Women, Obamacare...ooouuuch!!

     When it comes to healthcare and politics, there have generally been two areas that are off limits: women and children.  Do what you want to the fifty percent of the population that has an obsession with the TV channel changer, but you will lose votes if you corrupt care for the kids and their mammas.  So does The Affordable Care Act (Obamacare) stick to this maxim?  In particular, how does the not so new law of the land affect women?

    A substantial area of impact is preventative services.  Ideally, these are exams, tests, and studies that prevent disease instead of waiting to treat problems after they arise.  Since 2012, the following services are available to women with no co-pay involved:

  Well-woman visits.

  Gestational diabetes screening 

• Domestic and interpersonal violence screening and counseling.


• FDA-approved contraceptive methods and contraceptive education and counseling.


• Breastfeeding support, supplies, and counseling.


• HPV DNA testing, for women 30 or older.


• Sexually transmitted infections counseling for sexually-active women.


• HIV screening and counseling for sexually-active women.
  Mammograms and Colonoscopies (with certain restrictions for age)

    Remember, these services are not “free”; you are still paying for them with your premiums and deductibles.  It is vital to understand with all these changes there is no proverbial free lunch.  Someone is paying, and it is both the employer and employee who is supplementing both their own care as well as the care for those who don’t pay or are subsidized by the government.
    A somewhat controversial aspect of Obamacare is the mandate for contraception coverage.  The initial law stated that the following services would be mandated for coverage by insurance providers:

Barrier methods, like diaphragms and sponges
Hormonal methods, like birth control pills and vaginal rings
Implanted devices, like intrauterine devices (IUDs)
Emergency contraception, like Plan B® and ella®
Sterilization procedures
Patient education and counseling

    This coverage proved controversial among Christian hospitals, Christian charities, Catholic hospitals, and other businesses owned or controlled by religious organizations that oppose contraception on doctrinal grounds.  A compromise was reached that allowed religious organizations to opt out of the requirement to include birth control coverage in their employee insurance plans. In those instances, the insurers themselves will offer contraception coverage to enrollees directly, at no additional cost.  The controversy rages still with at least 63 lawsuits nationwide challenging the mandate.
    In addition to preventative services, women will have access to maternity care through their current insurer or through an expansion of Medicaid.  Policies issued by the ubiquitous health exchanges are also required to offer a level of maternity care.
    Proponents of Obamacare also state that women will benefit, although not uniquely, from the expansion of coverage, elimination of pre existing conditions, and government subsidies.
    Detractors of the Affordable Health Care Act quote generalized objections when asked specifically how Obamacare will impact women.  They raise issues of increased cost of premiums, restriction of access to doctors, being forced into Medicare or various health exchange plans, and cumbersome regulations.  All of these potentially will negatively effect health care delivered to women.
    A much less known but incredibly powerful regulatory agency may have a marked effect on women’s health care under the new law.  The US Preventive Services Task Force is a 16 member panel of appointed medical personnel charged with the daunting task of determining what constitutes prevention under the new law.  In other words, they decide if services, tests, and procedures are to be paid for.  More importantly, however; they also decide what won’t be covered, which can potentially restrict access either economically or pragmatically.  The word we all run from is rationing, yet on the surface it seems as if this is what may happen. According to their website the following services are not considered “justified” and will not be covered as preventative:

Chlamydia screening in most women over 25
Cervical-cancer screening in those over 65
Breast-cancer screening using digital mammography or MRI instead of the traditional x-ray.
Screening for ovarian cancer and the genes that raise a women’s risk of breast cancer   Clinical breast exams in women older than 40.
Even having a doctor teach women how to do a breast self-exam is unlikely to be covered, since the task force says women are rarely the ones to find their breast cancers.

    This is the same panel that said women should not get screening mammograms before the age of 40 and then sparingly between 40-50.  They also nixed the idea of routine HPV screening in young, sexually active women. 
    For women, The Affordable Care Act is a mixed bag.  While it creates a positive atmosphere where prevention is stressed , it also may limit certain choices and individualized care.  Now more than ever taking control of your own health by making solid healthy lifestyle choices becomes paramount. 

Youngsters Get The Shaft!

