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Affordable Care Act is bad for NM, worse for US
Very clearly, the forced passage of the Affordable Care Act had much more to do with partisan domestic politics than the health of either health care or We The Patients.
The U.S. Supreme Court is discussing the ACA, the latest abbreviation for the Patient Protection and Affordable Health Care Act of 2010, pejoratively named Obamacare. Defenders of the law like State Senator Dede Feldman say the law is good for both New Mexico and the United States. They argue that it brings lots of money into our state, creates new jobs, increases insurance coverage, and eliminates the exclusion for pre-existing condition.
ACA may bring large buckets of federal dollars into New Mexico, but that money will be spent on bureaucracy, not on patients. ACA is likely to increase jobs – 38,000 to 47,000 new bureaucrats, regulators, insurance adjusters, IRS investigators, and compliance officers, but not one new nurse or doctor.
In 2008, President Obama said the U.S. health-care cost spiral was unsupportable and was contributing significantly to a soaring national deficit. Then he pushed through a bill – ACA – that will spend $12.7 trillion (with a “t”), money we do not have and we will have to print or borrow.
Senator Feldman also applauded New Mexico’s work on “quietly implementing” ACA, building a whole new I.T. (information technology) system for insurance authorization and compliance, not for medical information and care. Isn’t that just what we need – a whole new layer of complex bureaucracy over-laying an already bloated, user-incomprehensible insurance system.
Patients want health care
Supporters claim that ACA is good for us because it extends insurance coverage to people who currently do not have it. Insurance is not what patients want. What patients want is health care, and under ACA, they won’t get it.
If the doctor cannot afford to accept your insurance, such as Medicare, your insurance is worthless. If your insurance carrier doesn’t authorize the care you need or where you need it, having the insurance does you no good.
In day-to-day health care reality, government insurance is no different from private. First, they both make money or stay within budget using the “3D” strategy: deny, delay, and defer.
If – and often that is a big if – the procedure or drug that you need IS covered, the insurance will contract for the cheapest they can find. This is generally not the level of quality that you need. As a pediatric cardiologist, I fight this battle every single day, and so do virtually all of my colleagues, nurses and doctors alike.
Then there is the ACA’s IPAB (Independent Payment Advisory Board). Just as in Great Britain, IPAB will say what treatments are cost-effective (meaning available to patients) and what are not (not available.) In England, kidney dialysis and heart surgery are not considered cost-effective over certain ages, so they are not available and if you need them, you die.
Even if you can keep your insurance despite your pre-existing condition, you will wait and wait and wait, as they do in Canada, for a procedure that is approved but scheduled for months or years in the future, a treatment that you need now.
IPAB is even worse than you think. According to ACA, if Congress does not enact spending cuts in other areas – which are politically unpalatable and therefore will never happen – IPAB recommended cuts in medical services automatically become law.
Is this what you would call “good” for New Mexicans or for Americans?
Malpractice and exacerbation
The ACA has been called magical thinking, snake oil, smoke and mirrors, a monstrous scam, and government takeover of health care. While these all apply, the best terms for ACA are malpractice and exacerbation (the opposite of reform): It fails to treat the causes of health care illness, and, as a result, ACA makes both health care and us sicker.
Senator Feldman called the Supreme Court challenge to ACA “more to do with politics than the Constitution.” Very clearly, the forced passage of ACA had much more to do with partisan domestic politics than the health of either health care or We The Patients.
Deane Waldman, MD-MBA, is the author of “Uproot U.S. Healthcare,” adjunct scholar for the Rio Grande Foundation, and professor at UNM.
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Repealing ‘Obamacare’ Would Explode Debt, Says Government Auditor
The Government Accountability Office, which audits federal spending, has concluded that the national debt would rise precipitously if President Obama’s health care legislation doesn’t go into effect.
http://tpmdc.talkingpointsmemo.com/2012/04/repealing-obamacare-would-explode-debt-government-auditor.php
Then he pushed through a bill – ACA – that will spend $12.7 trillion (with a “t”), money we do not have and we will have to print or borrow.
That looks like a lie, too.
