By Doug Magill
At least two-thirds of our miseries spring from human stupidity, human malice and those great motivators and justifiers of malice and stupidity: idealism, dogmatism and proselytizing zeal on behalf of religious or political ideas. Aldous Huxley
For decades those that call themselves liberals have wished for single-payer health care. The idealism and zealotry of those self-proclaimed moral adjudicators discarded reality and potential consequences as irrelevant to the overriding moral good that supposedly could be accomplished. Clinging like lampreys to the dishonest calculations involved in the original cost estimates of the Affordable Care Act, liberals were almost in paroxysms of ecstasy as the legislation was rammed through before dawn on a Christmas Eve without any amendments or votes by Republicans.
The biggest problem was that no one in the Congress appears to have read the law. We have now, as a nation, reached the point where our legislators are no longer lawmakers – they are conduits for the needs of special interests via whatever gets put into legislation by lobbyists and congressional staffers. James Madison is spinning in his grave.
Aside from the ignominy of our elected officials becoming bystanders to the real decision-making relative to legislation, the ugly truth underneath is that so much of the legislative process leads to rule-making by federal agencies that now effectively have dictatorial power over many aspects of our lives. The only sanctuary is the judiciary, but the victories for liberty are few and far between against entrenched bureaucracies.
As far as Affordable Care Act is concerned there are an incredible number of references to decisions that are to be made by the Secretary of Health and Human Services who has delegated those decisions to her staff and are soon to become regulatory rulings not subject to review. Held until after the election, HHS has now issued over 13,000 pages of rules and regulation that are mind-numbingly complex and yet the majority of the requirements of how this monstrosity is supposed to work have not been published.
For over a year various organizations, including the National Governors Association have been petitioning HHS to clarify how they are supposed to implement Obamacare. There has been no response.
Each one of those instances of “The Secretary shall determine” embedded in the legislation is worthy of a discussion or even a floor fight, but all of them passed through Congress in the night like dark angels of misery. And we all will have to live with the consequences.
Yet, the very incomprehensibility of it all is creeping up on those very advocates of burgeoning government as the legislation begins to take shape in all of the agencies involved. What seemed like another liberal exercise in self-righteous moral ecstasy as the fantasy of government health care begins to take shape is crumbling before our eyes due to its illogic, favoritism, and market distortions.
While not single-payer health care, the burdens of Obamacare will squeeze insurance companies out of the business and result in single-payer coverage within a few years.
The regulations concerning pre-existing conditions have been issued by HHS (again, conveniently after the election). Everyone’s premiums will have to go up to cover those people, and no one knows what those overall costs will really be.
Women cannot be charged more than men which will require men to be paying a lot more for insurance containing coverage for which they are anatomically incapable of ever utilizing.
In defiance of any actuarial common sense, older people cannot be charged more than three times the premiums of young people. The burden on those younger, who generally do not need regular medical insurance at all, will be enormous.
And, by the way, people who are sick end up getting to pay the same premium as everyone else. Which burdens healthy people at a level that no one can estimate today.
All of those increases in costs will cause enormous premium increases. That will create a juicy opportunity for the demagogues in the Democrat party to cause the collapse of the health insurance industry. After all, when there can be no actuarial analysis, what is the point of calling it insurance anymore? It will be, in fact, nothing more than a disguised government transfer program with the capacity to bankrupt us all.
The wizards at HHS are building a system for applicants to use to determine eligibility for the Obamacare exchanges and Medicaid. This is effectively a redundant system as a number of states have already implemented methodologies to apply for and determine eligibility for Medicaid, food stamps, and other assistance programs. Nope. HHS refuses to allow data sharing between systems, so we are guaranteeing inefficiencies, duplication, and higher costs for everyone involved.
In order to make the concept of exchanges work, this system will be a place for insurance companies to offer coverage, and individuals to make their choices. This has been a major source of controversy between the states and the federal government.
In an incredible rebuke to the federal government, 25 states (including several which voted for the President in the recent election) have refused to develop their own exchanges. Only 18 states have agreed to do so, with 7 forming some sort of partnership with the government. Part of the problem is no one knows what these exchanges will cost, and whether the federal government will effectively run them once they are implemented.
If the federal government has to build all of these state exchanges, where will the money come from, and is it even possible to create such massive systems, procedures and training before the October 1, 2013 deadline? Of course the law does not provide funding for federally-run exchanges. Oops….no one knows what that means. Lawyers are staffing up I am sure to handle the avalanche of expensive litigation this will generate.
Of course there are a number of different mandates and requirements currently legislated in each state which have to be accommodated by the federally-run exchanges. That has not been taken into consideration yet.
Part of the original funding for Obamacare was CLASS, intended to be a long-term care insurance program (See The End of Class). Even before CLASS was implemented the chief actuary of Health and Human Services wrote that “this program would collapse in short order”. Purely an accounting fiction, it was supposed to collect premiums for several years before actually insuring anyone. It was an illusion intended only to pretend that Obamacare would save money. Even the ever-duplicitous Kathleen Sebelius had to throw in the towel on the program in late 2011.