     A little known provision of ObamaCare could potentially financially wreck the system.  According to insurance insiders, if enough young adults avoid the new insurance marketplace, it could throw off the entire equilibrium of the Affordable Care act.  Young folks, not on their parents insurance or making too much to qualify for medicaid, are required to buy health insurance or be fined under ObamaCare.  The idea is that by forcing young healthy people into the “risk pool” you balance out the higher utilization by old fogies like me.  Can you say, redistribution? The irony of this is it is taking bucks from those just starting out to supplement us aging, decrepit, sick folks, who often times can afford it. 

     Wow, the young liberals who fled to the Obama camp in 2008 and 2012 may have to rethink all this. I mean, it was okay to redistribute the wealth when it flowed from the older successful people but they may sing a different tune when they have to shell out their paychecks even though they may have not been to a doctor for years.  It’s really a matter of economics (isn’t everything).  The average 26 year old can expect to pay $3000 a year in health insurance premiums under ObamaCare, whereas the “fine” for not purchasing insurance is a whopping $100.  Granted this increases over the years, but it never comes close to premium amounts.  So given that most 20-30 year olds feel they are invincible, what is the likelihood they will run out and spend beer and chips money on health insurance.  I think I can make an educated guess, a lot fewer than the delusional health wonks in Washington think.  This is simply another example of how many “what ifs” make up the ObamaCare fantasy. 
   
        

Speaking of penalties, we heard the other day that the administration has rolled back the date for instituting the “tax” on businesses with more than 50 workers who don’t provide insurance for their employees.  As Gomer Pyle used to say, Surprise, Surprise, Surprise! Maybe they figured out that businesses on the bubble, either right at 50 employes or close to it have either stopped hiring or shifted formerly full time employees to part time to avoid the penalties.  Did they really not see this coming?  Are they so captive in their ivory tower confusion to think that companies wouldn’t react this way?  The moment the IRS comes out with new taxes, there is a swarm of consultants, lawyers, and associated evil doers figuring their way around them.  The same thing is happening here.  Consultants are making a good living coaching businesses on how to “adapt” (i.e. avoid) many of the oppressive new regulations.  The authors of ObamaCare either were so deluded about the real world or the laws were so nebulous and uninterpretable that they never anticipated the work arounds.
    
     The bottom line is once again the law of unintended consequences rules supreme and ObamaCare will set new records for unintended consequences.  

Let the Lawyering begin!!

     A milestone in the implementation of ObamaCare was reached recently, at least that is what the newspaper headlines trumpted.  While I know it is hard to believe that anyone reads the newspaper anymore, I found the proclamation a bit perplexing and premature.  It referred to the compromise that the HHS wonks and religious organizations agreed upon to resolve the controversy surrounding contraception.  You remember that the original law mandated that, for example, Catholic hospitals had to pay for their employee’s birth control through their insurance plan.  Well, as you can imagine, this played at the Vatican about as well as Kim Kardashian at a Mensa meeting, so more than 60 groups filed lawsuits to stop the implementation of this mandate saying it violated very basic precepts of their religious teachings.  The government and these groups apparently had a Kumbaya moment and settled most of the legal wranglings and reached a compromise recently that allows the employees of said religious groups to have their birth control and eat it too.  In other words, very little on principle was really achieved. 

         
     This issue is much deeper than birth control, there are multitudes of rulings in the law that can be seen as moral rather than legal issues, and this compromise goes nowhere to settle the real question as to whether we want government dictating morals and ethics.  You might argue that is precisely what a government is for, to legislate and implement law that is moral, ethical, and in the interest of the general welfare.  If that is the case, I hope you are satisfied when legislators who have a different moral and ethical belief system pass laws that totally oppose your point of view.  A republic is based on a representative government, not a democracy, so the premise for such action is the Constitution, not the Bible, Koran, of Bhagavad Gita.  I have yet to see anywhere in the Constitution that the national government has the power to compel me to buy insurance and, as a business owner, pay for services I might object to.  I see this ruling solving very little and opening the floodgates of lawsuits of businesses objecting to everything from contraception to hospice care.  Let the lawyering begin!!     

