news.yale.edu
By Paul Goldfinger, MD, FACC
I have been skeptical about Obamacare since the law was passed. I have tried to stay clear of the politics. My concern from the start has been, “What the heck is inside that law? How will it actually work in terms of the practice of medicine?” Hardly any details were released, and it now seems that some legislators may not have read it, as indicated by all the surprised lawmakers who are currently upset about cancelled pre-existing health insurance policies.
So now that the controversy is looking past the incompetent roll-out, and assuming that insurance plans will soon be available to purchase on the exchanges, the conversation is moving to the details about the insurance policies themselves.
Naturally, if one is worried about the practice of medicine, paying attention to health insurance is essential. The President promised that we could keep our existing plans and doctors if we want, giving the impression that the ACA was essentially about the non-insured.
He also gave the impression that the insurance exchanges would give private insurance companies the chance to compete in a free enterprise marketplace. But now we see that no company can get their policies into the exchanges unless those policies are designed just the way the government demands they be. As a result, millions of people are losing their existing plans.
Evidently this aspect of the ACA is hidden somewhere inside the huge pile of papers that make up the bill. It’s just that it was kept under wraps until now when so many Americans are getting those surprise letters.
So now that people are being dropped (including nearly 1 million in New Jersey) from their existing plans, the administration defends what’s going on by saying that those pre-existing plans are “crummy” and not worth keeping in the first place. Why are we hearing this news for the first time now?
So we get to the crux of the problem: The public is too stupid to understand what one needs in an insurance policy to get quality care. But history shows us, including what happened in the ’80’s and ’90’s regarding “managed care/HMO’s,” that people do know what they need. They just have to be educated about the particulars, and the bureaucrats who are running Obamacare, have assiduously avoided telling us the truth until now, and more hidden truths will keep oozing out of the ACA as the smoke screen continues to fade.
Maxster, Please remember my comment is about which I trust MORE. I wrote that I trust the government more than I trust the health insurance companies. Using your example of being put on a long government waiting list; that might be preferable to having a private insurance phone call inform me I do not qualify for a replacement or the amount that is covered is miniscule. In either case I always have the option to pay myself.
Ken
And when the government says there is a long waiting list for a hip or knee replacement, will you trust them then?
When, as President Obama said “well, maybe you’ll just have to take some pain pills instead of getting a pacemaker,” will you trust them then?
Ken, I am not trying to pick a fight. Seriously, you are a great guy; but when people rely more and more on government to the point of trusting them, then liberty and freedom is lost.
Reader20, From real life experience I share your mistrust of insurance companies however personal experiences have given me my faith in government. Back in the middle of the Depression my mother would send me for a quart of milk with a small non-metal coin from Welfare. My tonsils were removed at a NYC Public Health Station. In my teens I stood in line with hundreds to get a free dose of Polio vaccine during an outbreak.
Government has lots of problems (many self-inflicted by the elected officials we send to Washington) but over the years I have had more positive interactions with government workers than bad ones; the IRS being a notable exception.
Bob: If you are talking about preventable diseases, you need to be more specific. For example, in the field of cardiovascular prevention, we need to list obesity, hypertension, and cholesterol control. Another example is getting the flu vaccine. Did all of you get your shot yet? There’s a pharmacist near you who is waiting with a painless needle.
You mention healthcare costs after WW2, but don’t forget that health insurance back then was very cheap because people paid cash for outpatient care and because we didn’t have much in the way of medical technology, medical research and prescription drugs. Thus employers could easily afford to pay for “hospitalization.”
You want to blame the government for the “healthcare cost problem” but that doesn’t make much sense. The costs are high because the costs of modern healthcare are high.There are so many examples, but one is the development of statin drugs to lower cholesterol. The pharmaceutical industry gave the world a gift that saves many lives. The cost of those drugs have been high, but the cost is appropriate for the benefit.
The government runs the National Institutes of Health and the Centers for Disease Control and Prevention. That’s money well spent on healthcare, and only the government can do it.
One category of cost that raises the price tag markedly is fraud, waste and abuse, and the government is not responsible for those things—mostly it oozes out of the greed of private businesses and bad apples in the medical profession.
Insurance reform is one area where government involvement is appropriate,however we don’t need total government control of healthcare to accomplish targeted goals of that sort. Limited government involvement would have been a better approach than Obamacare. But the Republican Party failed to act when it had the chance, so President Obama did right in trying to tackle the situation, however his ACA is seriously suspect.
You are correct about the “decoupling” under the ACA. By allowing businesses to not provide insurance to part time employees, we will develop a part-time economy where workers will have limited hours and must fend for themselves in finding health insurance. It’s a double whammy for workers.
As with my car insurance, I think it’s best when I don’t need my health insurance. I wonder if drivers would be as careful as they are if their car insurance were provided by their employers, with no penalty for accidents or traffic tickets.
Some years ago, I had a boss who liked to say, “Don’t get sick!” For years, I thought that it was an odd thing to say — after all, who actually wants to get sick?
