Poking the bear in the eye – Obamacare and the federal abuse of power

A repeal of Obamacare in America would yield a healthier, stronger nation Photo: http://www.animalsw.com/ - Free Image

SAN DIEGO, October 26, 2012 – Today, at the University of Southern California Keck School of Medicine, this physician and writer will be debating a doctor of public policy. The subject: “Should Obamacare be Repealed.” Here is the argument, in a nutshell, for why a repeal of Obamacare in America would yield a healthier, stronger nation:

Obamacare takes 2,700 pages of ‘law’ and expands it (to date) to over 13,000 pages of regulations. By the time the Secretary of Health and Human Services and other government agencies are finished actually writing the ‘regulations’ to go with the law, the number of pages to the bill will be over 150,000 in total.

At its premise, Obamacare claims that ‘universal insurance’ = universal access, but we know that this is not true. Obamacare further claims that the widespread use of ‘preventative care’ will translate into better health. However, as reported recently in the Wall Street Journal and elsewhere, the huge Cochrane study of over 180,000 patients (in nine separate research venues/studies) revealed that there was no benefit from routine, across the board, screening and exams.

Obamacare will dump millions into Medicaid. Government subsidies will translate into government approved ‘coverage’ and, after about a decade, most people in America will actually end up in some form of government-sponsored insurance plan. But, even in this grand new era of national health coverage, millions of Americans will remain uninsured and millions will lose their employer-based health plans altogether. Will Medicaid actually deliver on good medical care?

It is an accepted fact that, under Obamacare, premiums will rise. Medicaid roles will increase by an estimated 17 million people, and yet the money to support Medicaid (and doctors to see these patients) will not be adequate.

The key to understanding the flaws in the Obamacare plan come down to the following: Quality, Access, Gov’t Control, and Abuse of Power. As the Medicaid roles increase, many would argue that the real ‘war on women’ occurs with Obamacare, as 3/5ths of all Medicaid recipients are women.

Quality and Access:  with upwards of 83% of physicians in various recent polls thinking of quitting medicine or decreasing office hours, and a clear shortage of medical expertise across the board nationally, many patients will be denied care by a doctor under the Obamacare system.  

Physician extenders can do many things well, but they are not doctors.  Obamacare does not come up with the over $300 billion ‘doc fix’ for Medicare. On Jan 1st, 2013, doctors will face another round of cuts totaling about 27% in Medicare reimbursement. Coupled with millions of new recipients added to the Obamacare pool, there will be longer wait times to see a doctor (if one is seen at all)—and this is the best case scenario.  In many cases, physicians and physician offices simply will not be accepting patients with an Obamacare or Medicaid card. Timely care and quality care will suffer.

Government Control:  With an additional 1/6th of the U.S. economy under federal control in the world of the newly implemented ‘Affordable Care Act’, we are supposed to hope that non-practicing health care workers and bureaucrats can oversee and manage better care than the free market system. This is hard to believe.

Abuse of Power:  The IPAB (Independent Payment Advisory Board), section 3403 of the PPACA/Obamacare bill, describes how fifteen unelected individuals will be appointed by the President (or, in his/her absence, the Secretary of HHS) to essentially and bluntly ‘ration’ medical care. Furthermore, section 10320 of the bill speaks to “expanded powers” of the IPAB, wherein such things as gas, food, eating habits, and the type of car you drive will be scrutinized and analyzed to assess additional penalties and fees.

Lastly, and perhaps most damning, will be the RACs (Recovery Audit Contractor program) wherein private contractors will be paid a percentage of the ‘take’ to find and take away money from providers for ‘errors’ in medical billing and charting. Even if a minor infraction is inadvertently committed, the RAC program will be authorized to assess penalties on top of a complete refund (from doctor to Uncle Sam) for the services/treatment, even if the difference in the ‘correct’ billing amount and the ‘actual reimbursed amount’ is minimal. This is just unfair. RAC auditors will be incentivized by the Feds to harass doctors.

Obamacare assesses 18 new taxes and penalties for a total of $836 billion in additional fees to consumers through the year 2022. Note that 70% of those paying the Obamacare individual mandate tax will actually earn less than the 400% FPL (Federal Poverty Level) and 10% of those paying the individual mandate will be below the poverty line.

Cuts to Medicare from 2013 through 2022 will total 716 billion. These are comprised of a $269 billion cut to hospital services, $156 billion in cuts to Medicare Advantage programs, $145 billion to DHS payments and other Medicare provisions, $66 billion to home health services, $39 billion in cuts to ‘other services’, and $17 billion to hospice services.

Beginning in 2014, there will be $106 billion in new costs to employer-mandated coverage; $102 billion in annual fees on health insurance providers, $55 billion in the actual individual mandate to buy health insurance; and in 2018 an additional $111 billion in excise taxes for ‘Cadillac’ employer health plans. From 2013 to 2022, 13 other taxes will add an additional $144 billion in taxes to consumers.

In February of 2011, an article in the Annals of Internal Medicine showed that the ’97 Medicare cuts actually increased hospital deaths by 8% due to nursing shortages. In a report by the Robert Wood Johnson Foundation, Robert Samuelson wrote “if universal coverage makes appointments harder to get, emergency room use may increase.”

Using statistics from August 2012, we see that the U.S. collected $2.28 trillion in the name of fighting poverty. Divide this by the 46.2 million people estimated to be below the poverty line and we get $50,000/poor person. Could, perhaps, we have simply devised a system to help the poor instead of actually recreating this Obamacare health care ‘reform’ monstrosity? Many would argue that $50,000/person spread out even over several years could provide a lot of coverage for any patient.

Those on the political left say that it’s all about ‘helping the severely poor’ and ‘providing universal access’, but let’s remember that we can help the poor without recreating our health system in over 150,000 pages of new regulations; and we can understand, again, that ‘universal insurance’ does not mean universal access.

Proponents of Obamacare want to point to the ‘pre-existing’ condition clause, but that is not an accurate ‘benefit’ accolade because 37 out of 50 states already have a pre-existing condition exclusion prevention clause; furthermore, this benefit can be ‘mandated’ without an entirely new health system. Many will also point to the “age 26” benefit of Obamacare that allows children to stay on their family plans until the age of twenty-six. But a reality check will show that military families under Tricare already do not have these extra three years for their kids unless they pay an additional $200/month for the child for each year until age 26. This ‘pay to play’ provision for the military can also work in the civilian population. If we want it, we can choose to pay for it.

Americans can do better than allowing more government intrusion into their lives. At some point, the authority granted over to others in positions of power will result in not only waste, inefficiency, and a ‘government first-patient second’ mentality, but it will yield to unadulterated abuses of power.

Future articles by this author will detail personal assaults and harassment for simply speaking out against the current power structure in America. The First Amendment Right to ‘free speech’ is more of a myth than most of us would like to believe. In school we are taught that ‘power corrupts and absolute power corrupts absolutely’. Imagine a scenario wherein not only your personal and political beliefs are scrutinized by government authority figures, but also the very healthcare choices of your loved ones are at risk. This is the Obamacare nightmare.

Let’s put patients first, the way Hippocrates envisioned it, and repeal Obamacare so that patients and doctors—not bureaucrats—write a new and improved health care reform plan.

 

Doctor Dorin is a board-certified physician and founder of America’s Medical Society.  


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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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