The ObamaCare twister that carried our healthcare system to the Land of Oz isn’t done with the destruction yet. Like Dorothy being swept up on her tumultuous journey, we awoke to ObamaCare and still wonder what is going to happen next. In an article entitled, “They Had A Dream,” Weekly Standard, June, 2014, Neomie Emery states,
“The Affordable Care Act looked for advice from academics, not governors, and proposed the state takeover of an industrial complex responsible for one-sixth of the gross national product based not on what had been proved to work through experience, but on what some intellectuals had guessed might work. If a camel is a horse designed by a committee, this camel was a 2,801 page non-bestseller filled with labyrinthine riddles that nobody seemed to know how to solve.”
Who knew the 1939 blockbuster would be relevant today? Along the yellow brick road was the VA scandal in which we got a horrifying look at what ObamaCare might have in store for the rest of America. Rationing care by long wait times and bureaucratic disregard for honesty replaced individual accountability and access to care currently enjoyed by the vast majority of Americans and envied in the prototypical socialized UK system where about 70% of citizens earning over $76,000 buy private insurance even though they are paying for the National Health Service. In another chapter on this journey, the exposure of the famous lie, “If you like your insurance, you can keep your insurance,” revealed a diminished leader and a disillusioned people. But do we really want to go back to Kansas?
The creep of outside interests into the practice of medicine and patient autonomy has been long in coming. Medicare was passed specifically stating that it should not be construed to interfere with the practice of medicine. However, physicians have become servile to the State in return for access to the Medicare patient. CMS now dictates what services are worthy of payment, how much the physician can charge, how records must be kept via physician quality reporting, rubrics justifying level of service, adoption of EMR, and proving “meaningful use” once electronic medical records are adopted. After coercing thousands of physicians into EMR, the government now has hired firms to randomly audit 10% of EMR users with an eye towards recouping incentive payments. New use requirements are even more onerous, and to date very few physicians and fewer hospitals have met them. The Wicked Witch of the West has nothing over CMS enforcers.
Entering the Emerald City allowed us to see what is in ObamaCare, revealing the crony capitalist role of Big Insurance as we Munchkins got a look at the tax-payer funded risk-corridor program intrinsic in the law. According to Jeffrey Anderson, ObamaCare relies on its risk-corridor slush fund to keep insurance companies happy, and it relies on its individual mandate to coerce Americans into buying overpriced insurance they don’t want. However, way before the Emerald City, physicians were being coerced into direct contracts with insurers, such as PPO’s and HMO’s, for fear of loss of access to their patient base. This is an intrinsic flaw of employer purchased insurance.
In this strange new landscape, hospitals, insurance companies, and pharmacies have accelerated their insidious assumption of the role of healthcare providers and advisors. The subtle change to “providers” rather than “physicians” was no accident. Some hospitals are now buying big data, including personalized consumer information regarding foods and products purchased, gym memberships, and whether an individual shops at plus-sized stores for clothing, according to Michael Dulin, chief clinical officer for analytics and outcomes at Carolinas HealthCare System. They are using this data to create profiles on current and potential patients to identify at risk “patients” for intervention.
Pharmacies are setting up clinics for immunizations, disease monitoring, and screenings. Why? Perhaps the new ObamaCare employer mandate for individualized wellness programs could open a market for them relieving employers from designing their own. Insurance companies, taking funds away from actual medical care payments, are sending labor-intensive reports that remind individuals to quit smoking, to take their medications, and to inform them of late medication renewals implying non-compliance. This paves the way for insurance run ACO’s and HMO’s, where physicians are generic and the insurance company is no longer insurance, it is the purveyor of your healthcare. These entities are interested in everything about you, except your dignity and privacy.
We are approaching that awful moment when the curtain is pulled back to reveal not the great Wizard and the nirvana of ObamaCare, but the false promises of the euphemistically named Patient Protection and Affordability Act and the dire consequences it has for America- economically, morally, and Constitutionally. We don’t have Dorothy’s ruby slippers or Glinda, the Good Witch of the North, to save us. We Americans, as physicians and patients, must embrace the new-found brains of the Scarecrow, the heart of the Tin Man, and the courage of the Lion to do what is necessary to reclaim our freedom and healthcare choices from the tyranny of government and third party payers. There’s no place like America, there’s no place like America… but it will take more than clicking our heels together to get us back there.