But a more recent estimate is that preventable causes — tobacco, alcohol, lack of exercise and diet are responsible for 900,000 deaths annually — close to 40% of total deaths in the United States. (source: the New England Journal of Medicine)
I’m no fan of insurance companies, but I don’t think insurance companies are mostly to blame for the increasing cost of health care. Insurance companies manage to sell products in other, more competitive markets than health insurance at decreasing prices. One example would be term life insurance that’s been significantly decreasing in price over recent years because the market is so competitive.
IMO, the government created much of the health care cost problem in the first place — with wage and price controls during WW2 that excluded employee benefits, so employers used health insurance as a benefit to attract scarce workers. Paradoxically, Obamacare may be causing some decoupling of the link of health insurance to employment, at least in some industries.
While I have a healthy skepticism of government — I most definitely don’t trust insurance companies. I have had to fight time and again to get the coverage I paid for when members of my family have suffered health problems large and small.
Also, in my state, the government has long regulated — to some extent — the content and requirements of insurance plans. And that is a good thing. It is only because insurance companies are concerned that they will get into trouble with their primary regulators that they sometimes back off from efforts to deny coverage for required treatment.
Four things we can trust: 1) most currently insured people will see their rates go up next year 2) >50 million folks will have their policies cancelled this fall; 3) a low number of uninsured — and particularly the uninsured young and healthy will sign up. This will mean dramatic rate increases for everyone in the insurance markets next fall; and 4) there will be severe doctor shortages for those with policies in the insurance markets — many doctors, including my GP — say they will not accept these patients.
Note that all four of these items were predicted and communicated over the past 2 years by Republicans, but no one listened.
@Ken
One should NEVER trust government, or have to trust government. That leads to dependency and eventual control in that one could easily see how one can vote for those that protect the handouts. Ooops, maybe that’s why we are where we are today.
Too many people holding their hands out for government benefits, and too few paying the bill.
Yes Paul, we will have to wait and see. Much comes down to which trust (or mistrust) the most, Government or Insurance Companies?
ken
Ken: The “stupid” reference has to do with a paternalistic attitude which seems to prevail today where government wants to decide for citizens what constitutes good care. The idea that insurance plans which people like should be forcibly discarded because bureaucrats like something else suggests that they have a bad attitude towards the intelligence of Americans. And it is even more obnoxious because this blindsided all of us who did not expect what is just emerging from Obamacare.
Of course, many of us have been mistreated by insurance companies in the past, but usually the consumers were aware of what their plans were doing. For example, no one imposed a doctor network. You had to choose such a plan. But it seems that is the way Obamacare is going, whether we like it or not.
And yes, Medicare is terrific, but who knows what it will look like in the future.
As for waiting to see what the future will bring, wouldn’t it be good if the nitty gritty of Obamacare were revealed to us now instead of having us be surprised each time the layers of the onion are peeled back? Or is it possible that they rammed this thing through without first working out the details??
—Paul
I never thought myself “stupid” but recall not understanding (being mislead) about the limitations of Insurance Companies HMO/managed care until I needed more than regular doctor visits and limitations of choice of hospitals which further limited choosing which Doctor could treat (operate on) me. Switching to regular Government run Medicare was a Godsend. So I will wait to pass judgment on the ACA vs private insurance offerings until all the unknowns are understood.
.
Tenter: Thanks for the input. Have you observed that your hospital system is cutting people back to under 30 hours to avoid having to provide health insurance? There is concern that we will have a part-time economy as businesses look to reduce their expenses.
Medicaid, a program for the poor, is definitely being expanded under Obamacare. Medicaid is a free benefit, so it will be desirable to many people. A patient has to qualify to be included, but I think it will be easier to qualify under the ACA.
The Medicaid program varies from state to state. It is a health benefit that is largely financed by the Feds, but the states also pay into it.
In the past, doctors tended to avoid Medicaid patients because the payments to doctors were so small that they couldn’t afford to accept those cases. So, in the end, the quality of care was sometimes poor as the Medicaid patients frequently wound up in crummy clinics.
In our Morris County practice, we never turned away Medicaid patients, but we weren’t so altruistic because Morris County is fairly upscale, so there weren’t a lot of Medicaid patients. But in urban areas, the quality of care for Medicaid recipients is often an issue. Many doctors in urban areas volunteer to treat the poor in special clinics set up by hospitals or community organizations.
What happens to them under the ACA is unknown at this time.
—Paul
Thanks for sharing your perspective as a physician. I work for a large hospital system and am curious to see how this impacts the insurance plan provided for employees by the hospital via BC/BS–which I pay a reasonable fee for each pay period.
I also understand many Americans who previously weren’t insured are applying for Medicaid as opposed to insurance via the Marketplace…I wonder if more people will be approved for Medicaid and how that increase in demand will be funded?
Thank you Blogfinger for having an honest discussion about Obamacare. Now, please don’t take this line as political, but we shouldn’t have had to “pass the bill to see what was in it.”
I suspect that the real problem is that the bill was more of a fancy artist’s rendition of what it might look like, but then came the real blueprint via thousands upon thousands of pages of regulations after the bill was passed that showed us that this was going to be a disaster.