The battle over Obamacare is a nonsensical partisan fight about socialized medicine, and neither side is focused on providing healthcare that works well.
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 generally 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 cover 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 between 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.
Continued below…
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’. |
|---|
The entire legislation was based on outright lies and misleading data, what they really want is single payer (socialized medicine) similar to Canada and England. We have (had) the best health care in the world, until the liberals took it over…The real issue is going to be quality doctors are going to disappear to the general public, extremely wealthy will be able to keep quality doctors, but most are not going to let the government tell them what they can charge and or how much money they make
Interesting points. But we only had very good health care for those who could afford it, and a lot of people can’t, even if they’re fully employed. For instance, if I have an 8 year-old with a broken arm who doesn’t have private insurance, almost no orthopedist will see him.
As a good businessman, I’m sure you know it’s not just benefit, but cost/benefit. The cost of our healthcare, and meds, are much higher than the rest of the world, to the point that for some surgeries it is cheaper to fly to Europe, stay for two weeks, and have a vacation with the surgery.
In my posts here, I’m trying to start conversations by looking at problems with fresh eyes, and not the tired phrases. Welcome aboard!
One of the reasons for the higher costs is the government policies that protect the drug and medical equipment companies. Drug companies are protected from competition, so they can charge whatever they want. One only needs to look at their financial statements to see that there are opportunities to reduce costs with different patent rules. Not to eliminate profit, but why should Americans be covering the costs a profit margin for the drugs sold to Europeans.
Stents placed in arteries are basically like very small Chinese springs. Remember those toys one was able to buy you stuck your finger in and pulled and it tightened around your finger. Stents just stay open in the artery. About a inch long and very small in diameter. Some treated with a slow release drug to reduce blood clotting. Why do these cost the hospitals $2500 +each (and patients use multiples in many procedures) when ther is so little material, maybe a dollar or two.
I remember in one of the Republican debates someone asked Ben Carson about the astronomical cost of meds. My ears picked up, but I quickly realized he couldn’t answer the question, it was the third rail.
We live in free market, so what is the balance between intellectual rights, and medical extortion? Just asking the question today is poison, lobbyists and partisans will be all over it.
Because it’s not just a problem with patented pharmaceuticals. Speak with pharmacists, drugs that used to cost a few dollars — or even less — have gone up orders of magnitude in the past couple of years.
It still has a lot to do with the fact that most countries regulate the price for drugs while the US does not. If the world market paid for the cost of the drug, plus an amount needed for new drug research and a small profit, then I suspect drug prices in the US would come down. there would be no need for Americans to cover much of the research and profit required by the drug companies.
As for Carson, he is a physician and I can tell you that most physicians his age have a poor understanding of healthcare costs and reimbursement issues. That is why so many of them are now part of health systems where healthcare financial managers oversee practices as physicians his age knew medicine, they usually did not know finance. The new age doc may be more in turn with reimbursement due to many new incentive programs that they make their living from.
As is always the question with great problems like healthcare, what does a good solution look like? I doubt that there is one single perfect answer, so let’s start talking about what a good solution should have.
First, it has to provide quality care for everyone, not just the rich who can afford to keep a doctor on retainer. And, we need a way to make the primary care choices for the poor to be something other than the ER.
Second, it has to provide proper compensation for the medical professionals. We can’t expect doctors to put in the time and expense for their education (and continuing education) and not be properly paid.
Third, we need a way to weed out the unacceptable healthcare providers. People who are more dangerous to their patients than the diseases they treat need to be removed from the healthcare field.
Fourth, we must find a way to eliminate the expensive middlemen in the process. Insurance companies do not add value to healthcare. They most certainly remove money from the patients and healthcare providers. There must be a better way. If that’s single payer / socialized medicine, then so be it. Of course, the single payer model puts the government in place as the single payer, and we all know that government bureaucracies are probably the worst. We need new ideas here.
Fifth, we need a sustainable way to fund this. It must include processes to ensure that bureaucracy and management does not begin to consume the funds that should be providing actual health care.
I’m sure that I missed other necessary facets of a good solution, and I’m sure that many will disagree with what I’ve said. But, until we start looking at what a good solution looks like, we will never figure out a way to get to a good solution.
Good points. Nearly impossible political objectives, alas…
See my comments to Roder. I don’t like what we have, but we have to do something. It really bothers me, the polls are clear that many people dislike Obamacare intensely, but when those same people are asked about the provisions and intents, a strong majority are in favor of quite a few of them.
It reminds me of the position on gun control. The same people who adamantly reject any increases in gun control, overwhelmingly want universal background checks.
Political football. *sigh*
Well I searched the constitution and no where does it say that everyone had to be provided health care, That said no one is dying in the streets there are charity hospitals everywhere. Don’t know you so not sure of your leaning, but to say everyone should get quality heath care is exactly what Obama and company want its called socialized medicine. In a free democratic society, those that work hard and earn money usually live better than those that don’t. There’s a lot of things that can be done to assist with quality heath care, but what Obama care is about is everyone to have insurance, with 30 to 40 % getting it for free to be paid for those who work and pay taxes. That is inequitable…Certainly we should help the poor and disabled, but the majority of people who don’t have insurance are those who can afford it but don’t want to pay for it.
