Health Coverage vs. Health Delivery: Which is it?

And so with the continued scrutiny of Obamacare (aka Patient Protection and Affordable Care Act), union leaders are now up in arms about the demise of the 40-hour work week, and destruction of health benefits. And you KNOW that if the Union leaders (who were so very vocal in getting this legislation passed through Congress) are backing away from it, there must be a little something that needs tweaking…now that Mrs. Pelosi  has allowed us a chance to look at it!

As we previously discussed, the mandate incentivizes the consequence of reduced work hours and potential worker lay-offs as businesses strive to accommodate the penalties and premium increases.  But the worse item that needs scrutiny is that as written, although the legislation may officially mandate insurance coverage, that does not necessarily translate into actual care delivery. Now that’s a big problem!!

How could this important detail have been overlooked? The legislation mandates that one of the new boards created, the Independent Patient Advisory Board (IPAB), bases the containment of cost on the reimbursement to physicians and hospitals.

It is very reasonable to assume that although a treatment is possible, if the reimbursement of service is so low, it is in essence not available. Medicare patients already have difficulty finding physicians just for this reason. With the power of the IPAB expanding to private insurance as well, all patient care becomes fair game for regulation.

Could this be a backdoor way of rationing care? Physicians already get paid little money for Medicare and Medicaid patients, and the Massachusetts experience indicates that the Health Exchanges will likely offer reimbursements somewhere between these two government plans. What keeps private practices afloat are the private insurance and cash paying patients.

The issue becomes clearer when one realizes that not one physician with actual patient care experience was consulted when Obamacare was drafted. The AMA represents only about 12%  of the entirety of US physicians. The AMA gets only 10% of its $300million budget from dues, the rest comes from the government to handle the insurance reimbursement codes—in short, it is a government agency.  In fact, there are reports that at the annual meeting, the AMA executives refused to take up motions from state delegates to deny support of the PPACA.  The doctors serving in Congress at the time were all Republicans—definitely not invited to the drafting party!

The rhetoric that there are no alternatives is utter silliness. In addition to the alternative plans circulated in Congress, boots-on-the-ground physician ALSO have an alternative to Obamacare. One such plan formulated by American Doctors for Truth, can be found on their website, ADs4Truth.org. With an elegant 11-point plan, these activist physicians address the issues at the heart of true reform that would deliver care to more people and with less stress on the health industry than Obamacare.

While they might not be politicians, it’s the doctors who must lead on reform. They are the subject matter experts, and they must be the primary authors to construct a plan that gets real reform  to deliver on patient care.