The ObamaCare Story: A Work in Progress

I’ve been working on a book The ObamaCare Story, based on 2500 Medinnovation blogs I’ve written over the last 6 years.

It’s a hard book to write. There’s no beginning and no end. Health care inequities were brewing before Obama became president, and inequities will not end with the Supreme Court decision on the legality of federal subsidies in late June, or when Obama finishes his second term. Individual inequities, deemed “social injustices” by some, are part of the human condition. Always have been. Always will be. To paraphrase George Orwell, some people are more equal than others.

With an ObamaCare book, there is too much to think about , too much to write about. There are too many unanswered questions. too many failed solutions, too many philosophic and ideological points of view.

Is a compassionate socialistic government the answer? Not if you consider Europe’s economic stagnation, or the inner city riots after we pumped $22 trillion into the war of poverty since 1965. Is unbridled American capitalism with attendant prosperity the solution? Not if you consider the fact that 30 million Americans remain uninsured. Quasi-socialism, ObamaCare style, isn’t working very well, if you ask the American middle class. And quasi-capitalism, Republican style, has yet to be tried for health care and is met with massive skepticism on the left.

The upcoming June Supreme Court decision illustrates the problem. If the court affirms ObamaCare’s right to subsidize the poor and quasi-poor, controversies over the unworkability of the health law with its redistribution of wealth and soaring national debt will continue. If the court rules against federal subsidies, what will the Republicans do about those 7.5 million poor folks left without subsidies? Extend the subsidies? Replace the subsidies with tax credits? Lower taxes for all and hope a resurgent economy with more federal revenues will repair the safety net and finance the have-not’s?

There are other unanswered questions as well.

Will technology, which has upended the economy and arguably contributed to unemployment by replacing humans with machines save us from ourselves?

Will technologism replace humanism, or will they be complementary and supplementary?

Will mass aggregations of health care data show us the path to lower costs, higher quality, and better outcomes?

Will robots posing as doctors, telemedicin ‘s virtual visits be superior to real human- to-human physical visits with doctors?

Are doctors working in teams, backed by evidence-based algorithms, better than individual doctors using clinical judgment based on experience and real-time interaction with patients ?

Can patients, empowered by iphones and endless streams of on-line health information, be relied upon to make the right decisions for themselves?

Is government, even with its teams of policy experts and access to reams of population data, be trusted to guide the right decisions, at the right time, for the right reasons at the point of care of billions of patient-doctor encounters without violating the patient’s privacy or the doctor’s pledge of confidentiality?

Should health care be directed from the top-down, from Washington. D.C, or from the bottom-up, by those in the health care trenches or those in integrated health organization’s executive suites?

These are just a few of the tough questions that make the ObamaCare story so hard to write. The ObamaCare story and its sequel will always be a work in progress, a struggle between progressives and traditionalists, with no clear answers in sight. Is ObamaCare "fair for all", or is it merely a "free for all" fairy tale.