ObamaCare Apologist Ignores Facts

Tom Metcalf MD, a friend and retired pediatrician, published an opinion piece in the Deseret News about how the Affordable Care Act (ObamaCare) is already helping Utah (http://www.deseretnews.com/article/765584785/The-Affordable-Care-Act-hel...). Like most supporters of ACA, Dr. Metcalf simply skips past the fiscal and other realities of this legislation. Here are some excerpts from his writing:

For example, seniors can get a 50 percent discount on name-brand drugs in the Medicare "donut hole;" kids can stay on their parents' health insurance until age 26; children under age 19 can't be denied health insurance because of pre-existing conditions; preventive care is covered without a deductible or copay in all new insurance plans; insurance companies can't impose lifetime caps on essential coverage; small businesses can get tax credits for insuring their employees; insurers can no longer cancel a plan when the policy holder gets sick; and insurers must spend 80-85 cents of every premium dollar on medical care of policy holders, not administrative costs. (Dr. Metcalf then gives numbers estimating how many Utahns are the beneficiaries of these provisions.)

The ACA is not the budget buster Republicans say it will be. If the mandate is upheld by the Supreme Court, the cost of the ACA will be spread among nearly all of us, and the Congressional Budget Office says the whole plan will be cost neutral in 10 years. The ACA is good news for people with insurance, people without insurance, small and large businesses, and people covered by Medicare, Medicaid and CHIP — just about everyone.

So what's not to like about the ACA? Republican leaders don't like it because it goes against their ideology, despite the fact that it will help their constituents. They "just say no" because it will keep power in the federal government and to spite our Legislature's desire to have Utah run its own health care, even though it would mean increasing costs and decreasing federal funding under the Health Care Compact recently passed by our state legislators.

They also say no because it represents change, which is always difficult for very conservative leaders — even though they know our current market-based system is increasing profits for insurance companies (who support certain legislators' campaigns in return), increasing costs of premiums and copays and limiting more and more of the insurance benefits for the rest of us. We all know our current system is unsustainable and that more and more middle class people can no longer afford health insurance.

My comment:

1) The 'donut hole' is a problem created by the silly approach taken to Medicare Part D, passed during the Bush administration, in which "We the People" (through our Congress) decided to pay for medications for our senior citizens (a worthy idea) but then turned around and asked the pharmaceutical industry what they wanted to charge us for their products. The solution to the 'donut hole' is not a taxpayer funded discount, it is to reorganize our medication purchasing so that we pay wholesale instead of retail, like every other first world country.
2) Children under 19 can't be denied health insurance, but only if a health insurance policy is actually being sold in the market place. Insurers have plenty of clever ways of getting around the seemingly good notions passed into law as part of the ACA. They are, for instance, re-defining what constitutes 'administrative costs' so that there will be no real increase in money spent for real health benefits. The devil for all these great ideas is in the details, which will all be spelled out in regulations. And these regulations are being written by and for the insurance companies. ACA does not change the business model of American health insurance, which is to take in as much revenue as possible and pay out as little as possible, no matter what happens to patients. The major flaw of ACA is its continued reliance on this wasteful business model. The number of people who have benefited from these various provisions of the ACA is zero, because we all would be better off if Congress had passed legislation eliminating the health insurance business model instead of the ACA.
3) Dr. Metcalf is simply incorrect (and out of date about the Congressional Budget Office) when he states that the ACA will be budget neutral in a decade. As has been repeatedly documented here, the CBO has repeatedly upped its cost estimates for implementing the ACA. The supposed budget neutrality is (and was always) smoke and mirrors.
4) I take great exception to the notion that the political problem with health system reform is all on the Republican side of the aisle. Democrats have been exploiting our national health system woes for political ends just as long and just as often as Republicans. The failing, stupid American health care system is a prime example of bipartisan failure and stupidity.
5) Prior to the passage of ACA, democratic leaders in Congress (prime example: Senate Finance Chair Max Baucus) took tens of millions of dollars in campaign contributions and lobbying from the health insurance (and other corporate interest in health care). Sen. Baucus hired a health insurance industry executive to actually write the ACA for the Senate Finance Committee. Dr. Metcalf, you border on self-righteous partisanship to offer your version of evil Republicans causing health reform problems.

I repeat what I have said often here and elsewhere: I hope that the US Supreme Court rules that the individual mandate is unconstitutional. If that happens, I believe that the US health insurance industry will do well what it always does, act in self-interest and essentially destroy much of the remainder of the ACA. And Americans will be where they have been for decades (and still are, with or without the ACA), needing to reform our health system so that it becomes better quality and more efficient. With real reform, health care will become affordable and therefore universal.

Dr. Joe Jarvis