The Mythology of Obamacare

There's Nothing Like a Surprise to Wake You Up

The announcement of the Supreme Court's decision this Thursday past was a surprise to everyone:  conservatives, the political Left, the news media, and Washington politicians, the President included.  Unfortunately no further clarification has been forthcoming; this massive, secretly written, never-explained and still-understood law.  Titled the Patient Protection and Affordable Care Act, (PPACA), it is neither protective of patients nor financially affordable for the country.  How, or even if, the law will ever be implemented is a mystery to all involved.

What's Not to Love?

Only politicians as cynical and deceitful as our President and his cronies could have designed such a large law completely under wraps and presented only as a Universal Good for All.  Seemingly sensible provisions are heralded, such as the elimination of pre-existing conditions as a barrier to obtaining health insurance, "free preventive services" for both young and old, ranging from contraception and abortion to cancer screening and colonoscopies for elders, expansion of the Medicaid rolls to cover tens of millions more Americans.  But like eating a huge and rich meal for free, but suffering endless and painful indigestion later, Obama arranged for all of the goodies to be delivered to the voters up front--but the massive tax increases and budget deficits that will be caused by the bill don't start coming home to roost until after 2014.  By then his last election will be long past--pretty clever move, wouldn't you say?

Some Bends in the Road

Two of Obama's most prominent lies that were told during the Congressional writing of Obamacare were his famous and often-repeated "guarantees"--that if you have an insurance policy you like, you will be able to keep that policy; if you have a doctor you like, you will be able to keep that doctor".  These two whoppers are already being shown as blatant untruths:  nationwide, employers are dropping health insurance coverage, and most doctors, like herds of lost sheep, are being forced into "Accountable Care Organizations (ACOs)" so that the government can efficiently tell them what to do, what tests and treatments may be ordered, and monitor them for "compliance" to make sure that nobody is getting out of line and giving more treatment than is allowed or will be paid for.  Most doctors will agree to this government control, because they have never "grown a pair" and it's tough to swim against the current of government management of all things medical.  Other physicians will simply retire or go to work in other careers.  A brave few will continue to soldier on as "private physicians" using the "direct care model"--which means they will work outside of the insurance company/government medicine mandate, and provide care directly to individuals who are willing to pay for this personalized medical care.  This is sometimes referred to as "Concierge Medicine", and has been working well across the country by a few enterprising physicians for ten or fifteen years.

But Why Won't Obamacare Work?

It can and will work--but not as advertised,  and probably not in a way that anyone in Texas will like.  The "care" that will be provided will be a far cry from what everyone has grown up with and gotten used to.  Think about it:  President Obama said that his plan would provide health coverage for millions more people--and would also save lots of money.  More services for more people for less money.  Where have you seen that work before, ever?  There's no free lunch; everything has to be paid for.  Despite Obama's assurances, and the glitzy ads the government is running on TV, all of these new "free" services will need to be paid for by someone, unless they turn out to be empty promises, kind of the medical equivalent of a prize in the Cracker Jack bos--it's there, but it's not worth much.  So to bring this all about will require more money (TAXES), lower quality services, or fewer people eligible to receive services, which is where the DEATH PANELS come.  Yes, there will be death panels; we've had them before in the United States and we will again.

Death Panels--wasn't that just Sarah Palin's scary talk?

I'm afraid not.  We had death panels and treatment selection panels as recently as the early 1970's.  Before renal hemodialysis (kidney machines) were widely available, panels would meet to decide which patients would be fortunately enough to live with a kidney machine or die without one.  How else will you decide who gets a scarce resource?  If you have one machine and fifty people need it you can probably only treat about a third of them--so someone gets to decide.   Happily more machines and goverment funding came available in the mid- to late-1970s and the death panels no longer had to meet.   But it's a fact of reality.  And the Obamacare law provides for at least two different types of panels that perform this cost-saving work.

As many of you know, I was recently hospitalized with a severe diabetic foot infection--it might have been more "cost effective" to cut off the foot that provide the extensive treatment I required.  Believe me, I was thinking of my future and what could happen under Obamacare some years down the line.  President Obama has already addressed this question quite frankly in a very public setting, and his answer was not pretty:

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So Sarah Palin was thinking about her mentally challenged son; I am thinking about me and my family and our medical problems.  How will we fare with the treatment decision panels?

But Won't Romney and the Republicans Get This Repealed?

More than 50% of Americans oppose Obamacare.  That's a fact.  But there is another fact that reminds me of an old saying we used to hear, "Possession is 9/10 of the law"--meaning that once a condition is in place it is pretty hard to dislodge it.  Maybe it will be repealed.  Maybe it will be modified.  Maybe it is here to stay.

The Conclusion of the Matter

There is a lot more to consider and discuss.  But the lesson I'd like readers to think about right now is this:  More changes are coming than any of us can really anticipate.  But anyone who thinks Obamacare is going to bring gold-plated health care like we are used to is in for a rude awakening.

Your comments are invited.