Project 21 New Visions

Elaina F. George, MD

The Antidote to the Affordable Care Act Is Non-Participation


by Elaina F. George, MD (bio)

Since the Supreme Court upheld ObamaCare, the final piece of the puzzle is in place. America begins an inevitable slide away from patient-driven health care — individualized medicine led by independent doctors in consultation with their patients.

In 1971, the Rand Corporation's "Rand Health Insurance Experiment" found that increasing patient costs via cost-sharing (making patients responsible for a portion of medical costs through "deductibles") with a maximum out-of-pocket expense of $1,000 led to reduced "overutilization" and led to reduced "appropriate or needed" medical care. This shows the detrimental effect of removing the free market from health care.

Controlling patient behavior by controlling costs is fundamentally flawed. In 2012, patients have higher out-of–pocket costs while overall health care costs still spiral out of control. It creates the untenable position of people having health insurance they cannot afford to use.

The ObamaCare mandate exacerbates this problem by forcing Americans to buy into a system with the power to deny recommended treatment based on what insurance company actuaries deem "inappropriate or unnecessary" rather than doctor and patient decisions. Placing punitive constraints based on private corporate interests at the expense of patients smacks of cronyism at best and fascism at worst.

And those supporting "Medicare for all" either don't know or don't care how damaging government has been to health care quality. Medicare was essentially set up as socialized medicine for senior citizens. Like ObamaCare, it was crafted by bureaucrats, politicians and special interests without patient or doctor input.

With doctors being virtually conscripted and revenue coerced, Medicare has become bloated and wasteful — funneling money and power to favored hospitals and insurers at the expense of physicians and patients.

Look at health care these days. The use of the diagnosis related group drives hospital payments for particular diseases — affecting a Medicare patient's hospital stay. The Medicare Payment Advisory Committee advises Congress on what should be paid under Medicare.
 
With ObamaCare comes the Independent Payment Advisory Board (IPAB), which can set Medicare payment and coverage guidelines — and Congress can only overrule it with a supermajority vote. It is essentially a rationing board.

ObamaCare will force doctors to choose if they will honor their sacred Hippocratic oath to do no harm or serve the interests of a government that mandates that cost control is more important than an individual's right to determine the course of their healthcare.

Instead of depending on Congress to repeal ObamaCare, doctors and patients need to work together. These are some steps they can take to regain some freedom:

• Physicians can stop participating in Medicaid and Medicare. Under current Medicare/Medicaid guidelines, doctors are treated as guilty until proven innocent. Between physicians being targeted for felonious fraud, waste and abuse and recovery audits which claw back money for services already rendered, it is very difficult for a doctor to practice good medicine while always looking over his shoulder.

• Physicians who plan to stop participating in Medicaid and Medicare should initiate conversations with their patients about why they have chosen to put patient care above all else.

• Medicare patients whose physicians no longer participate should have a conversation about costs. They may find significantly discounted services.

• Patients with high deductibles and co-insurances should consider foregoing insurance for routine visits and tests through independent physicians offering fee-for-service. These doctors may offer significantly discounted services. Additionally, freestanding facilities such as non-hospital labs, surgery centers and radiology facilities can be cheaper.

• If you are healthy, consider getting catastrophic coverage and add supplemental insurance. Healthy people have minimal medical costs. Preparing for unforeseen, life-altering emergencies is smart — and some of the savings could be used to fund health savings accounts.

• A non life-threatening problem may be handled by an urgent care clinic. Many such facilities are now staffed by ER-trained physicians and offer excellent care at a fraction of a hospital price.

America's health care system is broken, but ObamaCare is not the solution. Instead of depending on Congress to bring change, people must take back the power.

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Dr. Elaina George, a member of the national advisory council of the Project 21 black leadership network, is a board-certified otolaryngologist and host of a weekly talk radio show, "Medicine On Call," that explores health issues and the politics of medicine. Comments may be sent to [email protected].

Published by the National Center for Public Policy Research. Reprints permitted provided source is credited. New Visions Commentaries reflect the views of their author, and not necessarily those of Project 21, other Project 21 members, or the National Center for Public Policy Research, its board or staff.


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