An Apple a Day

Okay, okay, I realize that I have been less than generous in praising ObamaCare over the past several months, but it’s kind of like finding something good to say about a herpes outbreak.  This week I am actually going to mention a few of the things that may, and I emphasize the may, be

Anemia screening on a routine basis for pregnant women

Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer

Breast Cancer Mammography screenings every 1 to 2 years for women over 40

Breast Cancer Chemoprevention counseling for women at higher risk

Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women

Cervical Cancer screening for sexually active women

Chlamydia Infection screening for younger women and other women at higher risk

Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”

Domestic and interpersonal violence screening and counseling for all women

Folic Acid supplements for women who may become pregnant

Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes

Gonorrhea screening for all women at higher risk

Hepatitis B screening for pregnant women at their first prenatal visit

HIV screening and counseling for sexually active women

Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older


Osteoporosis screening for women over age 60 depending on risk factors

Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk

Sexually Transmitted Infections counseling for sexually active women

Syphilis screening for all pregnant women or other women at increased risk

Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users

Urinary tract or other infection screening for pregnant women

Well-woman visits to get recommended services for women under 65



    Whew! If you waded through all that I give you kudos.  Think about this for a moment, the government is mandating that your insurance cover these tests (and there are even more for kids and men) so what would you think your insurance may do if that is not already a part of your policy.  Do ya think they might jack up the premiums to compensate for the lost revenue due to mandated coverage...do ya??  I think we all know those answers, especially if you have seen your premiums recently.  This reveals another flaw in the system.  While I am not advocating a single payer system, the current structure allows insurance companies free reign to increase rates. Pundants claim competition in the exchanges will keep rates low, but how well has that worked in reality...not!
    So while I am a big fan of prevention and I am glad to see this kind of emphasis, remember...everything comes at a cost.

construed as good in this program.  Let’s start with preventative services.  According to the Affordable Care Act various screenings and preventative tests and check ups are encouraged and a person’s insurance has to cover them with no copay and no charge against the deductible. Below is a list of those tests for women (yes, this is a sexist blog) Oh and one other caveat, if your current plan was in force in 2010, this may not apply to you (clear as mud, I know):

The IRS Man Cometh

     In light of recent revelations, I feel it is both timely and appropriate to outline exactly the role of the IRS in administering ObamaCare.  What?  The IRS is involved in healthcare?? You bet your sweet premium it is.  The IRS, with the compassion of a pit bull in heat and the efficiency of the post
   

office, is mandated to play a key role in ObamaCare.  This is the same IRS that handles non profit requests as unbiasedly as Al Gore protecting an endangered polar bear. 
     The big stick, or big enema, that ObamaCare wields is a fine for anyone who doesn’t “buy” health insurance. (Remember buy is relative, if you are a middle class tax payer you are buying other’s health insurance for them with subsidies). So if you decide that rising premiums and falling coverage is not logical (imagine that) then who better to seek out and destroy your life, liberty, and pursuit of happiness than the IRS.  The Affordable Care Act (I giggle every time I say that) empowers the IRS to confiscate your tax refund to pay this new tax.  That means proving to the IRS you have insurance.  That means providing an inefficient, politically motivated, bloated bureaucracy with not only your financial wherewithal but also whether you had a prostate exam this year. So you are getting probed by both your urologist and a clerk at the Cincinnati IRS office who thinks conservatism is tantamount to leprosy.  Some one in the know was recently quoted as saying,
   
     “We the people have been told there is no choice. You must buy health insurance or pay the new Gestapo – the I.R.S.” 
   
     This wasn’t Rush Limbaugh or Glenn Beck...it was the Governor of Maine, Paul LePage. 
   
     In addition, Obamacare appropriates funds to hire new IRS employes to handle this influx of information.  Already the IRS has requested $473 million to begin the process (they didn’t specify how much was for line dancing instruction and Gilligan Island videos). 
   
     So to summarize, if you don’t have health insurance the IRS will be on you like Clinton on an intern. Now that’s an image that should make you sleep sounder at night.

Racism?? Are you kidding me!!

     A Louisiana state legislator, Karen Carter Peterson, recently made national headlines talking about opposition to ObamaCare by stating, “It’s about race. No, nobody wants to talk about that. It’s about the race of this African-American president.”
   
   
   

      Honestly I was wondering when it was going to come down to this.  This ignorant, manipulative rhetoric has been a staple of Obama supporters ever since he burst onto the national scene.  It is the fallacious argument that if you object to any policy or program it has nothing to do with the absurdity of the legislation, it is only because it is being pushed by a black man.  This is not only evil but insulting as it assumes that race is the only factor people consider when judging the benefits or downsides of an action.  Really?? Does this petty bureaucrat think so little of her president’s agenda that she has to ignore the substance and resort to a logical fallacy in defending the plan?  If I was to recommend to a patient that she have a hysterectomy, would her first inclination be to wonder about the validity of my advice due to my terminal Caucasian persuasion.  That’s absurd of course.  She would judge my advice based on the merits of the argument itself, pros and cons, benefits and risks.  So the American people are judging Obamacare based on the structure of the arguments not the fact that Barak Obama happens to posses an excess of melanin pigment. 
    
