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October 3, 2010

If Obamacare Is Repealed, What Then?

By Deane Waldman
Most opponents of Obamacare (HR 3590), including its Republican detractors, offer nothing substantive as an alternative. If health care is truly "broken," and if Obamacare is so wrong, what should we do instead?

The answer is surprisingly straightforward: practice good medicine, rather than smarmy politics, on sick health care. That is the thesis of my book, Uproot U.S. Healthcare.

There are five steps in good medical practice, whether on a sick person or a sick system. 

  1. Review all past and present evidence. Depending on logic alone is not acceptable.
  2. Diagnose the reason(s) for illness -- do root-cause analysis.
  3. Treat the cause(s), not the signs and symptoms. Avoid the "blame game."
  4. Partner with the patient. You cannot dictate to her, him, or it.
  5. Adjust the treatment plan if outcomes are not those desired.

As is obvious, Congress did none of these. (In medical practice, this is called malpractice.) What would happen if the principles of good medical practice were applied to health care?

Evaluating past evidence proves the following.

  1. When any system disconnects the consumers from control of their money, they cannot economize and have no reason to do so. Therefore, with limited "supply" and unlimited "demand" for health care services, the government must ration, as is done in every country with universal health care. Check out any recent British newspaper.
  2. Every cost projection of every entitlement program ever enacted by Congress has underestimated its true cost. In 1990, the GAO found that Medicare cost 854% more than Congress's original projection. Medicare is now projected to go broke by 2017. If ObamaCare is estimated to cost >$1 trillion, imagine what the actual price tag will be, the one our children will have to pay.
  3. When government manages anything, the bureaucratic cost explodes at the expense of the public. Before HR 3590, 40% of all healthcare dollars went to the bureaucracy. With the massive bureaucratic expansion enacted by ObamaCare, that number will approach 50%. When you are talking about trillions, Congress is creating an unsustainable waste of our tax dollars.

Root Cause Analysis shows 10 reasons for increased health care spending.

See details in "Uproot US Healthcare."
  1. New value (care not possible in the past)
  2. More people who live longer
  3. Actions without evidence
  4. Bureaucracy, Inefficiency, Reconciliation, and Regulatory Compliance. This is called the "waste of the middle."
  5. Disconnecting consumers from control of their money
  6. Rewarding outcomes that we don't want
  7. Defensive medicine
  8. Adverse outcomes and errors (medical)
  9. Money taken out of healthcare legally
  10. Fraud, abuse, errors (financial) and embezzlement.

Curative treatment

Clearly, we want to spend money on the first two above. To stop wasteful spending permanently or the use of medical terms to cure the patient, we need to fix #3 through #10. If action without evidence (#3) wastes money, we should require evidence before spending. Unless a regulation and its accompanying costly federal bureaucracy are proven to be worth the expense, show them the sunset. If defensive medicine is due to the tort system, replace the tort system. If you want insurance companies to make less or no profit (#9), change how they do business.

Partnering

The American people hate (I do not use that word lightly) being dictated to by government. Our nation was founded on an act of rebellion against what we now have again: a government that ignores the wishes of the people. 

The only way to develop a health care system acceptable to the populace is by asking them what they want the system to do and what they are willing to do. If government tells people what the system will do for them and to them, Americans will rebel.

Do you want proof? First, note the lowest approval rating for Congress in the history of our country. Second, witness the success of the Tea Party, whose sole unifying concept is its opposition to excess government spending.

With Obamacare being clearly "wrong," what is "right"?

Until we practice good medicine on health care, it will continue to decline, and we will keep paying with our money and our lives.

J. Deane Waldman, M.D., MBA is the author of Uproot U.S. Healthcare, Tenured Professor in both the Medical and Management Schools at University of New Mexico, and Adjunct Scholar for the Rio Grande Foundation.
on "If Obamacare Is Repealed, What Then?"