Notes on Obamacare Future- Government Controls versus
December 6, 2012
(Obamacare) will likely be a nightmare of missed deadlines, public confusion,
inconsistent exceptions, and dashed expectations. Every claim made for the bill will be shown
to be false: health costs will go up, not down; government spending and debt
will go up, not down; the economy will be injured, not benefited; people in the
millions will in fact lose their health insurance they have and like.
failures, abetted by the natural tendencies of Americans to swing the pendulum
ever so often, set the stage for a powerful restoration of architecture of
liberty. Freedom’s friends must be ready, not just with cerebral prescriptions for better
policy, but with a moral argument that affirms the God-given dignity of each of
us, that says, “Yes, we can” to everyone.
Governor Mitch Daniels, speaking to a conference of the William S. Buckley, Jr,
program at Yale, November 3, 2012
the most difficult long-term challenge facing Obamacare is cost-control. The ACA does contain substantial savings in
Medicare, but limits on other spending are less robust. In fact, the ACA is not
so much a program as a series of programs, regulations, subsidies, and mandates
that fill gaps in the current patchwork insurance system. It treats different groups of Americans in different
ways at different times, which complicates efforts to explain the law, enroll
eligible populations into benefits, and mobilize public support.
Oberlander, PhD, University of North Carolina Health Analyst, “The Future of Obamacare,” New England Journal of Medicine,
December 6, 2012
6, 2012 – The die is
cast. The health law is baked in. Democrats control the Presidency and the
Senate. The health law’s implementation begins in earnest on January 1, 2013. Then many physicians may take a SGR 27% cut,
with an 2% sequestration reduction, and a roughly 50% overall tax hikes. when one
includes all taxes and incomes exceed $250,000.
If we fall off the fiscal cliff, another recession
is imminent. Economic stagnation will
continue. Businesses will cut back on
hiring and expansion and reduce full-time employees to part-time work. Unemployment
will rise. Public discontent will fester.
Physician shortages will intensify.
The majority of states, 21 so far, will decline to set up health
exchanges. And as 78 million baby boomers
and 30 million, perhaps even 40 million, hit the entitlement rolls, government beneficiaries
unable to find a doctor to deliver
promised “free care” will revolt.
A political crisis will be at hand. The question will be, as a pointed out in the
title of my 1988 book, And Who Shall Care
for the Sick? lack of access to physicians. People will ask. If one cannot find a physician to help you,
what good is universal coverage?
The crisis will center on centralized government
controls versus decentralized clinic freedoms and affordability of care. It will be about how we can give patients enough
information to responsibly choose their own doctors and receive the proper treatment that fits their
needs. It will be about how to pay and
incentivize physicians so they can do
what is best for patients and still stay in practice.
to “The Fix”
Governor Mitch Daniels of Indiana has one solution –
universal health savings accounts in high deductible plans so consumer have
“skin in the game” and incentives to save money while putting aside money for
George Halvorson, chairman and CEO of Kaiser
Permanente has another approach– change the culture by having large
organizations own health plans, hospitals, and pay salaried doctors to work with
other health care professionals to save money, coordinate care, improve
quality, and improve quality and outcomes.
And there is, of course, universal mandated government coverage, or a series of incremental government steps,
such as those inherent in Obamacare, to lead ultimately to that coverage.
Free market aficionados advocate a combination of
tort reform, shopping across state lines,
state and federal vouchers for entitlement populations, moving age of Medicare entry to 67, reducing obligated
alternatives in state programs,
expansion of federal health benefit programs based on competition
between plans, and tax credits for all.
Issue and at Risk
At issue is government mandates or the freedom of
patients and doctors to exercise their best mutual judgments on what care to
receive or implementing government controls to dictate what needs to be done to
reduce and rationalize runaway entitlement spending as proposed by Obamacare
mentioned, at risk is a collapse of the
fragmented and increasingly fragile state of private practice due to lack of sufficient
scale and access to administrative, technologic and capital resources to deal with
governmental mandates, regulations, rules, penalties, and obscure bureaucratic details,
as yet undefined and evolving.
Clerks and Serfs
To serve as clerks and serfs of government and to
face the prospects of a 40% reduction in reimbursements to achieve “savings” on
hospital and physician costs over the
next 10 years, as envisioned and projected by Obamacare as Medicare is not
an attractive option for physicians and will render entering medicine as a less attractive
profession to enter.
Midterm Elections and Political Pendulum
Ahead lies the 2014 midterm elections. These elections could be a repeat of the 2010
midterms, particularly if Obamacare
continyes to fail to deliver govenment goods as promised.
For whom does the political pendulum toll ?
For American consumers and physicians?
For government bureaucrats and the denizens
of the safety net?
Which set of constituencies is a problem.
There is another problem as well.
In the United States, government elites that put
class envy and that elusive thing called social justice ahead of economic prosperity
and free enterprise will not likely to remain in power for long, as evidenced by the Socialist takeover of Britain after World War II and their subsequent defeat.
Churchill eloquently summed up the problem, “The inherent vice of capitalism is
the unequal sharing of blessings; the inherent virtue of socialism is the equal
sharing of miseries.”
sits on the financial cliff’s edge because of costs, uncertainties, and adverse
effects on patients, doctors, and the economy.
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