     When a policy is bad or failing, when logical arguments to defend it are proving illogical, when even supporters are horrified at how bad things are going, what is left is sycophants grasping for anything to bolster a crumbling building.  If the president was a woman, I’m sure there would be cries of sexism.  If the president was a Republican, there would be cries of wealthy elitism.  Let’s be honest, both sides can play this despicable game; however, we all acknowledge our revulsion at being labeled a “racist” and these Obamatons understand and exploit this political correctness with the fervor of a dog in heat. 
   
     I for one will not tolerate being accused of opposing this piece of legislation because of racism.  I oppose it because it is bad...pure and simple.  It will forevermore damage health care delivery in this country, bankrupt the national government, and hurt patients.  The president could be a troglodyte from Venus and I would feel the same way.     

On Memorial Day

    
   

So it is Memorial Day weekend.  A time marking the beginning of Summer, but much more importantly a celebration of those past and present who have sacrificed so much for us all.  The American military, in all its branches, seems to be more respected today than any other moment in my lifetime.  There is an unmistakable pride in the uniform, and those who wear it.  Family members proudly regale stories of loved ones currently or formerly defending our great country.  We relish the chance to say “thanks” to the stranger in uniform we encounter on the street.  It seems everyone loves the armed forces...then why do we seem to be giving them the old sucker punch in the gut when it comes to their health care? 
     Tricare, the current military health system, is under tremendous pressure to morph into ObamaCare.  The liberal ideologues that infest the Obama Administration are holding military families as economic hostages by jacking up Tricare premiums in some cases 70% in an attempt to corral military families into the quagmire of the Obama health exchanges.  Obama is telling America’s finest to pay up or ship out!  And this is not just the rantings of a middle aged baby hatching doctor, listen to the experts:  

   “The Affordable Care Act -- generally known as “Obamacare” -- could lead to increased health complications, emergency room visits and even shorter life spans for some veterans, according to a former under secretary of Health for the Department of Veterans Affairs.
     Dr. Kenneth Kizer, director of the new Institute for Population Health Improvement at the University of California, Davis, Health System, said the ACA’s creation of more healthcare options could cause increased “fragmentation” of care among vets who now rely solely on the Department of Veterans Affairs.
“Some data suggest that veterans receiving care from both VA and non-VA sources are more likely to be re-hospitalized and to die within a year compared with VA-only users,” Kizer wrote last year in a commentary for the Journal of the American Medical Association.”1

     So let’s hear it for the Commander in Cheat once again for giving the troops another great big Memorial Day “we don’t like you” enema to rid their system of one poorly run system and replacing it with an even worse alternative...ObummerCare.

"Free" ain't Free!

    

One of the selling points of Obamacare was mandating insurance companies to cover “preventative” care as a part of every single policy.  While prevention is a great thing, remember, these tests are not free.  They have to be paid for by someone, some way, some how.  The administration says they will be paid for by savings from eliminating fraud and waste, the same savings that so far have more than doubled the cost estimates for implementing the law.  In other words, the preventative care will be payed for by nonexistent savings from folks who are paying anything to start with.  Now there’s some government logic for you.   Realistically we are already seeing how these new mandated coverages will be paid for, by increased premiums!  Insurances have already jacked up premiums 50-75% in some areas in anticipation of the demand for new prevention services, and I can say as a provider they have also cut reimbursements to providers for preventive services.  So, follow this now, the government says every body has a right to a “free” colonoscopy, so docs will be doing a whole bunch more, but at a much reduced rate.  In other words, your “free” colonoscopy will actually cost you more (ala higher co pays and premiums) and because of the volumes, you will have to wait months to get it.  So for 85% of the population that were already getting screenings, you will now get your “free” screenings at a higher cost and with a longer wait.  This bureaucratic ballet will apply not only to a light up your behind but also various other mandated screenings.  A partial list of such is from the Task Force on Preventative Care website:

Pap smears
tobacco counseling
mammograms
obesity screening
diet counseling
depression screening
high blood pressure screening
diabetes screening

    All these things are good things.  I hope that by identifying at risk folks we can eventually head off some morbidity.  But don’t forget, “free” is never free!

Don't be an Obamaton!

