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new-logo25Author/Contributor: G. Keith Smith, M.D.




Many are speculating about  the outcome of what I call UCA for the [Un]Affordable Care Act, also known as ObamaCare. I think there are two basic scenarios.



First is that UCA will do  precisely what it was intended to do: inject economic chaos into the medical  marketplace, driving prices for insurance and healthcare through the roof, so  that people will beg for the sequel—single payer. That means everybody is forced  into one big government plan. There is no doubt in my mind that this was the  intention of the authors of this bill, several of whom were the corporate  players who would benefit from this. While it is worthwhile to understand  various provisions of UCA, detailing its shortcomings without assigning  malevolent intent to its authors is naive, I think. This legislation was meant  to “crash” the system. That is its purpose. Unaffordable care and insurance are  its goals. This is a medical economic false flag from which only Uncle Sam can  rescue us.

The second possibility is  that, as prices for insurance skyrocket, people will act and adapt. One course  will be for individuals and families to increase their deductible exposure if  they have insurance in an attempt to keep their premiums in check.  Deductibles of $5,000 or $10,000 will be commonplace. Others will drop  insurance altogether, figuring that at $2,500/month (typical premium payments in  high-priced states like Romney’s Massachusetts), they could bank this money and  in one year have a $30,000 cushion for whatever health expenses might come  along.

Both the newly uninsured  and the new high-deductible players will be doing something the medical  marketplace is increasingly gearing up for: spending their own money. People  spending their own money tend to ask the same question before buying:” How much  is it?” Those physicians and facilities not willing to reveal their prices  upfront will lose these patients to those who are price-transparent. Those who  are price-transparent will compete with each other for these patients. This new  and vibrant medical marketplace will cause the price of medical care to plummet.  The price disparities between the transparent doctors and facilities and the  others will become even starker. This medical price deflation will slow if not  utterly destroy the push for single payer as the UCA price crisis could  paradoxically be derailed by this market competition. After all, low cost, high  quality means no crisis. This is why cost was never addressed in the original  UCA debates, only “coverage.”

Anything that slows the  implementation of UCA will increase the likelihood that scenario #2 takes place,  as more time will be available for the development of a vibrant market. Refusing  to expand Medicaid is one critical part of the pushback. Various lawsuits could  also help.

One of the most  interesting slowing (if not derailing) strategies I have heard about comes from  Ohio, where two legislators have figured out a simple way to capitalize on the  fact that the states, not the federal government, retain the power to regulate  insurance companies in their state. Very simply, any insurance company that  accepts an UCA insurance subsidy would be prohibited from writing any new  policies in that state until that subsidy was returned to  Washington.

I actually think that  scenario #2 is more likely than single-payer scenario #1. One of the reasons I  am optimistic is that the track record of the government is so bad in all areas  that it might not even get its false flag right. For all the attempts to control  healthcare from D.C., the unintended consequence may be the creation of a  competitive marketplace.

UCA may very well ration  and kill before it fades away, but I think the seeds of its own death are within  the bill itself.


Dr. G. Keith Smith is a board certified  anesthesiologist in private practice since 1990. In 1997, he co-founded The  Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City,  Oklahoma, owned by 40 of the top physicians and surgeons in central Oklahoma.  Dr. Smith serves as the medical director, CEO and managing partner while  maintaining an active anesthesia practice.

In 2009, Dr. Smith launched a  website displaying all-inclusive pricing for various surgical procedures, a move  that has gained him and the facility, national and even international attention.  Many Canadians and uninsured Americans have been treated at his facility, taking  advantage of the low and transparent pricing available.

Operation of this free market  medical practice, arguably the only one of its kind in the U.S., has gained the  endorsement of policymakers and legislators nationally. More and more  self-funded insurance plans are taking advantage of Dr. Smith’s pricing model,  resulting in significant savings to their employee health plans. His hope is for  as many facilities as possible to adopt a transparent pricing model, a move he  believes will lower costs for all and improve quality of  care.

Dr. Smith resides in Oklahoma  City, Oklahoma. Contact:,  405-627-0274

Additional  links:

Oklahoma Doctors vs.  Obamacare:

AAPS lawsuit  covered on national TV with Judge Andrew Napolitano and Rand Paul:

Will There Be Any Physicians Left To Implement  ObamaCare?