Tuesday, August 3, 2010

OBAMACARE - is it really that scary?

Short answer. YES. It is very scary. okay, my post is finished. Goodnight!

just joking. The last two days of the Academy have been about health care - Obamacare and then positive alternatives to Obamacare. I am highly motivated to try and understand this issue to the best of my ability because I know that whatever happens to this federal law will directly effect me in my future career.
Warning - this post is going to be long, but hopefully it will be well worth your time. This issue effects EVERYONE and therefore must be understood. (I have condensed the information due to the nature of this format, but if you have any questions about anything that you read, please comment and I will get you answers).

Pro-Obamacare advocates point to the fact that millions of Americans are uninsured in this country - "we need to adopt this plan, this is the solution to providing care for everyone." I admit - this is a very valid problem in America, and we should work towards solving the problem (see future posting about this topic). BUT Obamacare is not the solution: This federal law limits what private citizens can choose to spend of their own funds to spend on medical treatment to saves their own lives and the lives of their own family.

This law is based on Obama's ideology that there should not be a Two Tier health care system - "rich" and poor receiving different levels of care.
I have a very basic question for you... a) Do you want to even things out by helping those who can't afford adequate health care? OR b) Do you want to limit health care available to those who CAN afford it? Obama's health law does some of A and a LOT of B. I have another question for you: should it be illegal for people to not save more than a certain limited amount for retirement, because some people didn't save at all for retirement? Should all people be required by law to live in the same square footage house, so that all is equitable? No, of course not... because in America, people are allowed to enjoy the rewards of their hard owned money to have a comfortable retirement and a house of their choice. Life, liberty and the pursuit of happiness, right? There is a fundamental difference between finding solutions to provide adequate care to the poor and not allowing anyone to spend more money that what is deemed  "necessary and efficient". If one is concerned about making everything equal, then this bill does exactly that. It doesn't really raise the level of the poor as much as it pushes the middle class and the wealthy down, so that all receive equal levels of below current medical standard care.

I completely understand if you don't currently believe that the law is a result of this ideology or that this law is truly as scary as it is characterized, so allow me to show you how will the law plans on accomplishing this equalization of society.

This 18-person board's entire goal is to push spending DOWN, below medical inflation. It will accomplish this goal through its complete and absolute authority to create rigid guidelines that HHS (Health & Human Services) will impose as "quality and efficiency standards" upon doctors. Doctors will be forced to comply with these standards (no exceptions) or they will lose their insurance contracts. These guidelines will lay out specific instructions about when an MRI is an appropriate medical procedure and when it is inefficient and wasteful, for example. It creates a "Cookbook Medical Care" phenomenon since doctors no longer have the right to determine what is the best decision for his/her patient - it will be decided by 'the Book'. These arbitrary, national standards of care will not be based on medical best practice, but on how to limit care so that the cost does not exceed the target budget, so that the total health care costs will be below medical inflation.

It is claimed that keeping costs below the rate of medical inflation will 'not reduce quality of care, just cut wasteful and excessive treatments.' But what is important to understand is that although the rate of medical inflation is approximately 3% higher the the CPI, or average inflation rate, the CPI is an AVERAGE. It is not economically savvy to expect all products and services to inflate at the same rate from hamburgers to automobiles... Health care has a higher inflation rate because it is a labor intensive service field where productivity levels cannot increase as much as other more technologically dependent fields such as manufacturing (which can continually increase productivity and therefore keep the cost/inflation rate lower). Reducing the cost of health care BELOW the medical inflation rate would be artificially capping essential life saving treatments, plus funding for future innovations and technological advances. Additionally, the cost of healthcare is not skyrocketing as it is purported - YES, the cost of healthcare has increased and it has become a larger portion of the family budget since 1940 - but the more accurate story is this: Productivity in other areas such as food, clothing and housing has increased dramatically (~20%) and we can get more for less money, and therefore have more disposable income to spend on healthcare and medical/technological advances. The healthcare industry has expanded widely in the last 70 years. For example in 1940, nitroglycerin was the only option for people with heart problems... then bypass surgeries were discovered (this saved lives!!!) ... and then stents were invented, making the process easier, cheaper and with more results and saved lives!!! Should we really reduce funding for stents in heart surgeries to keep down costs and instead revert back to giving nitroglycerin tablets (cheaper!!!)? The vast majority of Americans would say "NO!", because the advancements have unquestioningly increased quality of life and extended the average life span by 11 years in 70 years (from 66 to 77).

EXCHANGE LIMITS on what people can pay for insurance
I'm sure that you've heard of the state insurance exchanges that come with the Plan.... the exchange idea is not inherently bad (more choices for insurance is a good thing!) but the problem lies in the fact that the exchange will not be governed by the free market but by the government's heavy hand.  HHS will exclude insurers whose plans inside or outside the exchange allow private citizens to spend whatever they decide is "excessive or unjustified" on their own health insurance with their OWN money. It essentially imposes premium price controls to ALL plans, period. Exclusion from the exchange basically ensures that the insurer will soon be out of business. The phrase, "IF YOU LIKE YOUR PLAN, YOU CAN KEEP IT" has been touted everywhere, but the catch with that is that you can keep your plan unless it undergoes a significant change (key point: significant is not defined and therefore is open for interpretation... is a $20 premium increase significant? Is the addition of one more medical test to the plan significant?) Once a plan has changed "significantly" then it must now become a qualified HHS insurance company, subject to limits like every other insurance company. 

