What's Up with Obamacare? From a Doc...

First, let me dispense with one issue: there are a couple of probably-decent ideas embedded in the "Obamacare" legislation.  It's unrealistic to think that government won't have a hand in our healthcare business, but at least it should be limited and smart/helpful.  There are numerous problems with the healthcare insurance market (many of which are caused or made worse by government regulation), but the worst in some ways is the way "pre-existing" conditions can prevent people from obtaining insurance at all or at anything like an affordable rate.  Another is the fact that insurance is tied to an employer rather than chosen by and tied to an employee (individual/family).  And all of this is more complex because insurance companies operate within each state's laws rather than being able to function across state borders (thus unnecessarily limiting options for consumers/patients and decreasing competition that can lower costs to those consumers/patients).

These issues can (and probably should) be dealt with after Obamacare is killed.

Which brings us to this: why should Obamacare be killed?

There are many reasons, but let's focus on these four:
(1) It will increasingly reduce what personal freedoms we still retain over time.
(2) It will be a financial disaster for our nation.
(3) It will end up reducing the quality, level of service and convenience, and the innovation of our healthcare system.
(4) Government has a terrible track record of running any large enterprise well, and this would be larger than anything previously managed by the federal government.

REDUCTION OF PERSONAL FREEDOMS

If anything should get our blood boiling as Americans, it's further government intrusion on our freedom as individuals to live as we would live.  How will Obamacare restrict our personal freedom?  It comes down to two simple facts: if the government pays for something, it will increasingly attempt to control that thing simply in an attempt to control costs; also, if we give government bureaucrats the power to control aspects of our life that affect our health, they will increasingly wield that power.  And what decisions that you make on a daily basis do not impact on your health?  Suddenly, it gives government a powerful interest in controlling what you eat, what you drink, what physical activities you do or do not do, what hours you can work, what kind of work you can do, every aspect of your interaction with the environment, how much noise you can make and where...it can become quite exhaustive if you think about it.  And believe me, the government will think about it sooner or later.  Think Mayor Bloomberg of New York just randomly came up with his idea to pass a law restricting the amount of soda you can order at a restaurant in New York City?  No...it's because New York pays for much of the health care of its citizens and thus the expanding waistline of New Yorkers becomes a budget issue.  So, he wants to control that.  And what else will he want to control at the end of the day?

The second simple fact here is that incredible power over our lives will be placed in the hands of 15 bureaucrats in Washington if Obamacare fully comes into effect.  They are unelected and yet will have more power than Mayor Bloomberg to control what health care you can and cannot get, and every other aspect of our health as the federal government becomes increasingly in control of the whole system.

Is this what you want?  If not, you have one option at this point...and only one...help get Romney and the Republicans elected in November.  Otherwise, there is no obstacle to Obamacare taking this control of our lives.  Obama himself certainly won't overturn it if he is re-elected...he will just take it even further...that's one thing we can be sure of.

FINANCIAL DISASTER

When Obamacare was passed, we were told it would be at least close to "budget neutral" over the first ten years.  Of course, we knew even then that this could only be said because the Obama administration and Democrats in Congress pulled a series of Enronesque account tricks, "cooked the books" and forced the Congressional Budget Office (CBO) to make certain assumptions that were laughable on their face.

Then come to find out that even with all those accounting tricks and political games, the cost of Obamacare is ALREADY being increased significantly in the estimates of the CBO.  Well, anyone paying any attention to this stuff can't be surprised by that.

Not being surprised by the massive and increasing costs involved in Obamacare, though, does not change the reality that just at a time of great national peril with a massive and increasing budget deficit - and with even bigger outlays ahead with "promised" benefits of social security, medicare, and other "entitlements" - Obama has inserted another program with tremendous costs going forward.

To me, this is fiscal mismanagement of horrifying degree.  I don't know how they feel they can get away with it.  Maybe they think we will somehow "grow our way" out of the problem with our economy galloping forward for years?  Anyone who really thinks our economy is going to grow fast enough to pay for all this - I just don't get it.

The worst part is...if you've noticed...Obama and the Democrats have NOT PUT FORWARD ANY SERIOUS PROPOSAL to handle this mounting crisis.  No proposal to cut back on anything significant.  No proposal for serious reform of any entitlement spending.  Nothing.

It's a simple question: do you trust Obama on these matters at this point?  Or Mitt Romney, with his track record in business, as head man over the Salt Lake Olympics, and as governor of Massachusetts?

REDUCING THE RESPONSIVENESS OF OUR HEALTH CARE SYSTEM

There are some things the government can be effective at with health care.  When they want to, they can put an awful lot of pressure on people to get certain treatments deemed best for society.  This can often be a good thing for individuals as well in terms of health issues.  The classic example is immunizations.  The government can impact your schooling and employment options, travel, etc. in order to get people immunized.

