind the mainstream medical establishment to a halting, mediocre pace.

Acquiescing to Obamacare would be akin to national suicide because it reflects a fatalist’s view of life—a slumping of our hopeful posture that there can be a better tomorrow.

More details on this, and similar subjects about health, medicine and politics in America can be found online atAmerica’s Medical Society.

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This article is the copyrighted property of the writer and Communities @ WashingtonTimes.com. Written permission must be obtained before reprint in online or print media. REPRINTING TWTC CONTENT WITHOUT PERMISSION AND/OR PAYMENT IS THEFT AND PUNISHABLE BY LAW.

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Adam Frederic Dorin, M.D., MBA

Doctor Dorin is a Hopkins-trained, board-certified anesthesiologist, practicing in a large group in San Diego. He is a small business owner, a Commander in the US Navy Reserves, and the Founder/President of America's Medical Society, Inc., (AMS) a non-profit corporation created to serve and educate physicians and the general public in matters of national health-care reform and medical politics

Contact Adam Frederic Dorin, M.D., MBA

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