Obamacare and Reality

This should have been a 20-page bill with critical implications for national health care. Instead, it is a mess that has given the Republican party a load of ammunition they neither need nor deserve.
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Let me tell you a story.

In June 2010 my accountant called me. He told me that I had until July 1 to file a disclosure statement with the IRS for my offshore holdings. I had invested my pension with a hedge fund that later decided to move offshore. I'm not a mogul. My pension represented well under one percent of the fund's value. I called the fund's chief financial officer.

"Hi. It's Joe Blady. You haven't sent me the documentation for filing disclosure with the IRS."

"Don't worry," the CFO said. "Since you're not a majority owner, you're now exempted from filing. It's in the new health care law."

I laughed. "Really! What's on the other 2,699 pages?"

She laughed and hung up.

This essentially sums up what should have been the most important piece of domestic legislation since the Johnson presidency. How does such a thing come about? Legislators give their staffers marching orders to flesh out a bill, tell them the basic purpose, and then add the garbage that plays to donors and special interest groups. This should have been a 20-page bill with critical implications for national health care. Instead, it is a mess that has given the Republican party a load of ammunition they neither need nor deserve.

Why would Democrats worry about hedge funds and offshore investments? Just think about where the Republicans would be if the original bill simply barred insurance companies from rejecting people because of pre-existing conditions and allowed families to keep children on the family plan until the children turned 26? What if the bill also mandated that Congress provide a solution to cover the uninsured and poor within one year, and threatened to place these people on Medicare if Congress refused to act? What if Congress were also ordered to investigate the true role of insurance companies and the problem of tort reform? What if the bill had simply provided a basis for building a national health plan instead of imposing a nightmarish mess of regulations with implications no one understands? Done. No additional taxes. No changes for the many millions who are happy where they are.

I voted for President Obama twice. I'm an independent. I'm a physician, but retired for thirteen years. I think of myself as impartial. What I see is a problem that starts first with the insurance companies we're trying to include in the solution. The fox in the henhouse.

Look at the history of American business. Some 30 or 40 years ago, retailers began to realize that they could go directly to manufacturers for their wares. Why were they paying a cut to middlemen who were known as distributors? Just get rid of them. Costs for both the manufacturer and retailer went down, profits went up, and, sometimes, even the consumer benefited by paying less. The truth was that the distributor brought no added value.

The insurance companies are no different. They shovel money to both political parties and are allowed to conduct business as usual, scraping billions of dollars every year off the top of the health care pot while providing cures for no one. Obamacare limits them to profits of 20 percent! Ask any friend who is a small businessman whether he or she would be happy with a profit margin of 20 percent. If you could guarantee that, your friend would probably be willing to exchange a firstborn child.

Doing something noble, but doing it extremely badly, is not always a solution. In a stampede to provide wider health coverage while making sure wealthier people pay for it, the administration has provided a bill that is so flawed that even people like me, who are completely in favor of the underlying purpose, look askance at the new law and wonder what it would take to turn this chicken poo into chicken salad.

And let's not forget the Republicans. Instead of saying that there are nuggets in the mess worth saving, their only solution is to bring the nation to its knees. Why aren't they offering a stripped-down version of the bill that preserves the parts that even those opposed to the bill want to save? Why is no one proposing a bare-bones bill from which to expand a framework that might salvage some modicum of a health care system that was once the envy of the entire world? Their solution: more involvement for the health insurance companies that provide their golf outings.

I'm not sure how to distribute health care without insurance companies, but I do know that parts of the country have consortia of hospitals, doctors, and patients that seem to function adequately. I'm not sure how to cover all the uninsured. In my state, New Jersey, they still get care; it's just not administered in a way that makes sense financially. The point is that, when it comes to thinking about solutions, no one, not doctors, not hospitals, not the electorate, and certainly not politicians are willing to expend the effort to build a system through thought, study, and compromise.

Health care is expensive. Great health care is very expensive. We're going to get only what we're willing to pay for. We've got to take the trouble to decide what that will be. The disgrace we are witnessing in Washington is not the way to go about it. Who do these lawmakers really think they're representing? They look at polls that ask, "What do you think of Obamacare?" That's not the question. The question is, "Do you want to be able to get affordable insurance even though you have high blood pressure?" We had better start to get serious, or our situation will deteriorate to the point where we will only be involved in damage control, our ability to right our ship will slip away, and the lifeboats will be all that is left.

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