Be Careful about Replacing ObamaCare

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new-logo25Marilyn M. Singleton, M.D., J.D.


Since the day the Affordable Care Act was enacted, we have been subjected to the “repeal and replace” mantra. Replacement offerings are basically slimmed down versions of the ACA. A few brave souls have proposed a straightforward repeal. Of course, such bills were merely making political hay since Obama would never sign away his namesake law.

Several GOP presidential candidates have doubled down on the misguided “repeal and replace” promise, including the yet-to-be-elucidated “Donaldcare.” But the real question is whether the ACA should be replaced at all.

Any healthcare “system” – new or old – is subject to the long arm of the federal government. Central control does not have a good track record for creative solutions, security, fraud control, administrative efficiency, or the ability to change personal habits.

The federal government has yet to figure out a way to comply with HIPAA’s twenty-year-old mandate to remove Social Security numbers from health insurance cards. Consequently, the mere possession of a Medicare card poses the risk of identity theft in our most vulnerable population.

And speaking of identity security, a core tool of the healthcare system is the electronic health record. Health “providers” seeing Medicare or Medicaid patients must have “meaningful use” of electronic records in their offices or face monetary penalties. However use of wireless networks for sensitive information requires sophisticated security measures most physician offices do not have. Moreover, even with the highest-level resources at its disposal, the federal government has failed to secure its own records.


Death Panels Are Already At A Hospital Near You

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new-logo25By author/contributor Marilyn M.  Singleton, M.D., J.D. a board-certified  anesthesiologist and Association of American Physicians and Surgeons (AAPS)  member


When advance health care directives (“living wills”)  were popularized, the guiding principle was to allow patients to choose to “die  with dignity.” But one man’s dignity is another man’s poison. Surveys suggest  that half of those with a serious chronic illness prefer to die at home. The  other half prefer treatment in hospitals.

Advance directive legislation has evolved from a means  to ensure patient autonomy to a license for health providers to ObamacareHurtwithdraw medical  treatment—even against a patient’s wishes. Statutory advance directives provide  that individuals “have the right to give instructions about their own health  care,” but they fail to mention that such instructions may not be carried out if  individuals have chosen life. (See, for example, California Probate Code section  4701).

The Uniform Health Care Decisions Act (UHCDA), model  legislation developed in 1994, has been adopted in whole or in part by several  states. It provides that health-care providers—without legal consequences—may  decline to comply with an individual’s health-care decision that “requires  medically ineffective health care or health care contrary to generally accepted  health-care standards applicable to the health-care provider or institution.”  Not surprisingly, the key term, “medically ineffective” is not defined. Any  attempts at specificity would force an open debate on the morality of rationing  and “playing God.”

Patients must be informed of the rules before the final  seconds of the game. Under state laws, circumstances under which wishes can be  denied range from a terminal condition or permanent unconsciousness (Alabama) to  being permanently unconscious or “an incurable or irreversible condition” that  will cause death “within a relatively short time”  (Maine).

Unbeknownst to patients, many hospitals have policies  that flesh out treatment withdrawal standards. For example, Stanford Hospital’s  “Policy for Medically Ineffective (Futile) Treatment”  states:

Medically ineffective refers to treatment that would not  offer the patient any significant benefit. If an attending physician believes  treatment is not medically ineffective and assumes care of the patient,  treatment is not medically ineffective.

This tortured clarification anoints the physician as the  final arbiter. More

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