I'm a proponent of our vaccines recommendations and think the CDC is responsible in its approach, but my point is that government has ways to get such things done when it is considered in the public interest to do so.

What the government has a long history of being terrible at is running complex service-oriented enterprises.  There are so many variables and complexities in such enterprises that it seems to stymie sclerotic bureaucracies.

When a problem can perhaps be handled with gentle use of a scalpel, government tends to bring a sledge hammer.  Or a drill.  And it takes them far to long to realize they've used perhaps the wrong tool.

A few simple examples:
- Through Obamacare, the estimates were that some 30+ million more people would get insurance through government and other programs and therefore be able to get more regular health care at doctors offices and other care centers.  Access to health care services is generally a helpful and good thing with potential benefits.  But in a practical sense, consider 30 million more people suddenly hitting the nation's existing medical clinics.  Are there suddenly more doctors to see them?  If there are more people trying to see the same number of providers, doesn't that start to equate to longer waiting times, less time with the doctor, or having to see a less trained provider?

Did you hear anything during the Obamacare debate about this issue?  I sure didn't and I was following I think very closely.  Why?  Maybe I'm jaded, but I suspect it's because government pays for a good part of the training of medical providers, so if they included expanded training programs for more providers, they would have had to include those costs in the estimates for Obamacare, which would have made the fiscal impact picture look much worse.  Wouldn't want to be honest about the real costs involved, now, would we?  Leave that to later when the costs can be buried in other programs in other budgets.  Apparently.

- Many services currently provided through medical clinics are organized and ordered by physicians but run through nurses and other health professionals.  They can include additional education and health coaching, etc.  As financial pressures mount under Obamacare, the pressure will be to reimburse providers less.  Do that and the funds that pay for these extra services dry up.  There are many similar ways in which the quality of service and the responsiveness of the medical system will be impaired under Obamacare as it rolls out.  Think you've had problems with "the system" as it is now?  Let's just say you'll come to expect much less eventually under Obamacare.  Don't mean to be a downer, but I think it's inevitable given the realities of how the system would be directed and financed.

- Read more about a New York doctor's concerns about how Obamacare will hurt patients and doctors and the quality of our system here.

GOVERNMENT MISMANAGEMENT

I always like to ask friends who consider themselves to be liberal or "progressive" to give me an example of a large, complex, sustained, public service oriented program that the government has run successfully.  It's an awfully difficult question to answer.

There are reasons for this, and it's not that government workers are bad or want to provide bad service or bloated, inefficient services.

But, the reality still exists and must be recognized.  My own opinion on this may be summed up in saying that anytime the people managing the system do not have much or any "skin in the game," they tend to overreach and try to do more than they can effectively do.  Any time these people are sitting ensconced on high in their towers in the District of Coumbia and are not "in the game themselves" on a daily basis, they tend not to understand the "little" daily realities that complicate the efficient delivery of goods and services.  And similar issues exist on the side of the "customer" or receiver of services.  A distant government bureaucrat is impersonal and so there is no sense of balance or negotiation but just of "milking the system" for whatever one can get.  The more local the organization and control, there more there is a natural interpersonal pressure to have conversation, back-and-forth negotiation and questions and answers.  In a practical sense I think these kinds of things are what lead to so much government waste and inefficiency.

The complexities of the health care system - with which I am very familiar, I think, as a practicing physician - are immense.  I think the odds of Obamacare government being able to handle these effectively and efficiently are...to put it kindly...remote.

SUMMARY

This has been long, but I hope a helpful perspective.  What I may not have been able to convey given the length of this post is this: I truly believe we get ONE AND ONLY ONE chance to reverse this process, and it comes on the first Tuesday of November on Election Day.  Mitt Romney said it best on Thursday. “If we want to get rid of Obamacare, we’re going to have to replace President Obama.”  More than that: If he [Romney] does not win - and, critically - if the Republicans do not retake the Senate and hold onto the House - then Obamacare and its attendant consequences will become a fixture in government so integrated that I don't think it could ever be fully extricated.

If you care about the issues above, you must help in this effort or we will all suffer the consequences if we fail.  It's that important, and our only chance is NOW.  The Supreme Court - and Justice Roberts in particular - has declined to protect us against this erosion of our freedom when that should be their main job.  But beyond that, it was not the Court's job to protect us from the other unwise, even dangerous, effects of this legislation.  Only the President and the Congress can do that.  Let's not let up until we get that President - and that Congress - who can help us avert this coming disaster.