SHARED DECISION MAKING/Regional Decision Making Resource Centers
With this new law, "decision making aids will be implemented so that America can make better, rational decisions regarding treatment." Although this sounds wonderful, these centers could be known as the Propaganda Boards. The main goal will be to discourage excess (key: discourage excess = limit/ration care, even if the patient wants to pay for it). How? With phrases like, "you don't really need it, right?" This is not an exaggeration because the organizations serving as the advisors already have such things posted on their websites:
"In many people with a stable heart condition, medications are just as good as stents or bypass surgery."  (Do we really want to revert back to 1940's medical practice?)        
"Whether or not they receive treatment, men diagnosed with early prostate cancer will die of something else."  (Basically - so we are not going to treat prostate cancer - its not worth it)           
"At the end of life, too many people receive inexpensive treatment." (This statement only looks at the amount of money spent on people who have died but doesn't take into account how many more people were saved in the medical emergency because of the expensive, life saving treatments)       
"Women who wait 4 weeks on a treatment plan who have been diagnosed with breast cancer do not have more negative results." (Oh really? I should feel good that it is taking so long to get a treatment plan even while the cancer is spreading?)
ETC, ETC, ETC.... see for yourself at sites like http://www.informedmedicaldecisions.org/ and look at the DID YOU KNOW box.

I know that not many who are not on Medicare likes spending so much money on the old, but the limits put on Medicare in this law are disastrous! HHS has been given standardless discretion to reject any Medicare Advantage plan - which was the plan that allowed senior citizens to add their own funds to supplement the government subsidy - and therefore avoid rationing of care they wanted to save their own lives But under this new plan, the elderly would NOT be allowed to add their own money period, and would have to be subjected to the medical care standards that are determined by cold, money conscious bureaucrats and not their personal doctor. The result would be that the vast majority of the Baby Boomer generation would be considered as lives not worth living, and life-saving medical treatment in an emergency will be expressly denied. And the person and the family won't be able to do anything at it.

This new law limits "excessive health care"... by limiting what insurers can provide ..... by completely restricting what doctors are legally allowed to provide .... by limiting what private citizens can spend on their own healthcare, even if they want to spend the money.

What is "excessive health care" by the way? Donald Berwick, the new Administrator for Obamacare wrote that, "Most metropolitan areas in the United States should reduce the number of centers engaging in cardiac surgery, high-risk obstetrics, neonatal intensive care, organ transplantation, tertiary cancer care, high-level trauma care, and high-technology imaging." This is excessive care?
If I someday need a heart surgery at the age of 64, I won't be allowed to spend my own money to buy insurance to have the surgery and prolong my life 20 years? Exactly. If I someday have a high-risk pregnancy with my second child, I will be denied treatment - possibly endangering my life and the life of my baby? Exactly. If my baby is born prematurely, I will not be allowed to spend my own money to do everything I can to try to allow my child the chance to grow up and live a happy life? Exactly. If my kidney fails at the age of 51, I cannot spend my own money on insurance to put my name on the list for a transplant? Exactly. If my mom gets cancer and there is a revolutionary cancer treatment available that will extend her life 5 years, I am not allowed to use my money to purchase that treatment? Exactly. If I get into a car accident tomorrow and suffer head trauma, under the new law my parents wouldn't be allowed to use their resources to try and save my life? Exactly. I won't be able to access CAT or a PET scan to detect early cancer growth at the age of 72? Exactly. Please tell me what is so excessive about this healthcare?

One of the problems with Obamacare is a misunderstanding of what health care actually is for. The importance of healthcare is not the ability to run to the doctor with a sore throat or joint pain (though that has its place.) Healthcare and healthcare insurance is there to provide care for MEDICAL EMERGENCIES. This is when the majority of people need care... when they are really sick. If we eliminate all costly and expensive medical procedures, we are eliminating the foundation of why we even practice medicine and why we continually invent and research cures for debilitating diseases. Let's just let everyone die when they are sick, okay? What?

The emphasis in Obamacare has shifted from Curing to Caring... This has also happened in England with their government run health care system (among other European countries). England's focus is on taking care of and appeasing the masses (the voters!) by caring services, like ambulance rides to and from the hospital - it will even pick up your prescription at the pharmacy. Doctors will perform house calls - isn't that so very convenient? But this means that their care is limited to 1940 technology contained in a little black bag, instead of a doctor's office full of supplies (a cheaper visit though). But the patients who really need care are not allowed to receive it. When many patients need dialysis or a kidney transplant for example, instead of telling them that they are not allowed to receive life saving treatments (because it is "excessive"...) they are told, "We're sorry, there's nothing we can do for you", accompanied by a number for hospice.

The numbers speak for themselves. The cancer survival rate compared to the United States versus the UK is astounding. According to BBC, "The study showed the US had the highest five-year survival rates for breast cancer at 83.9% and prostate cancer at 91.9%.... The UK had 69.7% survival for breast cancer, just above 40% for colon and rectal cancer and 51% for prostate cancer... Spending on health care was a major factor, the study of 31 countries said. Researchers said that higher spending often meant quicker access to tests and treatment. Access to diagnostic equipment is key, say experts." http://news.bbc.co.uk/2/hi/health/7510121.stm

Obamacare reduces specialists, increases primary care/basic level of care physicians, decreases (even regresses) the release of new drugs and new technology, and reduces the life expectancy by completely limiting what individuals can spend on healthcare even if they want to spend the money.

I hope that this attempt at explaining the convoluted, complex 2000+ page law helped clarify at least one thing: We must repeal Obamacare before the majority comes into effect 2014. Our lives, and the lives of those we love the most, literally hang in the balance.

For more information about Obamacare see: http://www.nrlc.org/HealthCareRationing/Index.html

(Next post topic: "America can Afford Non-Rationed Healthcare For ALL!)

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