    What does Obamacare and a Georgia law stating “donkeys may not be kept in bathtubs” have in common?  40 percent of the population doesn’t know they are both the law of the land! 
    I read with incredulity a Kaiser Family Foundation poll released 2 weeks ago that 40 per cent of the population either doesn’t realize ObamaCare is law or think it has been repealed.  This is like the Duck Dynasty folks saying, “Gee, that income tax stuff, I didn’t realize it meant all of us had to pay taxes”.  So not only is this the most convoluted, confusing, and coercive law in recent history, but almost half of the good folks are not even aware the hammer is dropping.  Good luck in getting these Mensa candidates to fill out the necessary paperwork to get their ObamaCare.  Although I shouldn’t doubt their veracity and ingenuity as these are largely the same group of folks who managed to cop a free Obama phone.
    So just to recap, if you don’t get insurance through your employer, medicare, or medicaid you will have to purchase insurance (i.e. government freebe) through an exchange.  To do that you must fill out a form that until recently was 14 pages long.  Once the government hacks realized that most theoretical physicists had trouble filling out these forms, they “nimbly” consolidated the form to a mere 12 pages for those with a family of four.  A single person in perfect health can even escape with a 5 page form.  However, it’s still not exactly as simple as filling out your food stamp application as, for example, one question which asks for “the lowest cost plan that meets the minimum value standard offered only to the employee.”  Say what?  That’s like asking a chimp to calculate the quantum energy of a quark.  And those privacy fanatics will be overjoyed to know that a majority of the forms are devoted to tax return information and income verification.  Just another government data bank containing your personal information.  And remember Obamatons, this is a mandate not a suggestion.  You have to do it or be fined, made to watch “Ellen” reruns, and possibly given a embarrassing nickname.
    Here’s my take on the paperwork surrounding signing up for Obamassurance.  If you don’t even know it is the law of the land, then you probably will need a consultant to fill out the paperwork...and I am sure Uncle Sam will be happy to oblige.

Mandate Smandate

So what is this “individual mandate” we keep hearing so much about?  It’s not a date with a single man, but a legal requirement for all Americans to get healthcare coverage and penalizes them financially if they do not. Under this government decree healthy Americans will have to pay into the system for their own good whether they like it or not.  Flatly stated, you must, must, must have insurance or you get beaten with a wet squirrel by a bureaucratic wonk who will then fine you.  And without insurance it will be hard to find a doctor to take care of your wet squirrel inflicted carnage.

This individual mandate provision is what made all the headlines recently in the Supreme Court case which said is was A-okay for Uncle Sam to require you to buy insurance, much like the lessor known case of The United States vs Susie Sweatbelly which required all citizens to bathe daily to prevent widespread panic and noxious body odor.

The individual mandate will be accomplished in 3 ways...sort of a triumvirate of turpitude, either you get insurance the old fashion way...you earn it from your employer, or you join the happy and contented ranks of Medicaid and Medicare, or you buy it yourself through the previously blogged about health exchanges.  Pshaw you say, what if you can’t afford to buy it?  Not to worry, you will be given a grant, waiver, freebe, or subsidy by the good folks in Washington to get your very own policy.

All you need to do to understand that the individual mandate is the cornerstone of the ObamaCare debacle is to follow the money.  A massive 84 percent share of ObamaCare spending— or $ 899 billion— goes toward decreasing the uninsured population over the next decade. This is the amount needed to pay for the expansion of Medicaid (assuming all states participate) and the new state-based health insurance exchanges. (ObamaCare Survival Guide)

The bottom line, the individual mandate is key to universal coverage.  In Romneychusetts, the mandate resulted in 97% of folks being insured, so I suspect it has its merits; but what remains to be seen is how badly it bankrupts the treasury and the resulting quality of the care.

