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.