It has been said that death and taxes are the two irrefutable realities of our existence. By declaring the act that seeks to prolong death for every American to be a tax, the U.S. Supreme Court has neatly fused them together, making the debate surrounding Obamacare an inescapable reality unto itself.
My election series of columns has thus far made clear arguments in favor of re-electing Barack Obama with respect to the stimulus, deregulation, foreign policy and appointing justices to the Court, with Obama winning three of the four topics convincingly and a split decision on Wall Street regulation. When it comes to healthcare, I must admit that I am struggling a bit. Perhaps you can help.
Intellectually, I am a fan of a single-payer healthcare system. In America, this would essentially mean Medicare for all, with no option for private health insurance. The administrative cost and paperwork associated with patient care would be a fraction of what they are today and with the advent of electronic medical records an argument can be made that there are significant efficiencies to come. Practically, however, this is essentially the Canadian system and it is far from perfect.
My family is originally from Canada and most of my relatives still live there. While there is no question that general care is indeed more affordable, available and efficient, critical care is a problem. My aunt died prematurely due to the ridiculous lengths she had to go through to receive a proper and thorough diagnosis. But this painful anecdote belies statistics that suggest the mortality rate from disease in the US and Canada is nearly identical.
Doctors in the United States are compensated much higher than doctors in Canada; but this applies mostly to specialists and not general practitioners. Therefore, in Canada there are far more general practitioners per capita than in the United States. Perhaps this implies that although critical care is less available, greater access to preventive care mitigates the severity and incidence of diseases that require critical care. Frankly, I don’t know. But I do know, just looking at Long Island for example, that we have universal healthcare because the emergency room at Nassau University Medical Center is just about the busiest place on the Island. This is why I am in favor of an attempt to cover every individual in the United States and, for the most part, a proponent of the Affordable Care Act, or “Obamacare.”
When I began working for my father 18 years ago, we covered 100 percent of healthcare costs for our employees. Now, we can only afford to cover half. Moreover, this “half” is far more expensive than the entire amount was almost two decades ago even on an adjusted basis. It’s why I find it insulting when people suggest that Obamacare is crushing small businesses already. The fact is, Obamacare hasn’t been fully implemented yet, but this is the first year that two very significant things happened to our business:
- We were reimbursed several thousand dollars by our insurance company because they had failed to meet the minimum standards under Obamacare for the amount of money that must be allocated to actual care, and not administrative costs.
- This is the first year the insurance company didn’t attempt to raise our premiums by double-digits.
So, as a small business owner, I have already benefitted from a plan that hasn’t even been fully implemented. Moreover, it puts my business on a level playing field with other small businesses I know that skirt the rules by paying their people as independent contractors simply to avoid offering them health insurance.
There are other great parts of this legislation such as extending dependent care, outlawing the practice of declining coverage for anyone with a pre-existing condition, closing the Medicare “donut” hole for seniors, mandating electronic records, and identifying best practices across the nation. But I have heard time and again that Obamacare will ultimately result in a massive decrease in reimbursements for physicians— forcing them to see more patients to sustain current income levels—thus jeopardizing the quality of care.
This is a practical sentiment that I can sympathize with, but many of my friends who are physicians have been complaining about this for years. This isn’t an “Obamacare” phenomenon; this is a “healthcare-as-it-currently-is” phenomenon. And while I agree that adding millions of additional people to the insurance pool is beneficial for insurance companies and detrimental to the earning potential of physicians, access to preventive care and wellness visits is undoubtedly a positive step for America. I’m hoping my physician friends weigh in on this to express their viewpoints because I know many of them are tired of being businesspeople and accountants and simply want to get back to caring for patients and growing as doctors.
The politics surrounding Obamacare have drowned out any and all reasonable debate surrounding this issue. The mere fact that the GOP vehemently opposes this plan that was originally crafted by a conservative think tank, touted by Republican legislators and actually adopted fully by a Republican governor now running for president should indicate how toxic our politics are. On myriad levels, Obamacare is a good plan, and ultimately I am in favor of seeing it fully implemented. But if we eliminate emotion and politics, it’s fair to say Obamacare is only half of what is required. The real drivers of cost in the system are the high-cost liability insurance, rampant pharmaceutical dependence encouraged by advertising that is unnecessary and unethical, an overly-litigious culture that forces physicians to order unnecessary tests simply to thwart potential claims, paying doctors and hospitals per procedure instead of paying for the care the patient requires, and the extraordinary cost of end-of-life care. If over the next decade, Obamacare is married with serious attempts to tackle these issues, then it has a shot at not just succeeding but being a model system. If not, it will likely lumber along as a quasi-failure but no worse than had we done nothing at all.
WEEK 6 goes once again to the POTUS.
PHOTO: Barack Obama signs the Affordable Care Act into law, March 23rd, 2010. The act is the most sweeping healthcare reform since Medicare and based largely on initiatives created by conservative think tanks. (AP Photo/Charles Dharapak)