Cost and Inefficiency

     Karl Rove is about as partisan as a Yankee’s fan in October, so you have to take what he says in that context; however, when he simply quotes indisputable facts, there is no denying the validity.  In a
    This is an illustration of how absurdly wrong the administration was in estimating the cost of this legislative behemoth known as ObamaCare.  What was initially sold as a $940 billion price tag has since been estimated at $2.6 trillion, and some say that estimate will only escalate.  Just imagine if Wal-Mart missed its operating cost estimates by 300 per cent!  I suspect there would be some blue light specials on executive jobs.  This is another example of the law of unintended consequences.  You can quote me here folks...you ain’t seen nothing yet! 
    We are seeing government inefficiency already exploding in the role out of the 15,000 pages of regulations regarding ObamaCare.  And the waste keeps adding up like STDs at a hooker convention. And  these inefficiencies come at a high price tag, try $54 million just to hire new clerks to enroll folks in health exchanges.  If past history is any gauge, that will pay for ten technical school dropouts to be trained in Windows 98.  Most experts agree that we are nowhere close to having the infrastructure in place to do the simplest of tasks, like signing up people for their ObamaCare policies.  In fact,one official from the Medicare and Medicaid Services Department stated he was “pretty nervous” about the implementation of the program, following this with his hope that the enrollment period is “not a third world experience.” 
    Watch the enrollment process over the next year.  I suspect it will be a true harbinger of what is to come.

recent op-ed in the Wall Street Journal Rove writes, “The Affordable Care Act set aside 45 billion to subsidize, through 2014, coverage for an estimated 270,000 to 350,000 people with pre-existing conditions and no insurance. So far 135,000 have been covered but the $5 billion is nearly exhausted. Because of this HHS stopped signing up people in February”1

Boston Marathon, 2013

I’ve crossed the finish line at the Boston Marathon five times.  Five times my family has waited anxiously for me, hoping I wasn’t too sore so they could go shopping later that afternoon.  Five times I felt the elation of completing the super bowl of marathons; the longest running, most celebrated event in running history. 
     Yesterday, those memories were forever stained with the blood of an eight year old waiting to see his dad cross the finish line, much as my daughters had a few years earlier.  Viewing the horrendous video in loop after loop of replays, I spotted the large official time clock that sits on the top of the finishing banner.  It displayed 4:09 at the time of the blasts.  If I had been running this race and had been consistent with my prior Boston times, I would have been about a mile back on Commonwealth Avenue approaching the turn onto Boylston street.  I would have been stopped and rerouted, confused about the events.  Honestly at that stage of the marathon, most of us are not thinking that rationally.  We are a bit dehydrated, thoroughly fatigued, and thinking of one thing; seeing our loved ones at the finish.  I would have come around the turn on the final stretch, hugging the edge of the road feverishly surveying the crowd for a glimpse of my family.  My pace would pick up ever so slightly as I got one last surge of adrenaline seeing the finish line draped in its iconic Boston Athletic Association unicorn symbols.  But I would continue to gaze into the crowd, wanting only to see my wife and girls cheering for their dad for doing something a bit crazy. 

     I only wanted to see my family.

     Monday, April 15 there were thousands doing the same thing.  I can guarantee that most of those 26,000 runners were searching the spectators for a face or faces that only they knew best.  On this Monday, one dad searched in vain.  He would not see his little boy waiting for him at the finish.  He would not see him alive ever again.   

     These tragedies are universally abhorrent, but we can’t forget they are intensely personal.  We are all collectively saddened by the evil and senselessness; however, in the end it’s not about terrorism or politics, it’s about a dad and his child.  May God bless and watch over the three souls who are running with Him right now, and continue to watch over the families and injured who remain behind.   

A Little Philosophical

ObamaCare, one doctors opinion

“First, do no harm” Hippocrates, a long time ago

One unexpected by-product of the Affordable Health Care Act is that it has forced many physicians like myself to be introspective.  Now in many ways that is sort of like asking a lawyer to be honest, it’s hard to do and you don’t know why you would want to anyway, but I have looked inside over the past couple of years and reaffirmed why I became and still practice as a physician.  When the basic tenants of a belief system are challenged, as they have been with Obamacare, it is incumbent on the practitioner to validate why he does what he does, or find something else to do.  There indeed are many doctors who feel they are unable to practice quality medicine as they seem fit and have retired, pushed to the brink by what they see as strangling restrictions, limited autonomy, and mountainous paperwork.  Strains of ”This is not why I got into medicine” ring out regularly like a Greek Chorus in a Shakespearean tragedy.  That begs the question, “Why did you get into medicine?”, and it is the answer to that which Obamacare has forced out of us like a first time mom giving birth.  All these changes, like them or not, have raised for physicians the issues of purpose, motive, and professional ethics.

