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!