Reality Always Wins

Reality Always Wins

Deane Waldman

We cannot simply let the public statements of magical thinkers remain unchallenged, certainly not when these wish-fulfillment flights of fancy are offered by people who might be widely read. You and I -- dwellers in the real world -- often need to bring them down to earth and rub their noses in… unpleasant reality.

Keith Brekhus of Politicus USA called Obamacare a "smashing success," based on the drop in the number of uninsured Americans he attributes to the ACA. Depending on whose numbers you believe, an estimated 2 million more Americans now have insurance than before ACA. 

What did you expect when you give something away for free? The vast majority of newly insured are due to Medicaid expansion (insurance totally free) or insurance heavily subsidized by the government and effectively free. We wouldn't be good capitalists if we didn't accept "freebies" the government is handing out.

If that is such a good thing, Mr. Brekhus, why not extend it to everyone? Why not free insurance for all Americans? Does that include undocumented Americans? And… who will pay for it? The government, you say. But, aren't WE the government, ask We The People?

"One of the primary purposes of the legislation [ACA] was to provide health insurance to Americans who lacked insurance," writes Brekhus. Not so. 

The primary purpose of healthcare reform, per multiple statements by President Obama in 2009, was to "bend down the spending curve" for U.S. healthcare. So, how does committing our nation to $2.6 trillion of new spending accomplish that goal?

Do the first grade math. Two million newly insured at a cost of $2.6 trillion equals $1,300,000 per person! How does that qualify as "Affordable" health care? It doesn't, certainly not affordable for the U.S. Reality 1, Fantasyland 0. 

As most know, The Supreme Court will hear King et al v. Burwell on Wednesday March 4, 2015. They will decide the fate of ACA-subsidized health insurance in 37 States, affecting as many as 13 million Americans (the number is uncertain). If subsidies are ruled illegal and Congress does nothing to compensate, then those 13 million will be exposed to reality -- health insurance costs have gone way UP. Health insurance, never mind health care, is even less affordable than before the "Affordable" Care Act.

Think of it this way: third-party payment distorts the reality of a market. Employer-supported, pre-tax health insurance benefits further bend market reality. ACA subsidies turn market principles on their head. Maybe the Supreme Court will bring us back to reality.

A second panegyric to ObamaCare was delivered by syndicated columnist and Obama-acolyte EJ Dionne, who urged us to "appreciate what's it's [ACA] actually done." He too focuses on the drop in uninsured. In effect, Dionne shouts: Mission Accomplished, Victory, vindication for the president! Let us do as Mr. Dionne requests and "appreciate" the reality of the ACA.

Remember the $2.6 trillion of new spending? That is money we don't have. That means more debt that our children will have to pay back. I'm sure they will thank us. And where is all that money going? To us for better, more timely care? Hell, no. In fact, ACA takes money for Medicare services to pay for federal bureaucracy. It also takes large chunks of money out of your wallet, without you knowing: seventeen new-but-hidden taxesor increased ones already in force. Reality 2, Fantasyland 0, and more pain is on the way.

Remember how happy Brekhus and Dionne are about Medicaid expansion? Well, evidence shows that such expansion in twelve States even before ACA led to lost jobs. Current estimates range from as low as 350,000 lost jobs to as many as 2.6 million "able-bodied adults [who will] drop out of the labor force." How is this a "smashing success" or something to be "appreciated"? Not in our reality. Reality 3, Fantasyland 0.

Finally and most important, what does this do to our access to health care? Remember, the optimal reality we all seek is healthy, long-lived Americans. We believe that is accomplished partly by timely access to error-free, modern health care.

(Keep in mind that lifestyle choices including childhood vaccinations play a much greater role in achieving the goal of healthy Americans than anything doctors do.)

Does ACA make health care more available and better? All evidence suggests otherwise. Even as CoveredCalifornia (The Golden State's ACA Health Exchange) signed up 1.3 million new Medicaid enrollees, California doctors, or at least 70 percent of them, said they could not afford to care for ACA-insured patients. Reimbursements were below their cost of staying in business. So, more insured persons and fewer doctors to care for them. Sounds like the average person will experience what our veterans are used to at VA Hospitals.

As for better medical care, ask any doctor anywhere in the country if electronic medical records and following ACA rules and regulations make care better for patients? I bet one hundred percent will shout, "No, the exact opposite!" Reality 4, Fantasyland 0, game over.

The reality of Obamacare is frightening. Maybe I should join Brekhus and Dionne in their happy but imaginary world. Maybe we all should join them.

Dr. Deane Waldman MD MBA is author of The Cancer In Healthcare; Adjunct Scholar (Healthcare) for Rio Grande Foundation public policy think tank; Emeritus Professor of Pediatric, Pathology and Decision Science; and member, Board of Directors of New Mexico Health Insurance Exchange. Opinions expressed are solely the author's and do not necessarily reflect those of the Board.