Saturday, October 30, 2010


So, of course, after I tell you that I will diversify my topics, I start with a medical issue. One pet peeve of mine is the venom that some of my patients spew with regards to the new health care reform, which they derisively dub "Obamacare". The concerns expressed by my patients are that somehow, after the reforms take full effect, they will no longer have access to adequate medical care. What the patients don't seem to realize is that "Obamacare" has not gone nearly far enough to reform the system, and that the danger lurks where it always has been- with the insurance companies.
Case in point. One of my patients, who is employed but does not have health insurance, has a serious gastrointestinal problem that needs attention. He called me with great concern about his medical problem. He told me that he and his fiancee decided to get married in the next 2 days so that he could go on her medical insurance to take care of the problem.
In my hours of paperwork at the office, I am still dealing with insurance companies asking me medical information about patients that I have just seen. This is done not out of concern for them, but whether they can glean that they have a so-called "pre-existing" condition so as to deny them coverage.
Now I know that the health care reform bill is supposed to fix these problems in the future, but I have my doubts. So much of the reform is dependent on the cooperation and integration with states, that I am concerned that red state America, at least, will opt out. I am also concerned by the fact that the Federal Government has already given waivers to self insured entities such as Macdonalds so that they don't have to follow the new requirement to provide insurance to all children in their health care plan.
The issue, my dear patients, is not with "Obamacare", but with insurance care, especially the profit driven, cherry picking type of plans.


  1. I largely agree. The problem remains, as you point out, that Obamacare does not go far enough - but this of course leaves plenty of room for criticism of the program.

    Furthermore, as some commentators have discussed, Obamacare closely resembles the program put into place in Mass under Romney (Romneycare?) which has been an unmitigated disaster (and written with strong input from industry lobbyists, as in the case of Obamacare). This was partially due to the inclusion of mandates without adequate subsidies, but also because of the penalty structure for noncompliant employers. The program makes it law that all employers who employ over a certain number of workers must provide insurance. If they do not comply, they are forced to pay a fee - yet that fee is often less than the cost of providing insurance. The outcome, of course, is that employers can simply pay the fee and the healthcare costs - still spiraling out of control - are simply transferred onto the taxpayers or individuals.

    The good news out of all this is that most Americans seem to realize this already. As this AP poll shows [], the number of Americans who think Obama's plan did not go far enough outnumber those who think the govt should stay out of healthcare by a 2-to-1 ratio (40% of those polled).

  2. Agreed. The major problem here is that the legislation was drafted in a way that was essentially a negotiation between the health sector and legislators. It was done this way because the Democrats did not want to alienate them--and in fact they won the support of the drug companies and, after passage, healthcare stocks went up. (They also went up when the Senate bill officially dropped the public option).

    The bill does not have enough teeth to ensure that all US citizens will have insurance. Some populations will be better off; most people will stay in the same boat--either underinsured with ever-weakened HMOS or uninsured (only now paying a tax penalty).

  3. I agree that some populations do benefit from the health care plan. Under the plan, Medicaid will be greatly expanded, as will reimbursement of primary care physicians taking care of Medicaid patients. The real problem is whether these provisions of the plan will survive the inevitable revisions that will come with a newly constituted Congress.