By Jane M. Orient, M.D.
As Americans watch congressional hearings on the Internal Revenue Service, they should ask themselves what this enormously powerful, corrupt, politically motivated agency might do with its new job of administering Obamacare.
We have heard testimony from those whose tax-exemption was delayed or denied, or who underwent abusive audits, or faced seizure of their accumulated earnings, apparently because someone viewed them as opponents to the Powers.
The people who are testifying are obviously still alive.
What if this agency had the power to control access to medical care?
Of course, it will not have this power under Obamacare. Not exactly. These are the powers it will have:
The IRS will decide whether you get a subsidy to buy the increasingly expensive health coverage mandated under the law. Since that coverage could cost a third of your income, its “affordability” obviously depends on whether other taxpayers have to help pay for it. And by the way, the subsidy doesn’t go to you – it goes to the plan. To qualify, the plan has to please the administration. It has to allocate enough for politically correct “prevention” (such as abortions) and not too much to services that lead to “disparity” (such as treating hip fractures in the elderly).
The IRS will determine which insurers will survive. A plan that is not eligible for subsidies is likely to die for want of enough customers. The administration has a record of picking winners (its cronies) and losers (its opponents).
The IRS will influence the chances that your job will survive. Your employer may be hit with ruinous fines for not having benefits that qualify or for having workers who apply for subsidies on the exchange. As the rules are impossibly complex, government agencies have a lot of discretion, which can be used to reward and to punish.
The IRS will control your ability to get real insurance. Big employers are now discovering that they can satisfy the mandate by offering “skinny” plans that are even more limited than the “mini-meds” whose waivers are about to expire. These plans offer all the approved “prevention” you could ever want (likely excluding mammograms, prostate cancer screening and other “unnecessary” items) – but no surgery or hospitalization. If you want to buy insurance as an individual, you may find that premiums have become impossibly expensive, if plans are available at all.
The IRS will determine whether you get your anticipated tax refund – or a demand to pay for the subsidies received by your plan, say, because you got a raise last year. To figure this out, the IRS will have to collect enormous amounts of new information and match it up with data from Social Security, Homeland Security and consumer reporting agencies.
All of this does not mean that the IRS will be dictating your medical care. But the IRS has shown enormous interest in medical records. When executing a search warrant to obtain financial information on a single employee of a health-care provider, the IRS seized medical records on 10 million Americans. Its agents reportedly threatened to rip servers out of the building if the records were not turned over voluntarily.
The IRS can’t be trusted to keep donor lists confidential. How can it be trusted with sensitive medical data?
The government has another potential source of medical data. Almost half of Americans’ medical records will soon be in the hands of Epic Systems, whose founder and CEO, Judy Faulkner, is a top Obama donor. Faulkner is reportedly the only industry representative appointed by Obama to the panel overseeing the $19 billion medical records incentive program from which Epic Systems benefits.
Someone observed that if a rifle is mounted on the wall in the first scene of a play, it will be used by the end of the play. Even if the medical data are collected, at huge expense, for a noble purpose, the weapon is there to be used for a sinister purpose if it falls in the wrong hands.
Will the hearings result in meaningful reform? Perhaps. But remember, we have seen sensational hearings on IRS abuses before, not long ago. Relief was temporary. The IRS needs to have its powers permanently curtailed, not expanded.
Jane M. Orient, M.D., executive director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University of Arizona College Of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of “Sapira’s Art and Science of Bedside Diagnosis”; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored “YOUR Doctor Is Not In: Healthy Skepticism about National Health Care,” published by Crown.