The affirmation of the constitutionality of the Patient Protection and Affordable Care Act, or Obamacare, on June 28 by the U.S. Supreme Court was a big step forward for our country. But parts of the act itself are a step in the wrong direction.
First, the steps forward. For the first time since the enactment of Medicare in 1965 the federal government has taken the position that health care is a right of the U.S. public — a heroic political achievement.
Obamacare accomplishes this by expanding public programs such as Medicaid and Community Health Centers, and requiring most Americans to buy private insurance or pay a tax penalty. These requirements are enabled by a variety of tax-funded subsidies to employers, employees and individuals.
To its credit, Obamacare also outlaws the most antisocial practices of private insurers — excluding people with a history of illness from coverage, charging outrageously high premiums if they’re sick or retroactively canceling coverage if a health insurance subscriber has the temerity to become ill and actually submit a claim.
But there was one especially troubling step backward that is the source of the unease felt by many health policy experts about the law. Prior to Obamacare, our private for-profit insurance industry’s future was bleak. Facing the choice of satisfying Wall Street’s incessant demands for profitability or face declining stock prices, they were being forced into a death spiral of ever increasing premiums and ever harsher attempts to limit claims payments by denying services and otherwise restricting coverage to only those with the least probability of becoming ill. Those most vulnerable to illness were being left to fend for themselves.
By requiring tens of millions of healthy Americans to buy private health insurance with the help of federal subsidies, Obamacare has come to the rescue of corporate America once again. This insurance mandate gives the term “corporate welfare” a new and more robust meaning.
While I heartily applaud the intent of expanding health care to all, this means of doing so is actually destructive. From the perspective of our health care system as a whole, health insurance companies provide few if any benefits but do a lot of damage. By shoring up private for-profit health insurance, one of the most dysfunctional parts of our health care system, Obamacare will make health insurance companies much harder to get rid of.
And get rid of them we must. Private for-profit insurance is an extremely expensive and destructive way to expand coverage. Their administrative costs are estimated to be 25 percent more expensive than Medicare (which is a very efficient and low cost program to administer). And when you add their additional costs to manage “medical losses” (the insurance term for health care costs) the true overhead of private insurance companies probably approaches 50 percent. If it were only for the costs I wouldn’t have much of a problem. We could find the money.
But the U.S. system of private insurance also damages care. Insurers interfere directly with medical decisions involving individual patients. In addition, they so fragment our system of financing health care that they make much more difficult systemwide changes, such as reforming the way we pay doctors and hospitals and rationalizing the distribution of medical resources such as expensive technology.
Like other parasites (tapeworms, for example), health insurance companies don’t set out to do harm. It’s simply a by-product of what they must do to achieve their primary mission — the creation of wealth for their owners. They’re doing what they must to survive and to thrive. They’re just the wrong tool to get the job done.
While Obamacare represents some progress and provides a platform for future improvements, it leaves much yet to be accomplished. To really have health care for everyone at a cost we can afford, we have to replace private for-profit insurance with nonprofit publicly administrated insurance financed through a fair system of taxes. Only then will we have the tools to begin fairly and effectively to control overall systemwide costs, and improve the way medical care is delivered.
We are already paying more than enough for such a system and will continue to do so under Obamacare. It is estimated that the excess costs of private insurance, all totaled, reach at least $400 billion a year in the U.S. — more than $1 billion dollars a year in Maine alone.
That’s a pretty expensive parasite. Removing parasites is often difficult for the doctor and unpleasant for the patient. But both feel a lot better when it’s done.
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.
obamacare is more than one step backwards. History will show it to be the fulcrum that collapsed the country economically, politically & socially.
That was the point in the first place. In the no so distant future, the country’s economy and government will be rebuilt to a much better form of government. At least in some peoples eye’s. Wake up people.
I am thinking that day may be coming sooner than you think. We could not afford Obamacare in the good ole days, what makes people think we can afford it now?
Wow. Even without the hilariously absurd hyperbole, your comment is still wildly inaccurate.
No, Temperate, the Commies aren’t poisoning our drinking water, Obama isn’t a Muslim, the American Care Act isn’t going to destroy our country, your tinfoil hat isn’t going to stop any mind-control beams and there isn’t a monster under your bed.
If anything, Obamacare is going to play a part in preventing our country from collapsing.
It’s a step forward, period. The detractors repeat the mantra “repeal and replace”, yet they present no real proposals as to what would be the replacement. Back durning the year+ long healthcare debate, no real proposals. This cost a lot of “political points”, but in the long run it will have all been worth it. Something that to be done and this administration did it in earnest.
