Obamacare by Decree

Obamacare. A word that is 100% guaranteed to be polarizing in almost any discussion about heatlh care. In the 2 years since a 2700 page law dubbed Obamacare has come in to being, the HHS Department and Madamn Shebullshits have issued some 12,000 pages of regulations and edicts, all in the name of making health care, and health insurance, more accessible and affordable.


So far, we have yet to see either.


That hasn't stopped them from pressing forward, alienating large segments of the public, turning health care providers (and the Supreme Court) in to adversary's and generally making a mess of things, all due to Obamacare provisions.


But wait, there's more!


Some 85,000 or so physicians will play a crucial role in Obamacare, including the 16+ million new enrollee's in Medicaid. So how will this impact the doctors?


The Hudson Institute has some insight in to the future of Obamacare from a physician's perspective.


This $800+ billion (a low estimate in our view) will be funded by new taxes on everyone who uses health care (including the poor and middle class) as well as significant reductions in Medicare funding plus increased cost shifting for out of pocket expenses to seniors and the disabled on Medicare. This is part of Obamacare that no one wants to discuss.


Beyond the complexity of Obamacare (which no one admittedly read before voting on it) the one individual given almost total control over health care rests with a non-elected official that holds the title of HHS Secretary. Given virtual czarist powers, we have already seen the way the current Secretary has bludgeoned her way through almost every aspect of the health care system with complete disregard for the outcome.


The most recent public battle, which is still being waged in the form of a lawsuit due to Obamacare and HHS directives, involves the issue of mandated "free" contraceptive devices for everyone, including those who oppose such on the basis of religious views.


How did the HHS Secretary gain such control?


References to the HHS Secretary appear over 3,000 times in the 2700 page Obamacare legislation.


Former HHS Secretary Leavitt said "It puts more power than is prudent in the hands of one person, and it is not an answer to our current health care crisis".


Also from the Hudson report comes this tidbit about Obamacare.


Incredibly, the bill’s powers are not limited to the broad macroeconomic issues described above. They also regulate a wide range of medical areas in minute detail, extending their reach even to one of the most personal arenas: the dentist’s chair. Section 4102 of the ACA, for example, states: “The secretary shall develop oral healthcare components that shall include tooth-level surveillance.” As Secretary Leavitt describes it, the mandate for tooth-level surveillance would  require “a clinical examination in which an examiner looks at each dental surface, on each tooth in the mouth.”


In the real world we call this micro-managing.


In DC world of Obamacare, this is just business as usual.


A recent survey indicated that 60% of physicians surveyed said Obamacare would have a NEGATIVE impact on patient health care . . . and these are the folks on the front line of health care delivery. Another survey of new physicians found 57% were pessimistic about the future of health care and 34% feel that way specifically because of Obamacare.


And then there is the concern about the economic impact of Obamacare.


From the economic perspective, doctors’ top concern raised by the Obama health care law is in the area of reimbursement rates. The reimbursement question usually centers on the Sustainable Growth Rate (SGR). The proposed cut in reimbursements would hit doctors hard, imposing initial cuts of over twenty percent


I wonder how many in the general population would be willing to take a 20% pay cut in order to advance the noble cause of "health care for everyone"?


While the Obama health law will cover an additional 32 million Americans, 16 million of those newly covered Americans will get their coverage through Medicaid, according to the

Congressional Budget Office. Doctors are well aware that Medicaid reimbursement rates are lower than those they get from privately insured patients. In fact, according to Moffitt,

“physicians in Medicaid are paid 56 percent of private payment.” This reduced reimbursement rate is the reason that Medicaid patients often have difficulty finding a doctor. Imposing these lower reimbursement rates on a growing number of patients will likely have the impact of exacerbating access issues in the future


And even this fails to take in to account funding at the state level for Medicaid expansion.


Where will the money come from?


How high will taxes have to go at the state level and how many services will be cut back to fund Medicaid expansion under Obamacare? At what point will we, as a society have to say, enough is enough. It is time for the poor to bear the cost of their own care rather than relying on the taxpayer to provide their every need from womb to tomb.


The proverb that says "Give a man a fish and he can eat for a day, but teach a man to fish and he can eat for a lifetime" needs to be considered in this regard.


Beyond economic issues, physicians worry that the new law will interfere with their practice of medicine, and in a variety of ways. To begin with, there is a generalized concern about decision making being taken from doctors and having medical decisions made instead by government officials. Doctors worry about the imposition of “uniformity of practice,” the establishment of strict guidelines that fail to permit individual doctors to make decisions based on their in-person interactions with patients. As Dr. Saul Greenfield writes in the Wall Street Journal, “every physician must, at some point in the patient-care process, make decisions and take responsibility for them. And unless the doctor does so, the outcomes will be compromised."


Does the government REALLY know what is best? Mayor Bloomberg wants to tell New Yorker's what size sugary drink they can and cannot consume within the confines of "his" city.


Isn't all this going a bit too far? And where will it end?


If doctors cannot practice as they wish, it raises the question of whether they will practice. As Dr. Mark Siegel has noted, because of the anticipated changes in health care, “To stay in business under ObamaCare, doctors will have to adjust. Some will see fewer patients themselves and hire nurse practitioners to help carry the load; others will work part-time and supplement their income elsewhere. Many will join groups or become salaried employees of hospitals or clinics.”


Will Obamacare be the primary cause of killing the goose that laid the golden eggs? Was the real goal of Obamacare to make health care, and health insurance, more affordable or was it more a legislative Mt. Rushmore designed to feed an ego?


The further Obamacare goes, the more one has to wonder if this is really what we, as a country, need or want. And in particular, how much control will those who hold the office of HHS Secretary in the future want, and what kind of whims and ego-driven, power hungry schemes await us?


In addition to the cost of Obamacare, which may single-handedly bankrupt the country, there is the issue of will there be enough medical personnel to service the needs of 30+ million newly insured people coming on board in 2014?


Obamacare is the iceberg and the United States is the Titanic, speeding right toward a disaster.