Care Package

“So what do you think about the government’s healthcare changes?”

I get this question almost everyday from patients—either just curious about my view, or sincerely worried about their ability obtaining care in the future. Like most, I partly paid attention, during the legislative phase, to pundits on news programs, or skimmed through industry emails and articles. I assumed that once everything was said and done regulations would follow and we would begin to see the true picture. Fortunately, I read a book while on vacation that jarred me from my indifference.

And it scared the hell out of me.

The Truth About Obamacare,” by Sally C. Pipes, delineates how we arrived at this historic legislation and its implications for all of us. Ms. Pipes is the President and CEO of the Pacific Research Institute, a think-tank that admittedly looks for free-market, and not government-mandated, solutions to societal problems. I’ve always been curious about the fundamental element of the governments plan—providing health care to the uninsured without raising costs (i.e., taxes). According to this book, it is fundamentally, basically, simply—impossible. Costs have must be cut somewhere, somehow and this cost-cutting will come in the form of rationing healthcare and, of course, raising new revenues.

The rationing could be insidious to you and I. Ms. Pipes points out the elements of the legislation that mirror the National Health System in Great Britain. Rather than playing NICE, we’ll have PCORI, an organization conducting studies in what works, or not so much, in healthcare. Treatment not considered cost-effective (the equivalent of placing a dollar value on human life) may fall to the wayside. A patient’s ability to receive expensive, end-of-life healthcare will come to a screeching halt.

Raising taxes on hospitals, health insurers, pharmaceutical companies and medical equipment manufacturers to pay for government mandates causes reductions in new healthcare innovations. Developing new, more effective and possibly safer medications and treatments cost money and lots of it. Taxing the ability to create these innovations seems counterintuitive.

Robbing from Medicare’s Peter to pay Medicaid’s Paul also seems to shift revenue in ways that doesn’t make sense. The book plainly describes how effective Medicare Advantage plans are to our seniors. Yet, starting this year payments to these plans are frozen at their current levels. Then, in two years time, reduction in payments evolve over  the following two to six years. If that’s not enough to get our attention the book describes how Medicare payments to hospitals serving low-income patients cut by $22 billion, home care by $40 billion and both inpatient and outpatient hospital services by $157 billion.

If you and I stay healthy and meet certain standards, our employers can offer us a discount on our heath insurance. If we choose not to take part in workplace wellness programs, we can take a real hit to our pocketbooks. Forced incentive to stay well—if it works. However, when all the other mandated benefits kick in, we may witness a hemorrhaging of money and an increase in our national debt on a scale that could make today’s deficit look like a rounding error. At the end of the book the author gives free-market solutions that could meet the same results without affecting our personal freedom or destroying the best of what we have achieved in health care. Assuming we could repeal the health care reform bill.

Of course the author could be entirely wrong. At least our legislators seem to think so. But now the health care reform bill has my full attention. I will be asking, and hope you will also, when we offer new mandated benefits where will the revenue come from? If we cut costs, or benefits, what are the unintended consequences? How much will our future generations benefit, or suffer, from the actions we are taking today? If the Devil is in these details then we all need to read this book and understand where we are and, more importantly, where we’re headed.

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About Steve P. Sanders

A general internist writing and sharing ideas and art.

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