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By Paul Goldfinger, MD, FACC
So far, not a single patient has been treated under Obamacare, yet the law is already mired in controversy. The lack of sufficient specific details about the ACA has caused skepticism and unanswered questions. Now, with this insurance debacle, there are new questions, so I will speculate and try to answer a few. Let’s hear your ideas:
Q: If the ACA is about insuring those who have no healthcare, then why are they going after those who do have insurance? The President said that the plan allows those who have insurance to keep theirs.
A: I think he was afraid to reveal the facts to the American people about the true extent of the ACA and the demolition of the individual insurance market. Insiders have known about the necessity to cancel millions of insurance policies. The truth seems to be that the ACA is about government takeover of the entire healthcare system partly through ACA- designed insurance plans sold by complicit private insurance companies. In order for the ACA to work, the government has to have everyone participate using their approved policies.
Q: Why did the insurance companies agree to discontinue their healthcare plans and then replace them with plans based on ACA requirements? And why didn’t the insurance companies warn millions of their customers that cancellation letters would be coming?
A. The insurance companies were lured by the chance to sell 30 million new policies for the uninsured. They accepted the changes in benefits and rules imposed on them by the ACA, not because their existing plans were poor quality, but because they were coerced by the government.
No one has actually explained what was meant by “substandard.” But I think it means not compatible with government control of healthcare. So now it looks like the insured may get their old policies back, at least temporarily— “substandard” and probably more money.
The failure of the insurance companies to inform their customers in advance represents lying by omission.
Q: How does a government run insurance plan (mediated by private insurance companies) dictate how medicine is practiced?
A. You can get a small idea by looking at an existing government plan: Medicare. Here are a few true examples:
1. Your doctor orders a battery of blood tests, so you go and have them done. Medicare decides that it won’t pay for two of them. No explanation is given. You get a bill for $350.00 which you must pay out of pocket. Your doctor tries to help, but he can’t. He’s embarrassed and upset , because he thought that the tests were necessary. When this happens a few times, he will find it necessary not toorder those tests anymore.
2. A gynecologist wants his patients to have a checkup every year, but Medicare will only pay for every other year. The doctor can compromise his best medical judgment or bill the patient. Eventually he starts ordering exams every other year. This is interference in care via insurance.
3. You have hernia surgery, and the anesthesiologist does an excellent job. That job is difficult and risky. The doctor bills $1,300. Medicare pays $275.00. Inappropriately low fees for doctors force good physicians to leave practice or work for a large hospital corporation as a salaried employee. This is an attack on the medical profession through insurance.
I would prefer to talk about the actual practice of medicine, but that iceberg has yet to float our way. However, health insurance is a major factor in the quality of care, so let’s talk about that.
The anxiety embodied in the above conversation demonstrates the danger of citizens becoming dependent on government programs. We are all now beholden to what the Government choses to do.
Politicians will be elected or voted out by the quantity of benefits they bestow. If you were on Medicaid, would you vote for a politician who would cut Medicaid? Nope. Would you vote for a politician who promises to increase your healthcare benefits? Yes, as we just have seen.
QED: our political system will prevent our elected officials from doing what is right and instead rewards those who give away the most free stuff.
We have a multi-trillion dollar deficit. There needs to be a dramatic reduction in government spending, especially for the biggest budget area: entitlement programs. Will that ever happen with the way voters now decide who to elect?
Greece, here we come!
Also, Aetna allows you to keep your “child” on your family plan until 31!
Paul, with the latest link, I guess I was just adding to my earlier opinion & link above in response to Ken.
But to add my opinion to my latest link, there are lots to be scared about with regards to Medicare and all of it’s parts, A,B,C, and D. Cuts are cuts, and it affects the whole pie.
And, we see now how those cuts are beginning to affect Medicare advantage. To increase costs to seniors in order to provide subsidies for others and add millions to Medicaid is just plain wrong in America; especially those on fixed income and vulnerable to rate increases.
Editor’s note: Medicare part A is hospital coverage, B is medical coverage (doctors, etc), C is Medicare Advantage plans, and D is the prescription drug plan
Maxster: Please don’t send us links unless they are accompanied by your own opinion on this subject. Thanks, Paul
Here’s a little more on how Medicare Advantage is being affected by Obamacare
http://www.app.com/article/20131117/NJBIZ/311170012/NJ-Obamacare
It’s difficult to clarify partial truths being spread by other commenters without providing some background and context. Without them it would just be a case of “yes it does!…no it doesn’t!”