Just my conservative take
Roder Russo
Health Care related index funds, as measured by a variety of sources, are the single best performer in the entire world for a number of years now. I don’t do standard deviations but have little doubt that as a whole they’re two or three SDs away from the bottom of the pile. It would be silly to ignore the fact that the treatment of our collective illnesses has and continues to enrich “shareholders” in a way that surpasses every other form of investment and, as we know, they’re prepared to fight at any level to maintain those profits.
My point is that health care premiums and deductibles have been rising since the beginning of time, long before Obamacare came to town. An interesting “feature” of Obamacare is the visibility of the deductibles; previously they were what I like to refer to as the “silent” deductibles, those incurred when someone with a “$500” deductible received their EOB in the mail a month after a claim and discovered, for whatever reason, that the claim was denied or this, or that, or whatever. Untold tens of billions of dollars have accrued to insurance companies via millions of unpaid claims where grandma or grandpa or the uneducated single mother of four simply threw up their hands and “let it go” because they lacked the resources and knowledge to pursue the matter.
You have nailed, as you usually do, the essence of the matter: Obamacare is a mess structurally and a huge success morally. My solution is hardly original: kiss the insurance companies goodbye and hand everyone a healthcare ID card–with the associated unintended consequence of watching tens of billions of dollars of stockholder’s equity disappear along with the viability of endless retirement plans and pension plans invested in them. Or continue to waste 30% of the total cost of healthcare on “administrative” costs.
As someone who strives to know the endpoints of my viewpoints, I know how “socialist” that sounds but we do have models, successful ones, in Japan, Australia, and most of Europe that deliver healthcare more efficiently, with better outcomes and at considerably less expense.
Sorry, but I’ve spent a lot of time in Europe, Canada , and Australia. I would never trade the health care in the Us for any place I’ve been. For example I have a good friend in Westen CNada who had a Hernia, he had to wait 6 months for Surgery, then he had to travel a long way from his residence where several facilities existed near by. They like it in Canada because it’s free, but there taxes are not
I understand and appreciate those who need help and can’t afford it, but Obama care is not the answer. Single payer is not the answer as well. I’m no expert, but we could start by not allowing doctored to have an interest in hospitals or surgical centers. In addition what these facilities charge is rediculous
Joe you have done an excellent assessment of the situation-too many people have opinions but no practical experience or knowledge to back it up
I agree with you, Joe, that there has to be a market-driven alternative that would be infinitely more efficient than the ACA. And I am also deeply disappointed in the Republicans for not proposing one. Perhaps they will under Paul Ryan’s stewardship, but I’m not holding my breath.
Bravo, Joe!
We hear many times during the year how the number of insured has increased in America since the ACA was passed. Just recently it was published that the uninsured rate in the country dropped from 17.3% to 11.7% in 2015 or from an estimated 48 million to just over 35 million due to the ACA. That is great news that 13 million people now have coverage in 2015 that did not before the ACA became law. ( And that increases to 17.6 million in 2016) At the same time, those with insurance (the total pool of insured, not just those that have gained insurance since the ACA) that report they are unable to seek medical care increased from 12% to 23% in 2015 due to changes in their plans such as higher deductibles and copay’s. That was an increase from 36 million in 2013 to 69 million in 2015 or an increase of 33 million. So those with insurance that still can not get medical care increased by over 20 million since the ACA took effect. (Gallop and Commonwealth polling data). The question we need to ask is the same one asked on that the Liberty Auto Insurance TV ad about car insurance; “what good does it do to have the insurance if you can’t use it”? Why did Obamacare allow for such high deductible plans that are being used to replace more acceptable plans that covered more costs?
The use of the Emergency Room where costs are much higher due to the staffing, 24 hour coverage and technology will continue even with the ACA because the ACA does not provide the needed benefits that the poor require. And with our current parties arguing over issues that they argued over for 20-30 years, positive legislation will be nowhere to be found in the next administration either.
I had an experience with Social Medicine just recently. I contracted an aggressive infectious disease while I was in Spain. There everyone goes to the emergency room at a hospital rather than going to a doctor. Of course most do not need to be in a hospital and 80%+ are released after medical care. I was admitted for treatment. I started off in a room for 3 people. Once they discovered I had in infectious disease they isolated me to a single room. I spent 5 weeks on my back with an IV in my arm receiving antibiotics and blood transfusions. I went through many surgeries on my leg. I was bathed each day, had my linens and clothes changed, and fed well. They wanted to keep me for another 2 to 3 weeks but I insisted that I had to leave. My travel insurance policy would only cover commercial airline travel – which was questionably possible by this time, but I convenced them in had to go. I had to have assistance for this trip and the insurance policy provided this. An ambulance came to my room with a gurney and I was met and wheel-chaired to and from each plane, and a gurney was at the plane in Lafayette to take me to the hospital here. I spent another week in the hospital and one month of daily hyperbaric treatments.
I was told by the medical profession here how lucky I was. Luck had nothing to do with it – I was blessed. They told me that chances are that my leg would have been cut off in the US to get rid of the disease. And I have a friend who experienced just that here in Lafayette. I have my leg and my life, and I have nothing but praise for the social medical system that kept me alive. I could go on about the cost of my treatment in Spain and Lafayette, but that is another story.