ObamaCare: A Physician’s Point of View On The Negative Ramifications of America’s Affordable Health Choices Act of 2009Friday, July 24, 2009 21:40
Healthcare reform is obviously the hot button topic of the day, and unfortunately, as a good (and well educated) friend of mine admitted today, the sum of the average American’s knowledge about the current healthcare bill comes from the nightly news. From their perspective, ObamaCare sounds pretty good.
I’d like to share my take on this issue, but first, before the inevitable attacks begin, I’d like to share some things that shape my point of view. Despite the letters after my name, I don’t come at this from the viewpoint of a doctor who is worried about their bottom line. If you’ve been around for a while, you know I don’t practice medicine, as a result of having a child with multiple healthcare needs. I am also not a Republican. If you must know, I’m not a member of any political party.
I do, in fact, come at this issue from the perspective of a self-employed person who is all too aware of the pitfalls of trying to get health insurance for someone with a pre-exisiting condition. I am very familiar with shortcomings of individual health insurance plans in the US. I also know what happens to household finances when a critical illness occurs, and your health insurance leaves you footing most of the bill. But, above all, I am an American who believes in small government and individual freedoms.
Despite the shortcomings in the US healthcare system, I stand opposed to HR 3200, otherwise known as America’s Affordable Health Choices Act of 2009. Since the bill is 1018 pages long, this post could probably go on forever, but instead I’ll list a few of the biggest problems I have with this bill.
- ALL Americans will be forced to obtain health insurance, and unless they qualify for Medicaid, they will PAY for it. The public plan is not a free ride. There are premiums and “cost-sharing” charges associated with medical visits under the public plan. In fact, the basic plan will only cover 70% of the calculated value for anything beyond preventive care (pg 29 lines 23-25). Opting out and paying for your healthcare elsewhere will not be an option, unless you have a lot of money, because if you don’t carry an approved plan, you will pay a 2.5% tax on your adjusted income as a penalty (pg 167 lines 18-23).
- If you do qualify for Medicaid, you must be enrolled (pg 102 lines 12-18). If you somehow manage to budget well enough to afford individual insurance, it will not be an option. This means you will have no choice, no control, and you will be subject to whatever limitations the government decides to put on the care Medicaid will pay for. If you can’t find a doctor in your area which is accepting new Medicaid patients, and the number who do is dwindling, you will have to move or travel long distances to find a doctor who does.
- There will be a system called Individual Affordability Credits which will decrease the premium and cost sharing responsibility for people whose income is between 133% and 400% of the federal poverty level. Unfortunately, for the first two years of the plan, people who qualify for these credits will only be able to receive the basic level of public insurance. In year three, they will work out a system that will allow you to cover the difference between your affordability credit and the enhanced or premium plan options, but until then, only the relatively wealthy will get that option (pg 131 lines 13-24).
- Private health insurance companies will no longer be able to deny people coverage for pre-existing conditions (pg 19 lines 18-25), or deny renewal of a policy. They also won’t be able to charge people with pre-existing conditions a higher premium. In addition, under the bill, no one can be charged a premium higher than the one designated for their age and location (pg 17 lines 1-7). This sounds really good, until you realize that in order to remain solvent, health insurance companies will just raise the rates for everyone across the board.
- If you don’t have a private individual health insurance plan before the public plan goes into effect, you won’t be able to get one. After that date, private insurers will be prevented from writing new policies. The only exception will be for dependents of those who are already insured by an acceptable plan (pg 16 lines 11-20). So, if you start out on the public plan because it’s a little less expensive, but find out you hate it, you’re stuck.
- Hospitals will need government permission to expand the number of beds, operating rooms or procedure rooms they have beyond the number accounted for on the day the bill goes into effect (pg 317 lines 21-25 and 318 lines 1-3). If they do meet the numeric criteria for expansion, the decision will still require public commentary. If they are denied, there is no administrative or judicial review (pg 325 lines 21-25). The government will therefore be able to limit the availability of healthcare in a given region.
- There are too many pages covering this next part to list them all clearly, but the government will be forming various bodies to decide what healthcare we should be getting, and what types of care our scientists should be researching. They will be using these panels to determine what type of care the government will pay for, based not only on evidence, but also on cost effectiveness and overall benefit. They will use similar criteria to decide where research should focus, thus putting up major obstacles against researching and treating rare diseases. The decisions of these panels could lead to a person being denied care because they are too old to get enough benefit, or the treatment doesn’t have a high enough success rate to justify the cost. Imagine the impact this could have on treatments for aggressive forms of cancer, so-called orphan diseases or diseases of the elderly. For the preemie parents out there, imagine what this panel would do with the recent study data that less than 5% of 24 weekers are unimpaired as toddlers. Do you think they’d see the million dollar NICU bill that baby incurred as beneficial or cost effective to the whole?
As I’ve read articles today, and worked my own way through HR 3200, I’ve spotted many more potential problems out there. In the end, what I hate the most is the aspect of government control and oversight over pretty much every aspect of healthcare. I hope you’ll use the highlights I’ve listed above as a jumping off point, and take a look for yourself. I also urge you to contact your representative to tell them where you stand on healthcare reform.