Obamacare is a mess. I’ve watched my own premiums go through the roof. The electronic medical record – not required, but encouraged – is a pain in the lower anatomy for medical practitioners like myself. Both political parties are in a donnybrook about it, the courts are being brought in constantly, and the polls show great dissatisfaction from large segments of the country. Obamacare is also coincident with the implementation of ICD-10 diagnostic codes in the USA – another layer of bureaucratic pencil pushing – for which many of my co-workers erroneously blame Obamacare.
Having said that, I support Obamacare. At least it’s a first step. I’m on the front lines of medicine in the Emergency Room, and I see the mess – and insanity – of the problems we had before it came along.
First, a quick story. I know a man who, as a child in the Great Depression, had appendicitis. The surgeon told his mother, a dirt-poor widow with too many children, that he would only perform the surgery if she paid him $50 first. Relatives in other parts of the country came up with the money, and the child’s life was saved.
My question is simple: should we be able to deny life-saving medicine to someone, particularly a child, simply because he can’t pay? There are people who would probably say ‘Let the kid die,’ but I don’t think most Americans would agree.
If you say ‘No,’ then there’s our problem.
Obamacare did not force the US into socialized medicine, simply because we already had socialized medicine. Since 1985 we have had COBRA,1)That law was followed by EMTALA, often called ‘COBRA on steroids’. which requires that a sick patient cannot be denied essential medical care. That law forced the ER to become the primary care provider for a lot of patients. And it provided those patients with the most expensive, and most inefficient, delivery system for their illnesses.
Which brings us to one of the recurrent themes in this blog, the insanity of modern partisan politics. Because what most everyone has missed, is that COBRA socialized medicine because it mandated that the rest of us will pay for it. Consider that the people who use the ER for primary care are those who do not have health insurance, which largely means the poor. You can’t get blood out of a turnip, and the money has to come from somewhere. So the rest of us had to pay for the costs of COBRA, it’s just that the cost is hidden in hospital fees, insurance premiums, and taxes, direct and indirect.
Which gives us insight into the reality of the Obamacare debate: it isn’t about facts, economics, or the public will. It’s about political football, and the fatuous, absolutist battles about liberal and conservative.
Because the president who gave us socialized medicine, the man who signed COBRA into law, was none other than conservative icon Ronald Reagan. Reagan didn’t think of it as socialized medicine, and conservatives at the time may have griped quietly, but they largely went along with it.
So although I don’t like Obamacare as it stands, something had to be done. And I fault the Republicans, not for opposing Obamacare, but for not keeping their promise to come up with their own plan; I cannot believe that there is not some strategy with free-market incentives that would have been better and cheaper.
To my mind, all of this is evidence that our political fights aren’t about good government, they’re about the football mindset. Both sides are playing win-lose, neither of them right now are nearly as interested in good governance as they are in vilifying the other side, and winning the next football game.
I mean winning the next election.
We all need to ask ourselves three simple questions:
- Should a child be denied life-saving healthcare?
- Should an adult be denied life-saving healthcare? And if the answer to either question is ‘No,’ then:
- What’s the most economical way for the rest of us to pay for it?
Everything else is bunk.
Picture courtesy of Picserver.org.
Footnotes [ + ]
|1.||↑||That law was followed by EMTALA, often called ‘COBRA on steroids’.|