By Jane M. Orient, M.D., of the Association of American Physicians and Surgeons
The Republican “repeal and replace” slogan sounds simple and appealing, but gets very complicated when you get to the next step.
“Repeal” generally means “repeal Obamacare,” which is often immediately qualified: “except for the parts we like.” The problem is that the parts you like depend on the parts you, or your fellow Americans, don’t like.
For example, you may like not being denied coverage because of pre-existing conditions. But you may not like having to pay more to cover other people’s pre-existings. You might like the “free” contraceptives, but not like the mandates that force you to pay for “free” care for other people’s children.
Then what do we replace it with? Republicans have a bunch of competing ideas. Each would replace the Obamacare centrally planned system of subsidies, thresholds, and mandates with a different system of government dictates. The Republican mandates might be milder, at least at first. Call it Obamacare lite.
We’ve seen them do it before. We already have Clintoncare lite: the so-called Health Insurance Portability and Accountability Act, or HIPAA. That was supposed to solve the problem of pre-existings and insurance cancellation. It didn’t. What it did accomplish is to establish a pervasive web of federal controls over medical practice that becomes more expensive and onerous every year.
Republicans might use a different term, such as “refundable tax credits” instead of “subsidies,” but it’s still forced redistribution of wealth. The cut-off points (thresholds) constitute a cliff where marginal tax rates leap upward, punishing those who increase their income, and thus creating a poverty trap.
So how do we solve the problem?
The basic problem is this: Medical care costs too much. The basic solution is to get the federal government out of medicine, and replace the third-party payment system with the only honest ways of paying for medical care: cash, catastrophic insurance and charity. It’s simple – but extremely difficult.
Obamacare didn’t create the problem. It just made it a whole lot worse, destroyed much of the system that people depended on and created vast new dependencies.
The tax code, Medicare, Medicaid, the HMO Act, HIPAA, the stimulus bill and other laws created our situation. Obviously, we can’t just repeal Medicare.
Obama’s phone and pen cannot make doctors any smarter or more efficient. But even making them perfect wouldn’t begin to solve the problem.
Some estimate that at least 40 percent – possibly much more – of the $2.7 trillion poured into the “health-care system” does not buy a single doctor visit, X-ray, aspirin, wheelchair, hospital meal or anything else recognizable as medical care. It buys compliance officers, planners, form filling, paper shuffling, coding, insurance and hospital executives – and a lot of graft and corruption. It’s an attractive target for fraudsters, even organized crime. And a lot of this is paid for with pre-tax dollars.
This hemorrhage is hidden by complex accounting designed to game the system, and facilitated by the absence of honest pricing. Nobody seems to know what anything actually costs, with all the backroom deals, secret contracts and insurance “re-pricing” scams.
People don’t care too much because it appears that somebody else is paying. People have come to believe that it is terribly unfair to be sick and have to pay for medical treatment – but perfectly OK to force other people to pay, and at greatly inflated prices.
Government can’t fix the “health-care system” any more than Obama can take out your tonsils. But it can refrain from tying up or tripping those who are trying to take care of patients.
We should start by repealing the mandates – on individuals, employers, medical facilities and professionals and insurers. No American should be forced to buy a product he does not want or need or feels he cannot afford. No individual or company should be forced to provide services or products to government specifications. The American way is the voluntary way.
We also need to stop trying to operate in the dark. Government should actually be transparent and not just talk about it. And instead of spying on Americans in their doctors’ offices, it should be shining a bright light on exactly where all that Medicare and Medicaid money ends up.
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 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.” She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943.