Blog | Friday, July 6, 2012

Obamacare: not getting your way is no excuse to lose your mind


For now, I'm sticking to my guns. I'm calling the Supreme Court ruling on Obamacare a victory for Americans, and I'm proud to call it "Obamacare" (rather than Romneycare, which would better reflect history). But it's not entirely clear how ACA's implementation will ultimately affect us all. Here are some potential pitfalls:
--As insurance reform, rather than health care reform, it continues to fund the bloated, cash-sucking U.S. private health insurance industry.
--It's going to cost us all something. Whether that "something" is more than we're pumping into health care now, or simply a shifting around of costs. isn't clear.
--A lot more people will have access to preventive care, but there are not nearly enough primary care physicians available to take care of them due to perverse financial incentives.

That's really about it. That's the worst I can come up with.

Here are some potential benefits:
--As insurance reform rather than health care reform, it should unify conservatives and liberals. More coverage, but reliance on the public sector. Still waiting for that Kumbaya thing, though.
--It's going to cost something, but nothing we're not already paying for. You think paying for insurance for people is expensive? We already tried not paying for it, and we pay anyway, every time someone wanders into an ER, every time an uninsured diabetic gets another leg chopped off.
--A lot more people will have access to preventive care. This may give us the incentive to reform medical education and practice to encourage more primary care docs.
--It's a moral victory. It's not a single payer, and still allows the insurance industry to steal our money, but it makes a statement that as a nation, we believe that the health of our citizens is as important as fighting fires and keeping criminals off the streets.
--We get to make people buy broccoli. And Brussels sprouts.

Doctors are nervous about this (not the veggies, but the law). Primary care docs work on narrow margins, tight budgets. The uncertainty created by the reform is destabilizing. Will we need to completely restructure our office? Lay people off? Hire more? Cut our salaries? Move to a smaller or larger space?

Ultimately, I'm optimistic. I think the law is a start, and that we'll find ways to adjust. Hopefully.

The Right has of course wet itself in rage. They're doing somersaults trying to explain how Chief Justice Roberts could have "betrayed" them. Some are even promoting armed rebellion. Over a tax. A tax proposed by the Executive Branch, passed by the Legislative Branch, and upheld by the Judicial Branch. So where is the balance of powers problem here? Did all the branches just lose their minds and betray their oaths?

I'm hoping for mental health care parity so these folks can learn that not getting your way is not an excuse to lose your mind.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.