Blog | Thursday, February 16, 2017

Repeal and replace Obamacare--STAT!


Am I referring to Obamacare here or Obama himself?

I am glad that we have a new president. Like most of the country, I was ripe for a change of direction and a new approach to foreign and domestic affairs, and we are certainly getting that. New readers here might erroneously suspect that I voted for Trump. I didn't. For the first time in my presidential voting history, I wrote in my choice for our top two office holders.

I have written multiple posts on my unfavorable views of Obamacare since it was jammed through congress without a single Republican vote. (Do I sound slightly partisan here?) Interested readers are invited to peruse posts on this blog within the Health Care Reform Quality category, if you dare.

There are two kinds of people who oppose Obamacare:
• folks who believe it is wrong on policy grounds
• folks who wield it as a political cudgel to bash Obama.

Some opponents are a hybrid of both of the above.

I was also suspicious that the Affordable Care Act (ACA) was always an interim step preceding a full nationalization of our health care system. Obama is on the record favoring such a policy during his 2008 campaign. If Obama could have achieved this politically in one step, he would have. The ACA represented the political upper limit that he could achieve, hoping that this would make a full would bring us within reach of a government takeover. Some conspiratorial skeptics believe that the ACA was designed deliberately to fail so that private insurance companies would have to abandon it, as they have. Then, the beneficent government would have to step in to rescue Americans who needed medical coverage STAT! While I offer no opinion on this wild charge, there were many smart people who averred when the ACA was delivered to us, that the numbers would never add up. And they didn't.

It is my belief that government is simply not equipped to assume control of the entire health care system and operate it at the highest level of quality possible, while controlling costs. Remember how smoothly the healthcare.gov web site release was? Do you think this would have happened if Google or Facebook was in charge? Which company do you have a higher opinion of in terms of quality and efficiency, the Bureau of Motor Vehicles or Amazon? If folks want to have a government insurance plan like Medicare, I am fine with this. But, give us access also to the free market. I like choice because competition breeds excellence. When FedEx came onto the scene, it forced the U.S. Postal Service to really step up, which they have.

And, we all know that the plan's proponents were somewhat less than truthful. Feel free to Google Jonathan Gruber to become reacquainted with his 2014 comments which make reference to stupid American voters and other niceties. How long did it take the Obamians to admit that the statement, “If you like your doctor, you can keep your doctor,” was known to be false from the outset?

Let's face it. The ACA promised us quality and cost control and in my view it has failed on both counts. I do congratulate the president here, as I have previously, for taking on the challenge of health care reform. Republicans over several presidential administrations failed to seriously confront this challenge. And the plan does cover more Americans, which we all agree is a necessary goal. But, the collateral damage of this achievement warrants a new direction, admitting that it may not be possible to uproot the entire tree.

The replace part is going to be tougher than the repeal part. Will the GOP take a lesson from their adversaries and jam it through without a single Democrat vote?

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.