Obamacare's Three-Step Cancellation Program
Step One: Cancel your insurance
You may have thought that the most painful part of Obamacare was the rollout of healthcare.gov. Sadly, the worst is yet to come. Obamacare has a Three-Step Cancellation Program that ends with cancelling you.
Step One: Cancel your insurance
By "cancel your insurance," I mean precisely the opposite result of what President Obama initially promised: to reduce (eliminate?) the stain of having millions of uninsured Americans. In October 2013, millions of our countrymen and women began to receive notices that their health insurance carriers were canceling their existing insurance effective 2014 in order to comply with Obamacare.
In response, the president first tried to assure people they would get better and cheaper insurance through healthcare.gov. "Better" meant what the government said you had to buy, rather than what you wanted or needed. "Cheaper" was a shell game of subsidies as well as hidden, delayed taxes. Even with the government giving us back our own money, Obamacare insurance is much more expensive than what was previously available, and even then, it was unaffordable. Tell me again, what did the third letter in PPAHCA stand for?
Last week, the president said he would "fix the problem" by administrative fiat, telling the insurance companies to reverse all the work they had done trying to comply with his law. Paraphrasing our State Insurance Director, the president was demanding that a battleship he was running at 50 knots should Just Stop, Right Now!
The dysfunctional healthcare.gov reputedly has signed up 100,000 people. Let's assume they were all previously uninsured, so subtract 100,000 from the 45 million uninsured, reducing the number to 44.9 million. Now add the (minimum estimate*) four million previously insured who are losing their insurance. You see that step one in Obamacare's Cancellation Program has increased the uninsured to 48.9 million.
* A different estimate suggests that seven million will lose their employer-supported health insurance. This would raise the number of uninsured to an all-time high of 51.9 million. So much for the president's promise to eliminate the uninsured as a class.
Step Two: Cancel your doctor
Step two was just recently reported. UnitedHealth, by far the nation's largest provider of Medicare Advantage services, fired thousands of doctors off its panels due to ""substantial funding pressure from the federal government." The quote is politically correct language referring to the $15 billion a year Obamacare is cutting from Medicare physician reimbursement. This is just one of the several cuts to Medicare reimbursement enacted by ACA. It alone affects 27% of all Americans on Medicare.
If you are a business and your revenue stream is suddenly reduced, you either cut your costs or go out of business. UnitedHealth simply responded appropriately to government action: they reduced their cost basis.
The direct result of Step two of the Obamacare Program is to reduce availability of doctors' services. That is what I meant by cancelling your doctor.
Where, you ask, is all that money going -- $716 billion in total -- that is being taken away from patient care services? To BARRC: bureaucracy, administration, rules, regulations and compliance. In The Cancer In Healthcare, I call this "bureaucratic diversion," but you can call it what it really is: stealing health care dollars to pay healthcare bureaucrats.
Step Three: Cancel you
Step three in the Obamacare Cancellation Program will eliminate the most costly element in the whole healthcare system: you, collectively known as We The Patients.
ACA's Independent Payment Advisory Board -- IPAB, Sarah Palin's "Death Panel," recently renamed HTAC, Health Technology Assessment Commission -- is meeting right now in secret (if they are following the law). In 2014, they will declare some medical treatments Cost Effective and others Not Cost Effective. The latter, obviously the expensive ones, will not be authorized for payment and therefore not available to 99% of the American populace.
So, if you are a member of We The Patients with a very expensive medical problem, especially if you are older (however defined by IPAB), you will be cancelled, meaning you will not get treatment and you will die. Whether it is some non-famous 71-year old (not Dick Cheney) who needs a heart transplant; a 60-year old who needs dialysis at $10,000/month; or a 50-year old with lymphoma who needs chemotherapy that only has a 75% chance of curing the patient, you die. You are too expensive. You get cancelled.
The Obamacare Three-Step Cancellation Program is now complete. Thank you for believing in President Obama's signature reform plan for our healthcare system. His legacy appreciates your continued support, even from the grave.
Deane Waldman MD MBA is the author of The Cancer In Healthcare, Adjunct Scholar for the Rio Grande Foundation, a member of the New Mexico Health Insurance Exchange Board of Directors, and Emeritus Professor of Pediatrics, Pathology and Decision Science. He can be reached at www.deanewaldman.com.