Despite President Obama’s recent declaration that the Patient Protection and Affordable Care Act — Obamacare — will be “a lasting legacy that I am extraordinarily proud of,” the legislation remains under vigorous attack. Polls demonstrate that up to 60 percent of Americans want it repealed. While many in the newly elected Congress focus their attention on reversing or limiting the implementation of Obamacare, the courts are assessing the constitutionality of some of its fundamental edicts.
Constitutional questions aside, a whole host of concerns about specific impacts of the PPACA underlie the opposition to it, including the fact that the law fails to control costs as calculated by the government itself. The major objections to Obamacare rest on four of its fundamental features, all of which represent a marked shift of authority and control of health-care decisions to the government: 1) mandating insurance coverage while eliminating insurance options such as high-deductible plans with health savings accounts (HSAs), which people increasingly prefer; 2) shifting millions more into already unsustainable public health-insurance programs; 3) directly or indirectly limiting access to technology by reducing payments for specialty medical care and limiting patient-driven options on available care; and 4) significantly increasing taxes to pay for the plan. While stopping short of the overt single-payer system openly desired by our president and many Democratic congressional leaders, the PPACA inarguably moves dramatically toward many of those same endpoints.
The government is allocated overwhelming authority over most medical care and has an increasing influence on every medical decision and available option for patients. To control the physician-referral pattern, the government manipulates payments to doctors in specialties of its choosing. To limit the use of medical technology, government declares reimbursement rates for its use. To control the use of diagnostic tests and therapies, the government dictates collected charges. To control availability of innovative drugs, government decides what to pay for and what not to. To limit the use of chronic care, government subsidizes end-of-life “discussions” with elderly patients. And by crafting requirements about the composition, structure, and breadth of the health insurance that employers may offer, government restricts your choice of doctors and plans.
All of these may be rational activities of government when it is a direct payer, because government — as insurer — has the motivation to reduce its own payments for medical care. But none of these are in the interest of the patient — they are calculations often based more on economic than medical reasons.
Beyond that, the federal government faces massive budget deficits, and no one disputes that the costs of Medicare and Medicaid have spiraled out of control. In light of the financial train wreck of government health-insurance programs — they now cost almost $1 trillion per year and are projected to go bankrupt as Baby Boomers become seniors — it seems reasonable to ask this fundamental question: Why does the federal government have to be a health-insurance company? The answer is obvious: It does not.
For virtually every other product or service in America, we rely on the private sector. For the dozens of other types of insurance, we look to private companies to compete for our business on the basis of price and value. We even look to the private sector to make up for deficits in public health programs, such as drug coverage in Medicare. And there is little veracity to the argument that government insurance is needed to increase competition, given the thousands of insurance plans from the hundreds of insurers nationwide — not to mention the fact that government often erects barriers to competition, such as the ban on interstate insurance purchases.