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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.