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Will Republicans Keep the Court from Blowing Obama’s Cover?

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by Jane M. Orient, M.D.

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The Big Lie of ObamaCare is in the title: the Affordable Care Act. Administration officials invoke “affordable” over and over again.

The U.S. Supreme Court could well blow the Democrats’ cover in King v. Burwell if it rules that people in the 37 states that did not establish an Exchange cannot legally get taxpayer subsidies for health insurance.

The subsidies hide the reality. People generally look only at what they themselves have to pay. They do not care what faceless taxpayers are paying to insurance companies for their policies.

Of the 11.7 million Americans who now have private health insurance through federal and state marketplaces, 86 percent of them are receiving financial assistance from federal taxpayers to help pay premiums—or, more accurately, their insurance company is.

“More than seven million people could lose subsidies, making insurance unaffordable,” said White House officials, according to the New York Times.

These subsidies (“tax credits”) averaged $263 a month and reduced the premium by 72 percent, on average. Taxpayers who manage to earn more than a certain threshold thus have to pay 100 percent of their own premiums plus their “fair share” of 72 percent of premiums for those who earn less.

Assuming that they will be blamed for the surge in the number of uninsured, although they did not write the law, congressional Republicans are scurrying for ways to “fix” the problem of a purported “mistake” in drafting the law.

The only problem they apparently see is that people would lose coverage—not that ObamaCare drove premiums to unaffordable levels. And the only remedy they can think of is to force others to pay the unaffordable cost, at least for a time. Not having learned from vast experience, they assume that an extension of subsidies will be temporary.

One would like to see Republicans explain to the people why the whole structure of ObamaCare is a mistake, which worsens and solidifies the problems that make American medical care so costly in the first place. These are the simple, incontrovertible facts:
• Guaranteed issue/community rating always drives up premiums and leads to a “death spiral.” Unless premiums are based on risk, people have no incentive to buy insurance when they are well.
• Mandates to pay for expensive services people do not need or want help purveyors of such services but drive up premiums.
• Third-party payment itself always and everywhere drives costs far higher than people would pay if spending their own money.
• Administrative micromanagement drives up costs and limits access.
• Insurance is not the only way to buy medical care—just the most expensive way.

ObamaCare needs to be repealed. Tweaking one of the interlocking parts just makes the interconnected rest even more unworkable. If the Supreme Court exposes the true cost by removing the veil of subsidies, Republicans should not try to cover it up.

If people lose coverage, another shocking truth might be revealed, to the horror of the insurance cartel: they might be better off. The unsubsidized share of premiums—instead of being sucked into the insurer’s bank account—would be available to buy actual care, which people might now avoid because of high ObamaCare deductibles. A market might develop for true catastrophic-only insurance, with appropriately low premiums. Note that if ObamaCare insurance becomes unaffordable because of lack of subsidies, the individual mandate penalty/tax does not apply.

Of the money paid to insurers, at least 15 percent goes to administration and much more to activities like “quality assurance” that provide nothing recognizable to patients as a medical service or product. And if the insurer does pay for something, it decides exactly what, when, and how much a beneficiary might receive.

There are many alternatives to dependence on the government/insurer monolith, which the cartel would love to crush, such as health sharing ministries, direct-pay practices, and indemnity insurance. More resources are becoming available to patients (for example, medicalselfsufficiency.com and selfpaypatient.com).

Republicans should not help to suppress alternatives by propping up the ObamaCare monster and leaving the façade of subsidies intact.

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http://www.aapsonline.org/

About the author/contributor: More

The Truth About the Drug Companies: How They Manipulate Us Physicians Without our Awareness

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Duty to Warn

new logokohlsBy Gary G. Kohls, MD

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The pharmaceutical companies are an amoral bunch. They’re not a benevolent association. So they are highly unlikely to donate large amounts of money without strings attached. Once one is dancing with the devil, you don’t always get to call the steps of the dance.”—A psychiatrist, quoted in the Boston Globe, 2002.

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The New England Journal of Medicine, under the editorship of Marcia Angell, MD, published a study in the May 18, 2000 issue whose principle author was the chief of Brown University’s Department of Psychiatry. The academic psychiatrist had reportedly made $500,000 in one year doing consultancy “work” for various psycho-pharmaceutical companies that marketed antidepressant drugs. In editing the article, Dr Angell discovered that there wasn’t enough room to print all the various co-author’s conflict of interest disclosures. Because of space limitations, Angell put the full list on the website rather than in the hard copy issue.

In a foot note to the article, she wrote: “Our policy requires authors of Original Articles to disclose all financial ties with companies that make the products under study… In this case, the large number of authors and their varied and extensive financial associations with relevant companies make a detailed listing here impractical. Readers should know, however, that all but one of the twelve principal authors have had financial associations with Bristol-Myers Squibb – which also sponsored the study – and, in most cases, with many other companies producing psychoactive pharmaceutical agents. The associations include consultancies, receipt of research grants and honorariums, and participation on advisory boards.

Angell then proceeded to write an editorial in the same issue. It was titled, “Is Academic Medicine for Sale?” In it she expressed her concern about the merging of commercial and academic interests.

“Q: Is academic medicine for sale?

  A: No. The current owner is very happy with it.”

In response to Angell’s editorial, a reader sent a letter to the editor asking rhetorically, “Is academic medicine for sale? No. The current owner is very happy with it.” More