Including the fictitious savings of CLASS, Obamacare is now a ravenous monster which will explode our debt. Projected by the Democrat witches that brewed this mess to cost $900 billion over ten years, the Congressional Budget Office recently announced to little fanfare that the actual cost will be $2.6 trillion.
Even though no one has taken any of Obama’s budgets seriously (the 2012 attempt failed in the Senate 97 – 0) our fiscally-challenged president has been revealed to have buried a $17 trillion funding shortfall in the Obamacare obligations. When considered in addition to the existing Medicare and Medicaid unfunded liabilities we are looking at $99 trillion in debt for our great-grandchildren, with no known way to pay for it.
We already owe over $16 trillion in debt today, with no serious discussion of how that is to be paid for.
The administration’s history of duplicity is more than ever on display as regulations are being jammed in with only 30 days for public comment when the standard is 60 days, and 90 for complex rules. It also turns out that many of the rules were approved within HHS and ready to go as far back as last spring, but were held until after the election.
Now that the Obamacare sand castle is being washed by the tides of reality an incredible 18 democrat senators (who voted for Obamacare) have written to the Senate Majority leader petitioning for relief from the medical device tax which was part of the funding for Obamacare. The party that considers tax rates irrelevant to human behavior has discovered that medical device companies will be laying off people, closing facilities and restraining expansion plans due to the taxes. One of the senators called it a “job-killing tax.”
Welch Allyn, a manufacturer of diagnostic equipment announced that it will be laying off 10% of its workers due to the tax. Stryker will close one of its plants and cut 5% of its workforce.
The list is long and includes such well known names as Abbot Labs, Boston Scientific, Medtronic and St. Jude Medical.
Another surprise was the issuance of new insurance regulations by HHS that had a new and unforeseen 3.5% monthly user fee to be added on to the premiums charged by insurance companies who will provide policies via the new government exchanges. Those fees will be passed on to customers, and will make the program even more expensive.
How this is supposed to help uninsured people is being lost in the blizzard of regulations and taxes and fees.
For the physicians who will have to deal with all of this the burdens are becoming unbearable. A recent study by Physicians’ Foundation detailed that more than 22% of the doctors it surveyed will be cutting hours and 15% intend to retire in the next couple of years. Cited were an incomprehensible increase in the demand for pre-approval by the government for routine tests and an explosion in the number of codes required to report diagnoses and treatments from 14,000 to almost 70,000.
The Independent Payment Advisory Board (IPAB) which will dictate cost-cutting measures to control Medicare costs is now being really understood for what it is – a draconian bureaucracy with no accountability. Its recommendations will cause denial of care to many patients as it discards treatments that it might consider too expensive, and will lead to indirect cost-cutting measures that may be reflected in denial of care entirely for patients that may be considered not cost-effective to treat.
Doctors will soon be subject to new quality control evaluations that have nothing to do with patient care and can lead to penalties if their reporting is not timely or sufficient.
Obamacare also included money to incentivize physicians to use electronic medical information systems. Doctors now spend an enormous amount of time keying in data to systems that are not directly involved with or provide patient care.
Because the burdens of paperwork and medical information systems doctors now have less time to spend with patients and are feeling that feeding the bureaucracy is becoming their primary duty.
Which is causing a significant percentage of physicians to consider dropping out of the current system and charging patients directly.
Because of the expansion in coverage in Obamacare the demand for more physicians has sharply increased, but no one knows where they will come from. So, what does the government do when it is faced with a problem caused by its own meddling? Meddle some more. Tuition incentives and bonuses for managing costs the Obamacare way.
Another area which will dramatically affect doctors is the “free” annual checkup included in Obamacare. No charge, no deductible, no co-pay.
Most people will have not read the law and will think that they get a free visit to the doctor every year. Sorry. It is intended only to be a “preventative” exam, and in that visit the doctor can only discuss with the patient the exam and any previously-diagnosed condition. New ailments or problems cannot be discussed as part of that visit. If there is a new concern then another visit will have to be scheduled, and paid for. Doctors will hate this and will be constantly audited to prevent them from breaking the law by being concerned about their patients.
Hippocrates be damned, the bureaucracy is the customer now, not the patient.
Doctors from totalitarian states that are now practicing in the United States are aghast. They have seen all of this before. When physicians become employees of the state and work to state standards they are no longer doctors. They become employees and technicians more worried about their pensions than patients. They will be government employees.
And everyone’s care suffers.
There are more burdens in Obamacare that are just beginning to catch the attention of those are supposed to guard our nation’s future. The increase in the threshold for medical expense deductions from 7.5% to 10%. The annual cap in flexible spending accounts. The investment surtax that will cause further distortions in our capital markets and damage an already-struggling economy. The Medicare payroll tax increase.
Oh yes, and the cuts in Medicare which were double-counted in the justifications for Obamacare.
Obama’s handpicked head of Medicare, Dr. Donald Berwick, proudly proclaimed in 2008 that “Excellent health care is by definition wealth distribution.”
We are about to get massive wealth distribution, but not excellent health care. We will in fact be facing long wait times, restricted physician access, diminished innovation and quality, and the tyranny of regulations and bureaucracies that will cripple the country, destroy lives, and send our society on a dark downward spiral.
Doug Magill is a cancer survivor and freelance writer. He can be reached at Doug@MagillMedia.net