Why do I do what I do?  Unless I can answer that affirmatively then working in the straightjacket of Obamacare restrictions would be intolerable. This is not some Miss America-save the world-naive-medical school interview answer because it is tempered by both experience and maturity.  I share many of my colleagues sense that this is not a job but a calling.  I honestly don’t know what else I would do, and that is not out of ignorance of other options, it is an honest understanding that God made me to be a doctor.  That is not presumptuous or haughty, it is simple a realization of purpose much as another may know that they were created to be an entertainer or a priest.  It is also not to say that at times I dream of being other things, like a world class Kenyon marathoner, but that is a different story.  This is important in this time of transition because with this certainty of purpose I can sustain any external change (such as Obamacare) an not stray from my calling. 

This applies to anyone.  No matter the changes, the obstructions, the disappointments, if you understand and are passionate about your purpose, fulfillment is obtainable.  Viktor Frankl said, “If you understand the why...you will discover the how.”  If medicine is more than a job, if taking care of folks is more than a means to a financial end, if promoting wellness is a lifestyle, then no Obamacare bureaucrat can damper the joy that comes from doing what I am supposed to do.    

Health exchanges Part Three

So do we know if this health exchange model that is the backbone of ObamaCare is worth the gazillion pages it is printed on?  Giving “consultants” and “policy experts” something to study and predict is like your local weatherman telling you what things will be like next week in that they have to fill the time with something, but in the end it’s really anybody’s guess. 

The only remotely plausible tool for predicting future outcomes is to base it on an existing model, and, believe it or not, we have one for the exchanges.  It is lovingly called “RomneyCare”.  Yes, our fearless ex-nominee instituted a plan while Governor of Liberalachusetts, and there is no side stepping the fact that Obama’s exchanges look spookily like the Massachusetts exchanges.  So how have they fared?  According to a conservative think tank, the Mass experiment has costs 20,000 jobs, health insurance costs have risen 4 billion dollars, and a typical family of four in Massachusetts now pays the highest health insurance premiums in the country.  But besides that it has been loads of fun.  (http://www.beaconhill.org/BHIStudies/HCR-2011/BHIMassHealthCareReform2011-0627.pdf)

Okay, I realize fewer folks are without insurance in Massachusetts than elsewhere, but with government subsidies about half of the folks are paying for  both themselves and the other half.

The writing on the chart indicates that more folks might get coverage, but it ain’t gonna be your momma’s policy.  The national exchanges (for those states that don’t run their own) will certainly have insurances with limited coverage, high deductibles, and changing premiums.  The take home is more people covered, higher costs, but more limited access and options.  Now for some this may be an acceptable set of circumstances.  My advice is just don’t get sick!

Health Exchanges: Part duo

While most of my ultra right wing, build the bomb shelter and store the freeze dried food, friends would say there is nothing good about the government exchanges, there actually are a few points that aren’t so bad. (Please, put the gun down and back away from your computer).

First, there are choices.  Within the GeorgiaMart, for example, there will a variety of plans offering a variety of coverages.  The geniuses in Washington recognized that the 22 year old college student might require different coverage than the 63 year old truck driver, and they made provisions to give each a bit of a choice.

Next, even though the plans will be offered by different companies, the content of the plan will be standardized so you can compare pomegranates to pomegranates when choosing a plan.

Plans must conform to basic standards such that all plans have to cover at least a minimum of stuff (you’ll pay extra, for example, if you want coverage for sex change operations, but all plans will have coverage for , say, Paps.  This applies to either before or after the sex change, depending on which way you go.  Okay, this is getting confusing.)

Finally, the exchanges will be subject to some of the good old competition that made America great and liberals hate.  The sheer volume of people using the exchanges will allow for competition and possibly lower the rates (that is if that crazy theory of capitalism holds water).

Don’t forget, the policies bought through exchanges aren’t free (like Obamaphones) and depending on your income, you may actually have to pay something to get coverage.
  (thanks to Obama Care Survival Guide for background material)

Health Exchanges, what the hey?

     So what are these Health Exchanges we hear so much about?  They are the cornerstone of the whole plan so it is important to understand what they are and what they do.  Essentially they are individual markets where folks and businesses can shop for health insurance, sort of like a Quickie Mart for health care.  You have to buy this insurance either individually or through your employer or you will be beaten, flogged and forced to watch reruns of Three’s Company.  Okay, maybe not that bad, but you will be fined.  There are some other differences. Some folks will be given money to buy their insurance by the government (kind of like Washington giving you some bucks to buy Twinkies at the Quickie Mart) and second, the government will regulate what insurance is sold in these exchanges (like Mayor Bloomberg saying you can’t buy at Big Gulp at Quickie Mart because the government has determined it is evil).

