Saturday, June 30, 2012

What's Unspoken about Obamacare

     In the aftermath of the Supreme Court's ruling this week on the Affordable Care Act, known as "Obamacare," two areas of important subject matter seem to have dodged debate.
     Yes, I am proud that the three branches of our government acted together with great discernment to pass the law in Congress, confirm it in the Legislature, and approve it in the Supreme Court.  Justice Roberts provided the deciding vote, Justice Scalia's libertarian dissent was a masterpiece of eloquence, and the enforcement of health insurance for every American using a tax penalty will finally place us in the ranks of civilized nations when it comes to taking care of our own.
     Yes, it has been deplorable that many working Americans could not afford or obtain health insurance and therefore risked financial ruin if they were to become very sick.  Like other doctors I have not known how to handle patients who showed up at my door with what could have been cancer or advanced heart disease, but had no money and no insurance.  Doctors all over the country routinely sent these patients to university hospitals down the road, where expensive work-ups and treatments were bankrolled, ultimately, by the government.
     This has been hashed over in news analyses since the ruling was announced on Thursday, June 28, 2012.  The big question is "Who is going to pay for all this health insurance?" You would think we were a nation in dire poverty.  But enough people are talking about all that.
     My question isn't, "Who is going to pay for it?" but "Who is going to benefit from this ruling?"
     What do you know, but if it isn't the insurance companies!  And the pharmaceutical companies!  The more we force people to get health insurance and urge them to go to the doctor, the more the insurance and pharmaceutical companies stand to post skyrocketing profits.  As if they weren't posting those profits already.
     Is anyone bringing this up?  What a victory for insurance companies!  And for prescription drug companies!  They must be throwing parties in their plush office suites!  Would it be discourteous for the rest of us to shine a spotlight on this fact, as though we were pointing to important personages in bed with other people's wives?  Are the insurance and pharmaceutical companies in bed with Congress?
     Is there some reason Obamacare doesn't address and restrict the obscene profits being made by both insurance and pharmaceutical mega-corporations?   Could it be that the number of lobbyists these subgroups have in Congress far exceeds that of any other special interest groups?  Could it be that the money those lobbyists promise for re-election campaigns is not to be turned down?
     The cost of health insurance and pharmaceutical medications cannot be overlooked when we talk about reducing healthcare spending in America.
     There will never be true healthcare reform in this country until someone puts the brakes on runaway insurance and pharmaceutical company profiteers.
     Health insurance companies generate their profits by:  1) denying insurance coverage to people who really need it, and favoring those who don't have health risks;  2) refusing to pay doctors for necessary services;  3) playing games with billing, coding and documentation requirements, as well as with "covered" and "non-covered" services, so that the difficulty of submitting payable claims results in non-payments to doctors, and savings for insurance companies;  4) arranging for insurance companies, not doctors, to make decisions about what is and isn't necessary healthcare for patients;  5) refusing to pay for what task forces and research studies have decided are important preventive tests;  6) confounding the world of medicine with   insurance coverage consisting of hundreds of different "plans," which no one, not even insurance representatives, can interpret--thereby garnering huge "savings."
     Pharmaceutical companies generate their profits by:  1) overcharging for products; 2) hijacking the FDA in order to extend patents on expensive products ad infinitum, thereby keeping generic equivalents from entering the market;  3) making special agreements with health insurance companies and payers like the VA Hospital system to carry their expensive products preferentially;  4) locking the borders for physicians and other Americans who might otherwise purchase the same medicines at lower cost from other countries;  5) impugning and restricting the sale of nutraceuticals that might have an effect equivalent to high-cost, brand-name medicines;  6) supporting a three-to-one ratio of pharmaceutical lobbyists per congressperson at any given time in Washington;  7) wooing and guilt-tripping physicians into prescribing absurdly expensive products by hiring chic, overly-cheerful, well-paid "drug reps," who bring free lunches to clinic, and act surprised that the doctors are so busy, and insinuate themselves anyway into the doctors' and nurses' days with the knowledge that their products will thereby find their way into the doctors' permanent pharmacopaeia, despite their relative uselessness.
     I will not support nor have faith in Obamacare unless it acknowledges that a large part of the "high cost of healthcare" falls to the insurance and pharmaceutical industries.  We must limit the influence these megalithic businesses have on Congress, and stop scapegoating the wrong players--doctors and patients, as well as small businesses that "fail" to provide health insurance to employees.  As long as insurance and pharmaceutical companies are the invisible benefactors of healthcare reform in this country, America's politicians don't care about their constituents.  They care about their political careers and their financial backers in the next election.

1 comment:

  1. I'm not so sure I want to join the "ranks of civilized nations." I wonder if our present system isn't so different from Churchill's famous evaluation of Democracy--the worst system ever developed, except for all the rest. These other health care systems--Britain, Canada, etc.--seem to promise a lot, but deliver far less than ours. We've all heard the true horror stories of patients dieing due to long waits for service and "death panels" that deny live saving care because the costs outweigh the social "benefits".

    But I think you've also nailed an important point that is ignored in the mainstream media. That is, the degree that Big Pharma is in bed with the Obama Administration and the Democratic Party. Most people would be surprised that big corporations would fear the Republicans. Most Republicans favor freedom and fair competition that rewards innovation and hard work. It's much easier to have government legislate your profits as with Obamacare. Here's just one of many articles on this subject:

    Nevertheless, I do think there is something good to say about Big Pharma: Isn't it true that almost all the innovations in drug therapies over the last several years have originated in the USA? This represents an unseen cost to Americans as the rest of the world can "free-ride" on the fees we pay. Would like to hear more about this and Obamacare from your perspective.