Another utopian socialist.
He may be a good physician, but he knows little of economics or the consequences of creating giant government.
Re: “the consequences of creating giant government.” Yes, my concern as well. I’m also worried about the hugely increased demand for a slowly increasing supply of healthcare — physicians, nurses, etc. The result: either much higher prices for care, or restrictions on it. Sooner or later the govt will have to squeeze that part of the balloon.
But my greatest worry is this (bear with me):
Most of us drive our vehicles very carefully, even though we have insurance to cover accidents.
But suppose you had no insurance. (I periodically risked going without it when I was a young adult with a low income.) Think how much more carefully you’d drive! And how much more slowly. Yes, you would. And you’d likely drive less. (And maybe walk more and become healthier for it.)
For many people, I suspect, the more auto insurance they have, the more they tend to drive and to drive faster and less guardedly. (For proof of that, keep imagining how you’d drive without insurance.) That means more accidents in which people are killed and injured. Although insurance is a wonderful thing — preventing bankruptcies and bestowing peace of mind, for example — it might have the unintended consequence of causing more accidents and hence more deaths and injuries than if no one had insurance.
Now consider:
In a report on how to fight pandemics, the March 2012 Discover magazine says the secret to fighting them is “knowing their real cause: disease factories built by people. Ironically, hospitals turn out to be highly efficient disease factories. They allow the proliferation and spread of dangerous germs among patients, and the evolution of those germs to extreme levels of virulence.”
In that same vein, the Journal of the American Medical Association warned us 12 years ago:
“America’s healthcare system is the third leading cause of death in the U.S., causing between 230,000 and 284,000 fatalities per year, behind only heart disease and cancer.”
The report didn’t say the third leading cause of death is poor health. It said the healthcare system itself. In other words, our country’s third leading cause of death is the legions of good-intentioned doctors, nurses, and others whose ultimate duty is to help us avoid death.
JAMA provides a breakdown of the deaths caused by healthcare:
– 12,000 deaths per year due to unnecessary surgery
– 7,000 deaths per year due to medication errors in hospitals
– 20,000 deaths per year due to other errors in hospitals
– 80,000 deaths per year due to infections in hospitals
– 106,000 deaths per year due to negative effects of drugs
Then add the nearly 200,000 patients that may be killed each year by blood clots following surgery or illness, the leading cause of preventable hospital deaths in the U.S., according to David Goldhill, author of “How American Healthcare Killed My Father,” citing a report in The Wall Street Journal. (Watch Goldhill’s video at http://www.cato.org/event.php?eventid=6597)
It makes one want to ask an absurd question: “Why don’t we drop our health insurance and stay away from doctors?”
If no one had health insurance, lots of things could happen, good and bad. Here’s a quirky thing I believe is possible:
In 2008, shortly after the economic collapse, I was watching a CNN reporter interview a woman on the street. She had just lost her job. The reporter asked how she was coping.
“Along with my job, I lost my health insurance,” she said [I paraphrase]. “Now I have to really be careful to watch what I eat, lose weight, exercise, and take better care of myself.” I got the impression that while she had health insurance, she tended to be a bit reckless with her health, figuring she was covered if she got sick.
Some people are like that; maybe many people are. That’s because, according to a Slate.com article at http://tinyurl.com/cqjvcuv, “Insurance is also the source of what economists call ‘moral hazard,’ where those who are protected against the consequences of their actions take greater risks than they otherwise would.” (See also “The Oregon Health Insurance Experiment” at http://www.nber.org/papers/w17190.pdf?new_window=1: “Although health insurance is expected to improve health through increases in the quantity and quality of health care, it is also possible that by reducing the adverse financial consequences of poor health, health insurance may discourage investments in health and thereby worsen health outcomes.”)
How many people are affected by the moral hazard can depend on the type; i.e., private insurance vs. a government bailout, which also is insurance. And how much legitimacy one gives the moral hazard may depend on one’s political leanings: Liberal Times columnist Joe Klein may not think the moral hazard is triggered by health insurance for individuals, but he apparently does think it is triggered by government bailouts for big banks: “Sadly, neither President Obama nor Mitt Romney have addressed the ‘moral hazard’ that accrues from having banks that are too big too fail….” See: http://swampland.time.com/2012/07/15/inconvenient-truths/#ixzz20sug2xIb. See a New York Times article at http://tinyurl.com/7z4qxnk. There needs to be a non-partisan study of moral hazard.