What’s a doctor to do? I have been visiting mine more often recently and been discussing the ACA’s effect on his practice. He has considered a concierge boutique model and is confident of 20 patients signing up, but if after one year half drop out, what then?
His other option is to work at the hospital: a five day week, leave at five, all office expenses eliminated. He, like us, is uncertain; also waiting to find out what his ACA future holds for him.
OG Jamie: I just read your comment about taxes and I want you to know that it caused my eyes to glaze over and then it triggered a deep coma. I’m sure you are a good guy, but if you send another comment talking about taxes on unearned capital gains for households making over $250K,I will be forced to place Blogfinger on a suicide watch.—-Paul
Jason – The 3.8% tax on unearned capital gains only applies to households making over $250k. A couple making that much (or more) can still deduct the first $500k in profit from the sales of their house. So, if a couple making $300k sold their home for $600k and cleared a $450k profit, they would be able to fully deduct that $400k and wouldn’t be subject to the 3.8% tax. The truth is that this is a 3.8% increase on unearned capital gains, not home sales, and it will affect very few people
Ken – If you have been pleased about Medicare, that is fine. I am literally scared because I go on it in about two years.
And, the future is the problem, what with $500 billion being cut from Medicare. And then, there is this: Like people losing their policies, the odds are seniors are not going to be able to keep their doctors. Doctors are already ready to either walk away from their practices or just going to work for hospitals because of cuts in reimbursement rates
And then there is this:
http://news.yahoo.com/unitedhealth-drops-thousands-doctors-insurance-plans-wsj-030014903–finance.html
There is an old sales tool called the Ben Franklin close. You draw a line down the middle of a piece of paper and you list the positives on one side and the negatives on the other side of the column. You’ll see that it’s a no-brainer with Obamacare. It’s bad.
The positive things could have been done by single item bills, not by taking over 1/6th of the economy and wrecking health care for the rest of America.
Children can stay on your parents health care till you are 26, is also not 100% accurate, ( there’s a shock ) The company I work for was able to get an exemption for non active employees. I retired in 2011 and my two oldest children just finished College. Ok no job yet, ( another shock ) At least they will be covered by my health plan. Nope, unless you are an active employee you can’t add your children after the age of 21 if they are no longer in College. Don’t know if this is for all employers but it was for mine.
Personally I think it was a good idea to have everyone covered by some kind of health care. But not the way this was done. No one knows what is going on, ( pass it to see what’s in it ) and anytime the Govt gets involved in daily life of the general public I am against it.
We are a great nation because of individual freedoms, not a controlling Govt. In my humble opinion.
When you sell you house and have to pay an extra 3.8% tax on your capital gains (just one of many new ACA taxes), then you will think it a failure.
Ken: I wish I knew how the program will work in practice. But so little information on that is available. We need more transparency. We may need to wait and see how it goes. It may have a happy ending, but I am concerned about having the government in total control. Where is the input by physicians?
Mostly what we know so far is about insurance coverage, and that is going badly at this time. We need to know what the provisions are in the new policies. What makes them better than the old ones?
We have heard about the pre-existing illness fix, the kids who can stay on their parents’ plan until age 26, and coverage for the uninsured. These are all good things.
But we also know about mandates, about exemptions/favored treatment for certain groups, about subsidies for some groups and about a huge increase in Medicaid. These issues are worrisome.
There is much that is not revealed or even known such as the cost and affordability of this gigantic program, the possible destruction of the doctor/patient relationship, and whether the quality will be better than what we have now. Also, will we have rationing, shortages of care providers, difficulty finding doctors,long waits for care and solutions for fraud, waste and abuse?
There certainly will be positive elements revealed as time goes by, but will it all be dragged down by the negatives? Will it be an overall success or a failure? I don’t know.
Paul, Are there any (even a few) positive elements in the ACA? I have been pleased with the government run Medicare and VA programs, it surprises me none of that experience was incorporated. Do you see any (even a couple of) positives in the ACA that should be incorporated?
ken.
Thanks Paul for some great examples of why the government should have nothing to do with financing or managing health care. The more involved the government gets, the worse the care. Look at the UK as an example. Care suffers because they ration care and because governments are not good at managing complex programs well (the military is a rare exception). Making it even worse is that the system is set up to massively redistribute money: form young to old, from the healthy to the sick, from the economically successful to the takers. This place is starting to look like a socialist European country.