By Dr. Marc Siegel
At the heart of the multi-headed abominable creature known as Affordable Care Act aka ObamaCare, there resides a singular deceit. It is too easy for lawyers and even U.S. Supreme Court Justices to miss this deceit in the process of arguing abstractions, but I and other doctors experience this reality every day our offices:
Insurance does not equal care. One patient’s needs can get in the way of another’s needs. My waiting room is like so many others in America, and when it is clogged with several patients with low-paying highly-regulated insurance, the waiting time goes up and the access to quality medical care goes down.
With all due respect to Supreme Court Justice Sonia Sotomayor, though it is true that everyone will get sick and need health care eventually, it is not true that health insurance automatically provides you with that care.
I can tell you as a practicing physician that the regulations and restrictions and red tape of health insurance (all increasing under ObamaCare) hamstring my office staff and interfere with my ability to take care of you.
What does provide an uninsured patient access to health care are laws that mandate that a hospital emergency room can’t turn you away when you are sick.
A false premise of ObamaCare is that mandating insurance for all somehow enables the ERs take care of all comers. In fact, studies show that Medicaid patients are much more likely to use the ER unnecessarily than are the uninsured. This clogs the ER and interferes with life-saving treatments for other patients.
Plus, the states, overburdened with administering the Medicaid expansion, will inevitably cut reimbursements to the hospitals, lowering the bottom line payments a hospital receives even as its volume increases.
Though politicians may even have the best of intentions when they compel you — in defiance of the Constitution, in my opinion — to purchase a product known as health insurance, in fact they are not even achieving their stated goal of providing for the public good, since this insurance doesn’t equal care.
There wouldn’t even be a case before the Supreme Court if Congress and the president had stayed within their roles and expanded the National Health Services Corp and federal clinics expressly designed to care for the underserved. If there is a public health care need then let’s get our government to provide for it directly.
In my office, and doctors’ offices across the country, the response to ObamaCare has changed.
Two years ago, when the law was passed, there was a pocket of patients who worked part time, had no health insurance, and looked forward to the day when they would be covered. But that early group of optimists has given way to a much larger group who worry that they will lose the employer-provided coverage they now have, and end up being forced to the state exchanges where they will be compelled to purchase (if the mandate survives) a policy they can’t afford with an inadequate federal subsidy.
Most of my patients are rooting for the Affordable Care Act to unravel especially if the individual mandate is declared unconstitutional. — Transcripts and audiotape from the court this week make this possibility appear likely.
If ObamaCare somehow survives with or without the mandate, 16 million new Medicaid patients will quickly find out what current Medicaid patients already know; that it is very tough to find a doctor or network of doctors who will work with your insurance.
ObamaCare’s Independent Medicare Advisory Board and other regulatory committees and mandates will make it more and more difficult for doctors like me to practice and to order the tests and treatments we feel our patients need. We will require more staff hours to deal with all the red tape. As more of us drop out and no longer accept insurance, another unconstitutional mandate will become necessary to compel doctors to participate again.
Doctors everywhere are hoping and praying that dreaded day never comes. Even though the individual mandate and perhaps all of ObamaCare now appears to be in serious jeopardy thanks to the Supreme Court, doctors and their patients are not yet starting to breathe easier.