Is Venice Sinking or is the Ocean Rising? A Health Reform Analogy

A feeling caused by uneasiness or apprehension

Definition of “A Sinking Feeling”

A spirited debate concerning Venice, one of the world’s most beautiful cities, is underway. The debate centers on this question: Is Venice sinking because its pilings and other underpinnings are disintegrating, or is the ocean rising because of global warming?

I thought of this question as I was reading Grace-Marie Turner of the Galen Institute latest report, “Obamacare’s Destructive Impact Already Being Felt,”dated February 25, on the sinking prospects of many health care sectors.

Reading it, I got a sinking feeling.

I asked myself: Is American health care sinking, or are our budgetary woes rising? Will uninsured numbers rise, or will deficits engulf us all?

It all depends on which gondola you are riding.

If you are in a gondolier on the left, you might say: health care is sinking because of excessive, irresponsible market-driven costs pushing us all down. In the process, fragmented providers are dragging millions of unfortunates to the bottom of the canals. Once centralized government forces are at the helm, we can refloat the system. This is the comprehensive OSHA (“Our Savior Has Arrived’) belief system.

If you are in a right-minded gondolier , you might well maintain: the weight of Obamacare is undermining the very foundations of the system. If it continues unabated and unrepealed, we shall all surely drown in an ocean of red ink. This is the incremental MWSU (Markets Will Save Us) belief system.

Grace-Marie Turner maintains the health system’s foundations are eroding.

Here is a sample of her reasoning.

Before Obamacare's provisions go into full effect in 2014, virtually every player of the health sector is sinking under the weight of government bureaucratic mandates , from doctors, to health insurance brokers, to health insurers serving seniors, children, small businesses, and families.

• Doctors: Doctors and hospitals are consolidating – fast – to protect themselves against government bureaucracies and ever lowering reimbursements.

• Brokers: Health insurance brokers are in bad shape. Insurers are cutting or even ending their commissions to meet the government's arbitrary and punitive medical loss ratio requirements.

• Health insurers: New rules on health insurance are causing people throughout the country to "lose the coverage they have now" and to have fewer options.

• Medicare Advantage members: Medicare Advantage plans serving 700,000 seniors have announced they are leaving markets due to deep payment cuts to the program in Obamacare.

• Patients and health consumers: Because of market withdrawals and other developments, many as 100 million Americans may find themselves seeking new health plans as insurers withdraw from Medicare Advantage markets, child-only markets, group markets, individual markets, and retiree markets.

• States: They are being forced to pay for Medicaid and other measures they can’t afford. They may spending their wheels, because the legal community is asking: is this whole thing constitutional? Will money now being spend to comply be money down a rat hole?

Meanwhile, the government gondola, propelled by taxpayer money and powerful bureaucratic engines, churns ahead, leaving rising debts and doubts in its wake, at least, so say its detractors.

Which gondola to ride? That is the trillion dollar question. The answer, I suppose, is: Whatever philosophy floats your gondola. But that may not be the proper response. In the end, just like the citizens of Venice, we shall all have to sink or swim together.

Richard L. Reece, MD, blogs at Medinnovation and has a website under construction. www.doctorreece.com. He is the author of three recent books, Obama, Doctors, and Health Reform (Iuniverse, 2009), Innovation Driven Health Care (Jones and Bartlett, 2007), and an E-book, Pros and Cons of Accountable Care Organizations (Practice Support Resources, 2011). He works with but does not speak for The Physicians Foundation, a 501C3 organization representing physicians in state medical societies. Opinions expressed in his blogs are his alone. He can be reached at rreece1500@aol.com and 1-860-395-1501.