     The original intention was for each state to provide an exchange (think of it as GeorgiaMart, TennesseeMart, OklahomaMart,etc); however, many states, about half so far, have said “Whoa Nellie! We don’t want to do this ourselves and be subject to further cost and regulation (mainly with the Medicaid aspect) so we are going to take our marbles and go home.” In this instance, the Federalies will run the state exchange, so you will have one, but it may be run by either your state or Washington. 

     Alaska Governor Sean Parnell said that “allocating state dollars and personnel to design and implement an exchange is the most expensive option.” In other words, he wants Washington to pick up the full cost for its creation and operation.
(Obama Care Survival Guide)

     So the bottom line with these exchanges is that if you get insurance from your employer and they continue to provide it, you won’t have to deal with the exchanges.  If they stop providing insurance, or you are unemployed, or you are on Medicaid, or you are employed but your company doesn’t provide insurance as a benefit you will need to get your insurance from the many different flavors offered by an exchange.  Next time we’ll talk about the good and the bad of exchanges.

What is "Affordable" ?

     March 23, 2010...a day that will live in infamy.  No, it wasn’t a second bombing of Pearl Harbor, it was the bombing of the American health care system with the 20 mega ton bomb known as the Affordable Health Care Act.  Let me say from the outset that I am no fan of this monolith, but I am learning like you, so I promise to only criticize, analyze, and  regurgitize (?) the facts.  When possible I will draw them straight from the document itself (http://housedocs.house.gov/energycommerce/ppacacon.pdf) or other reliable sources like The Enquirer and late night TV.  Seriously, I do take this journey with a healthy dose of reality as this is the law of the land and will affect all of us for decades to come.  It is possibly the most sweeping social reform to come out of Washington in years, and like it or not, parts, if not all, are here for the long haul.  So let’s take a tumble in the health hay and learn together what in the heck we are dealing with.

First things first, the name “Affordable Care Act” has yet to ring true.  According to AON Hewitt,
     “While health care costs are projected to increase at a lower rate in 2012 compared to 2011, the average cost per employee will surpass the $10,000 mark for the first time next year, according to Aon Hewitt, the global human resource consulting and outsourcing business of Aon Corporation.
     According to Aon Hewitt 's analysis, the 2012 average health care premium rate increase will be 7.0 percent.  However, the average total health care premium per employee for large companies is projected to be $10,475 in 2012, up from $9,792 in 2011, and $9,111 in 2010.  The amount employees will be asked to contribute toward this premium cost in 2012 is $2,306 (or 22 percent of the total health care premium).  Meanwhile, average employee out-of-pocket costs, such as copayments, coinsurance and deductibles, are expected to be $2,275 in 2012, compared to $2,007 in 2011, and $1,691 in 2010.” (http://www.prnewswire.coml)

To summarize: “According to a study by the independent Kaiser Family Foundation, health insurance premiums rose 9% for families in 2011 to a level that now exceeds  $15,000 on average per year— the biggest annual spike upward since 2004.”
(Tate, Nick. Obama Care Survival Guide)

So, I think we can agree that for you and me (a small business owner) costs are going up...not down.  Our company premiums for employes have increased as well as necessitating an increase in the deductibles.  Some will say that the costs won’t go down until all the provisions are in place (2015 or so).  That is theory; all I have to go on now is more out of my pocket.  I suggest asking your employer to give you a total premium cost and your out of pocket costs for insurance over the past year, then keep a running tally.  We will discover the truth together.

New Day...New Blog

        In an attempt to navigate the flotsam and jetsam that is the ObamaCare tsunami,  I am beginning this blog. Over the past few months I have come to realize that neither I or many of my colleagues have any earthly idea what the Affordable Health Care Act entails, and from listening to my patients I sense that they are just as befuddled.  Think of this blog as a group therapy session without the doughnuts.  As we trip the light fantastic through this Edenesque garden of Health Care Reform, let us remember that a little knowledge is a dangerous thing, and a lot of knowledge requires a chilled bottle of Chardonnay.  I pledge that this information will be factual, concise, understandable, and mercilessly sarcastic, and you will want to share it with all the relatives you never talk to.  There's a lot to cover in its 15,000 pages and I promise by the end both you and I will be more informed and hopelessly depressed.  Remember, however, that no matter how confused, no matter how ill, no matter how ridiculously bamboozled you feel, there will always be Honey Boo Boo and the Bachelor to fall back on.  Tune in tomorrow for your first dose.