I was unable to find any estimates of the cost of ACA higher than about a billion dollars. The biggest numbers i could find, even looking at all the conservative and Republican sites, were around $1 Trillion. e.g. sweetness-light.com/archive/cbo-now-says-obama-care-will-cost-1t
So I looked around for where thta $12.7T number could have come from, and I found this:
The biggest culprit, by far, has been an erosion of tax revenue triggered largely by two recessions and multiple rounds of tax cuts. Together, the economy and the tax bills enacted under former president George W. Bush, and to a lesser extent by President Obama, wiped out $6.3 trillion in anticipated revenue. That’s nearly half of the $12.7 trillion swing from projected surpluses to real debt. Federal tax collections now stand at their lowest level as a percentage of the economy in 60 years.
http://www.washingtonpost.com/business/economy/running-in-the-red-how-the-us-on-the-road-to-surplus-detoured-to-massive-debt/2011/04/28/AFFU7rNF_print.html
In other words, the column’s author took the entire amount of the swing from surplus (under Clinton) to debt under Obama. That’s a whole lot more than just the ACA.
Now I’m wondering whether anything in her column is true. It sure looks like she’s just making stuff up, pulling imaginary numbers out of thin air.
The ACA has been called magical thinking, snake oil, smoke and mirrors, a monstrous scam, and government takeover of health care. While these all apply, the best terms for ACA are malpractice and exacerbation (the opposite of reform): It fails to treat the causes of health care illness, and, as a result, ACA makes both health care and us sicker.
That’s just a collection of insults and characterizations, and not a fact to be seen in the whole paragraph.
There are a lot of things wrong with the ACA – but surely we should expect the people who dislike the ACA to stick to actual facts in their arguments against it. Lies and insults don’t make for a very persuasive column.
In England, kidney dialysis and heart surgery are not considered cost-effective over certain ages, so they are not available and if you need them, you die.
That’s flat out false, as best as I can tell:
Britain has lagged behind other European countries in providing dialysis places, but numbers have expanded hugely over the last 20 years. No units operate an age barrier or other fixed limitation on who can be treated. Every patient is considered individually.
http://www.edren.org/pages/edreninfo/witholding-and-withdrawal-from-dialysis/witholding-and-withdrawal-from-dialysis-more-info.php
Here is a quote from T. R. Reid’s book: “The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.” — T.R. Reid
I actually read all of the original health care bill (HR 3200), and the term “death panels” is a lie used by the Republicans.
All the bill was trying to do was provide the insured (over a certain age, I think) with a FREE consultation with their doctor once every 5 years to discuss end-of-life options. The language was convoluted and confusing, making it an easy target for misinterpretation. Perhaps Congress should pay some people like George Lakoff (“Framing the Message”) to edit all bills over 1200 pages for clarity.
The insurance companies have the Republicans in their pocket. God Bless the poor.
It’s unbelievable that Dr. Waldman, MD, MPH, professor and scholar, limits her discussion and avoids the broader context of needed health care reform in the U.S. She (and everyone else interested in this issue) should follow T.R. Reid’s reporting on health care and read his book, “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.”
As far as insurance companies go, a Bloomberg report found, “Health insurance companies made ever-widening profit margins in 2011, a result that defies the companies’ predictions that health care reform would put private insurers out of business”. Reid, in one of his reports, states: “The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.”
In a 2010 New Mexico Independent report, Trip Jennings stated that the State Insurance Division approved premium rate increases to an average of 21 percent on 40,000 New Mexicans. Health Care Services Corporation (HCSC – a parent company to NM Blue Cross and Blue Shield had a surplus of $6.7 billion earned from premium increases like the one in New Mexico and doled out millions in salaries and bonuses to its executives.
Insurance companies are in it for the money and care little about people needing coverage.
It’s a good day when I can educate a doctor. Doctor, ALL health care plans have a set of defined benefits. If you want more, you can buy them.
The big lie of the American health care system is that we have the best health care in the world. Clue: if a large percentage of the public qualifies for no health care at all, the system is, in fact providing crap health care. For this, we pay twice as much as we should. It’s a racket. Fire the insurance companies. Medicare for all.
I am sorry but Dr. Waldman has some misconceptions – she believes in the death panels. This is ridiculous! Here is what she says: “When the government rations medical care by approving or denying payment, they determine who gets care and who does not.” This is sick stuff and untrue!
Here is the brilliant Dr. Waldman:
http://www.riograndefoundation.org/content/looking-death-all-wrong-places. She is no scholar!