December 24, 2012
Please Pass the Kool-aidBy Deane Waldman
Some people never learn. This is particularly true of liberals such as E.J. Dionne quoted in the Washington Post and online at RealClearPolitics.com. Very clearly his "real politics" are a combination of magical thinking and Kool-aid drinking.
Drinking Kool-aid plus cyanide is bad for you. Some readers may not be aware of the derivation of this Kool-aid connotation.
Cult leader Jim Jones founded his utopian, communism-inspired community, called the People's Temple, in Indianapolis before moving to California and ultimately to Jonestown, Guyana. Reports on life there sound remarkably like Orwell's 1984, with 'Big Brother' Jones broadcasting over loudspeakers day and night.
In late 1978, California congressman Leo Ryan went to investigate the commune -- some members came from his district. When he tried to return to the U.S. with members being held against their will, he and a NBC film crew were killed. Ryan was the only U.S. congressman ever killed in the line of duty.
Fearing retaliation from the U.S. government, Jones convinced most of his followers to commit the "revolutionary act" of mass suicide. Vats of grape Flavor-aid were mixed and laced with cyanide. Babies and small children were fed the poison by their mothers. Those unwilling to drink were forced to do so at gunpoint.
On November 18, 1978, 912 individuals died from drinking the mixture, including 276 children. The actual powder used was Flavor-aid ®, not Kool-aid®. Unfortunately for Kool-aid maker Kraft Foods, because their product is so much better known, Kool-aid has acquired the negative association.
"Drinking Kool-aid" is thus code for doing something you know is wrong, but you do it anyway because someone convinced you that you should.
Believing that you can cut costs by spending $1 trillion dollars is... drinking Kool-aid. Blindly accepting that having health insurance guarantees that you will get health care is ...Kool-aid drinking. Promising people they will get free health care even as you drive doctors out of medicine, well, that is lacing the Kool-aid with cyanide.
Columnist (and Kool-aid imbiber) E.J. Dionne wrote that ACA "would allow 20 million American's to buy health insurance." A 2009 GAO Report showed that 12-15 million uninsured Americans were in the US illegally. Illegal residents fear the government (quite rightly) and avoid identifying themselves by signing up for government assistance.
When illegal residents need medical care, they get it through hospital ERs. The EMTALA (Emergency Medical Treatment and Active Labor Act) mandates that hospitals must provide all necessary care, regardless of payment source, even none. Thus, while care is free to those without insurance, the hospitals must "find" that money in your pocket or close their doors. This makes no good sense, but the Kool-aid sure tastes good.
The same GAO Report also described how 24% of uninsured Americans qualified for government-supported health insurance programs before the ACA, but refused to sign up.
How will ACA motivate them to reverse course and sign up? Well, say the Kool-aid drinkers, "Now it is free." We Kool-aid rejecters have to remind them it was free before ACA.
Wait, I get it. Eligible-but-uninsured individuals will sign up after they are forced to drink the Kool-aid.
Dionne attacks conservatives who claim that "big government run[s] wild," as though this is a paranoid fantasy. Let me ask any self-identified liberal this fact question: what is the largest single item expense in the entire healthcare budget?
What "costs" more than all the doctors, the drugs, hospital admissions, and wheelchairs combined? Answer: the regulatory healthcare bureaucracy, mostly Federal government but the states as well and more so for those who set up healthcare exchanges.
Before ACA, the healthcare bureaucracy consumed 40% of all healthcare spending. That was over $1 trillion in one year. That sum is roughly the same as the U.S. spent in ten years of war in Iraq.
With full implementation of Obamacre, the bureaucratic cost will rise to ≈50%. Make sure you understand: half of all U.S. healthcare spending will produce no health care.
One of the worst offenses to logic came from President Obama's own mouth. He said that his healthcare exchanges would use market forces to keep prices down. Either he does not know what market forces are and is engaged in magical thinking, or... I get it -- he is drinking his own stuff.
In a free market, the forces that balance supply and demand include price variability; consumers spending their own money; and suppliers free to compete for consumers' dollars.
In ACA health exchanges, the following are true. Insurers must provide Obama's list of eight essential benefits. They are not free to compete on features and are prohibited to compete across state lines. Payments are effectively fixed (and dropping) for care providers (suppliers of service). Finally, consumers (patients) do not spend their own money paying suppliers (providers).
ACA thus controls both supply and demand. No matter how you twist the words, this is a centrally controlled "market," the antithesis of a free market.
I am a physician, like virtually all of my colleagues. I simply want to care for my patients. I need resources to do this. The resource we need is money, not so much for us. It is needed for all those expensive things that our patients need. Doctors' fees are truly trivial compared to the cost of MRIs, kidney dialysis, heart surgery, or even one day in the ICU.
As mentioned before, trillions of dollars are going to healthcare (the system) even as hundreds of billions are being taken away from health care (the service). The outright theft of dollars from paying for care to pay for more bureaucracy makes me sick.
Ah, but I know what will make me feel better. I will just drink some of this Kool-aid that the President is serving up, for free!
Deane Waldman, MD MBA, is a physician who quit practicing medicine after the 2012 election. He is the author of "Uproot US Healthcare" and "Not Right! -- Conversations with We The Patients" (April 2013) as well as Adjunct Scholar for the Rio Grande Foundation in New Mexico.
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