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Universal Coverage Means Less Care

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Contributor & author: Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons (AAPS)

Interview – Contact Dr. Orient directly at (520) 323-3110 or by email at janeorientmd@gmail.com

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When the money is gone, treatment is canceled. There will be fewer beds, fewer CT scanners, fewer drugs, and fewer doctors. But all will be fair. No rationing by price, just by waiting lines, political pull—and death. There will be no medical bills to pay after a service, if you get any service. Only taxes in advance, service or no service.

That’s why the universal care advocates count enrollees, not the number of services, and constantly harp on “excessive” treatment, even while planning to make patients wait months for an appointment.”

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May 16th, 2017

The reported success of the Affordable Care Act (ACA or ObamaCare) is based on enrollment numbers. Millions more have “coverage.” Similarly, the predicted disasters from repeal have to do with loss of coverage. Tens of thousands of deaths will allegedly follow. Activists urge shipping repeal victims’ ashes to Congress—possibly illegal and certainly disrespectful of the loved one’s remains, which will end up in a trash dump.

Where are the statistics about the number of heart operations done on babies born with birth defects, the latest poster children? How about the number of babies saved by this surgery, and the number allowed to die without an attempt at surgery—before and after ACA? I haven’t seen them. Note that an insurance plan doesn’t do the operation. A doctor does. The insurer can, however, try to block it

Also missing are figures on the number of courses of cancer chemotherapy given, or not given, or the time from diagnosis to death in cancer patients before and after ACA. Five-year survival of cancer patients in the U.S. is generally better than in countries that have universal coverage, or the type of plan progressives want to import. Again, the insurance plan isn’t medicine. You can get medicine without insurance, and if you have insurance it might refuse to pay.

There are selected comparisons of change in mortality rates in states that did or did not expand Medicaid (such as New York vs. Pennsylvania). On the other hand, mortality did not decrease in one state (Oregon). These estimates—guesstimates really, are based on the weakest type of data, and the differences may have nothing to do with Medicaid. Maybe it was better AIDS treatments. We hope that the FDA does not use evidence this poor to evaluate drugs.

But what effect did ObamaCare have on overall U.S. mortality?

Between 2014 and 2015, U.S. mortality rates increased for the first time in decades. This primarily affected less-educated whites. Is ObamaCare the cause? There are many factors involved, drug abuse probably being the most important. But I suspect that if repeal had happened in 2012 or 2013, it would have been blamed.

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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/

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Bobbing and Weaving on Hobby Lobby

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new-logo25 Alieta Eck, M.D.

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The recent “Hobby Lobby” Supreme Court decision defended the rights of the owners of a company to refuse to fund a health plan that covered abortifacient “contraceptives.” The Hobby Lobby owners argued that such medications violated deeply held religious beliefs. So for now, by a disturbingly close 5-to-4 vote, the Supreme Court has asserted that government has no right to force business owners to violate their conscience—provided that the business is “closely held.” More

Obamacare: Sold to the Highest Bidder

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new-logo25By  Dr. Marilyn Singleton,

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The Affordable Care Act is like the television show Storage Wars, where unclaimed items in storage lockers are auctioned off after a quick peek through the door. People bid top dollar and hope for the best. Some find a goldmine, but the unseasoned bidders usually receive a Pandora’s Box.

Let’s look at some of the winners. The Center for Public Policy, a non-partisan public interest think tank in Washington D.C., estimated that $120 million was spent lobbying for health reform. Pharmaceutical Researchers and Manufacturers of America (PhRMA) alone spent $26 million lobbying for Obamacare in 2009. And PhRMA has spent well over $100 million on ad campaigns promoting healthcare reform legislation.

Upon passage of the bill, the stocks of some of the largest health insurers, including Cigna, UnitedHealth Group,WellPoint,and Aetna climbed. Major makers of electronic health records (EHR) systems lobbied hard, locking out smaller competitors. Chicago-based Allscripts Healthcare Solutions former CEO Glen Tullman, who had served as health technology adviser to Obama’s presidential campaign in 2008, made more than $200,000 in contributions to the campaign, and was frequent guest at the White House during 2009. With some nudging from the Stimulus mandate for EHRs, annual sales of Allscripts more than doubled from $548 million in 2009 to $1.44 billion in 2012. Cerner, another software purveyor, spent $400,000 lobbying for EHR. During the same three-year period, sales rose 60 percent.

Of course, AARP’s CEO, Barry Rand, wrote that the ACA was “vital” for the nation’s seniors. This makes no sense when the ACA in fact cut a half a trillion dollars from the popular Medicare Advantage program. It seems the ACA’s passage was vital to AARP’s insurance Medi-gap insurance products – which people with Medicare Advantage do not need. More

The Medicare Free Wellness Visit: I’d Rather See a Veterinarian

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new-logo25By author/contributor Marilyn M. Singleton, M.D., J.D.

 Marilyn M. Singleton, MD, JD, (San Francisco) is a board-certified anesthesiologist, professor and Association of American Physicians and Surgeons member (see bio at bottom of release)

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“In fact, the free wellness visit is mainly a lost opportunity to discover conditions unknown to the patient and for patients and doctors to enhance their special relationship. It is, however, an opportunity for the government to collect data about the patient.”

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A friend went in for his Medicare free “wellness visit,” compliments of the Affordable Care Act (ACA). He assumed it was like a doctor’s annual check-up. After all, when he took his dog to the vet for a wellness visit, little Sparky was examined and tested for worms. So my friend made the mistake of asking the doctor to listen to his heart and lungs – just because that is what we expect physicians will do. Then he got a bill. Neither my friend nor his physician realized that if the patient was actually touched during the free wellness visit, it ceased to be free.

Medicare’s annual free wellness visit includes a review of medical and family history; making a list of current “providers” and prescriptions; measuring height, weight, body mass index, and blood pressure; and giving the patient a schedule and/or referrals for appropriate preventive services. The visit is “free”—the doctor must take “assignment” (be paid by Medicare, not by the patient) and waive the usual 20 percent “copayment.” The Medicare Part B deductible does not apply.

Physicians and a host of others, including “health educators,” can furnish the visit. Indeed, the California legislature is considering authorizing pharmacists and optometrists to serve as primary care providers. It is likely, since we are struggling with a shortage of physicians, that most offices have nursing assistants furnish the free wellness visit. Or if a physician in a smaller office with fewer personnel chooses to conduct the interview, he is relegated to the role of a scribe.

What patients need is an annual visit to be examined by a physician. They need a visit in which the physician can detect that new asymptomatic heart murmur or discover cancerous or pre-cancerous skin lesions. The Medicare Handbook makes it clear: Medicare does not cover routine physical examinations (average cost, $80 to $200).

Yet Medicare is willing to pay $155.89 for the free wellness visit. Perhaps a better investment would be a physical examination that would allow the patient and the doctor—not an office worker—to connect with one another. We all know the value of human contact for engendering trust in a relationship. Twenty minutes with the physician behind the computer doing data entry is not how most patients expect to spend their precious time during a medical visit. More

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