Without health insurance, CNN’s interviewed woman became like the driver without car insurance.
Enter President Obama’s Affordable Care Act (ACA), whose aim now is to get almost everyone insured and require millions to buy health insurance.
A lot of young adults currently elect to have no health insurance (as I did years ago) because of its cost, or because they want to save as much money as possible while they’re young and healthy. Once forced to buy insurance under ACA (or pay a penalty tax), many can be counted on to frequently see a doctor for minor things simply “to get my money’s worth.”
How many more people, BECAUSE they have insurance, will pay less attention to diet and exercise like CNN’s woman on the street, and develop medical problems (such as diabetes) that require visits to the doctor that they would not have had to make while uninsured and cautious?
ACA will bring an estimated 32 million more people, mostly young adults, into the healthcare system, and countless others into it more often. It’s obviously supposed to do that, because Mr. Obama wants to spread the health around.
He also wants to spread Medicaid around to include millions of uninsured. Yet according to large study by the University of Virginia, surgical patients on Medicaid are 13% more likely to die than those with no insurance at all, and 97% more likely to die than those with private insurance.
Let’s not forget, too, that every day for the next 18 years, 10,000 Baby Boomers will reach age 65 and become eligible for Medicare; many of them will seek healthcare services before losing their employer insurance, and many others who’d had no insurance (until Obamacare) and had put off healthcare will put it off no longer.
Moreover, we have a obesity epidemic that is growing, especially among the young for whom obesity has jumped from 9% of the adolescent population in 2000 to 23% in 2008, and threatening to overwhelm our health care system. The main threat is the costly diabetes that is often obesity’s side effect.
Finally, “one flaw in the Affordable Care Act,” says Business Week (http://www.businessweek.com/articles/2012-07-05/the-case-for-way-more-mandates), “is that by prohibiting insurers from taking health risks into account in setting rates, it gives people no incentive to lower their premiums by losing weight or quitting smoking….”
The upshot is that millions more will interact with the healthcare providers who are, according to JAMA, our nation’s third leading cause of death.
These providers, unless there is a huge increase in their already insufficient number, will be stressed by the increased demand for services. Their error rate is likely to rise.
(Efforts are underway to deal with the shortage: “As Obamacare Looms, New Medical Schools Open To Address Doctor Shortage”at http://www.forbes.com/sites/brucejapsen/2012/07/17/as-obamacare-looms-new-medical-schools-open-to-address-doctor-shortage/, but see: “We don’t need more doctors” at http://www.cnn.com/2009/POLITICS/05/13/christensen.doctors/index.html)
Could our healthcare system then become the second leading cause of death? Or even, in the greatest of ironies, the first?
Do we really know what we’re doing? A tsunami is coming.
(I recently posted this online with supporting links at Relevant Matters – http://wp.me/pv0gT-by)
Good post, people often forget the “law of unintended consequences”.
Thanks, Cheesecake1955!
very good post.
Most progressives are so deep into the ideology they are incapable of the critical thinking necessary to analyze unintended consequences.
Progressives also tend to have received an education heavy on self esteem and indoctrination.
MALEMATTERS,
I am on your side of the argument. I spent more than 30 years working in hospitals and clinics and about half of what I witnessed was not necessary. Instead of counseling patients to take care of their health doctors pushed drugs on them to treat symtoms; and, admitted patients for observation to fill emty beds; ordered scans for gas and other minor complaints; and worst of all, ordered helicoptor rides that were unnecessary and ordered last ditch tests and surgeries to possibly save 80 year olds.
30% of health care is unnecessary (probably more).
Most of health care is descretionary.
If a patient chooses unnecessary care, or, descretionary care, they should pay the full price, not spread the cost of that care to everyone else.
The simple determination of necessary care and descretionary care used by the medical profession is a broken hip is necessary; a back operation for back pain is descretionary (called elective surgery).
How much would a high deductible cost a person if unnecessary and descretionary care was eliminated? A high deductible is needed to protect us from an unanticipated catastrophic event to prevent the destruction of our finances and possible bankruptsy. Nothing else is needed.
We have a shared cost business model to collectively pay for health care – THAT IS NOT INSURANCE. This shared cost business model allows exploitation by insurers and doctors alike. It allows patients to live unhealthy lives because there is always a pill or cure as advertised or reported by the media almost every night on TV, and it will cost pennies because I have coverage. Patients do not have to think; do not have to act responsibly; do not have to make any decision regarding health care, because the doctor will take care of them no matter what.
Time to wake up people before what we call health care breaks this nation.