Chaos for doctors if the Affordable Care Act is struck down

Imagine you’re a physician, and you have a full schedule of patients to see the day after the Supreme Court has thrown out the entire Affordable Care Act. Imagine you never liked “Obamacare” in the first place, so you are feeling pretty good about the Supreme Court decision.

Your first patient, an elderly retiree named Mrs. Jones, comes in for her annual Medicare wellness visit—one of the new Medicare preventive benefits offered at no cost to the patient. But this new preventive service benefit was created by the ACA, so presumably with the ACA overturned, Medicare no longer is allowed to pay for wellness visits. Do you tell Mrs. Jones that Medicare might not cover the visit? Provide the visit anyway, hoping that somehow Medicare will find a way around the Supreme Court ruling and pay for it? Offer it at no charge, or try to collect the 20% you would collect for a normal (non-preventive) office visit?

Your second patient, Mr. Jones, another senior, comes in for a follow-up visit for an ongoing chronic condition. You decide to renew his expensive brand-name prescription drug, knowing that he is eligible for a 50% discount because he has fallen into the Medicare Part D “doughnut hole.” Oh wait … the Medicare Part D drug discount was part of the now-defunct ACA. So does that mean he now has to pay full price? Do you prescribe the drug anyway, knowing he can’t afford to pay the regular retail price? Prescribe a lower cost no-name brand drug that he doesn’t tolerate as well?

Your billing person prepares to submit the claim for Mr. Jones’ office visit. It ordinarily would have been eligible for the 10% bonus that Medicare pays for all office visits, nursing home and custodial care visits provided by primary care physicians. But that was before the Supreme Court overturned the ACA, and with it, wiped out the primary care bonus created by the law. With the bonus gone, your practice will lose about $4,000 over the next six months. Does the bonus disappear immediately—with this visit? What happens to bonus payments that were already paid out? Who knows?

Next up is Ms. Wilkins, a single mother of three who is seeing you for her diabetes and congestive heart failure. She is fortunate enough to be among the 50,000 Americans enrolled in the low-cost Pre-existing Condition Insurance Plan created by the Affordable Care Act and administered by the state. Oh wait, that was until the Supreme Court decision. With the ACA gone, the authority and funding for the Pre-existing Condition Insurance Plan disappears. Will she still be covered for this visit and any tests or medications she needs? And if so, for how long before the program is forced to shut down? Where else will she find affordable insurance? Will she go without it? Who knows?

A text message comes into you from your 22 year old son, a recent college graduate who hasn’t found a job. He has a doctor’s appointment for the knee he hurt playing rugby, and wants to know if he still will be covered by your health insurance plan. But the requirement that young adults up to age 26 be covered by their parents’ plans was part of the ACA, so presumably, your health plan no longer is obligated to keep him. Will it drop him? If it keeps him on, for how long, and for what extra premium?

You start thinking about your oldest daughter, a fourth year medical student who plans to apply for a loan repayment program from the National Health Services Corps in exchange for providing primary care in an underserved community. But the funding for NHSC in 2012 comes entirely from dollars mandated by the ACA. Will the NHSC now have to cut back on its award amounts and recipients? When, and by how much? Will she no longer be able to get a NHSC slot?

Your practice has joined with other primary care physicians in the community to become an accountable care organization (ACO) under the Medicare Shared Savings Program. It has spent tens of thousands of dollars and countless hours to do the planning and set up the infrastructure to qualify. But the federal money to pay for the Shared Savings Program comes from funds obligated by the ACA, so with the ACA gone, the ACO program may be suspended as well. Does that mean your practice wasted all of that money preparing to become an ACO?

Your local medical school has applied for Title VII primary care grants for faculty and scholarships for low-income students—the only federal program specifically designated to support primary care training. But the Title VII grant program was part of the ACA. Does that mean that the grants will be suspended? Who knows?

Your hospital expanded its internal medicine residency program because of a provision in the ACA that redistributes unused residency slots in other specialties to primary care. Who will pay for them if Medicare can’t? Will the slots have to be eliminated?

I could write pages and pages more of programs created by the ACA that would be invalidated if the Supreme Court overturns the whole law. What I can’t tell you—what no one can tell you—is how the federal government will deal with the absolute chaos that will follow.

Rules will have to be withdrawn and re-written, contracts suspended, agencies closed down or downsized, agreements renegotiated, delivery reform pilots terminated or scaled back, and mandated insurance protections suspended—with little guidance from the Supreme Court or Congress on what to do next. And there’s almost no chance that Congress will step in to repair the wreckage.

In the meantime, physicians and patients will be left reeling by the resulting chaos and confusion created by the court’s decision.

I haven’t even mentioned the 32 million Americans who would have gotten coverage in 2014 if the law was sustained—but will lose the most if the court overturns it.

Henry Aaron, a renowned health care expert at the Brookings Institution, also predicts chaos if the Supreme Court overrules the law:

“And what if the Supreme Court throws out the whole bill?

That would leave America, including the nearly 50 million uninsured, even worse off than we were four years ago: with higher costs, more uninsured and a political atmosphere poisoned by the failure of an all-out effort to reform a health care system everyone knows is flawed.

Health insurance costs, driven by the steady march of new technology and population aging, will claim ever larger shares of our income. Those higher costs will make health insurance unaffordable for more and more people.

It would be hard to imagine any President or Congress returning for a generation to touch the endless political grief of basic health care reform with a ten-foot pole.

Is that the future we want?”

What are you going to do to prepare for the chaos that will happen if the Supreme Court overturns the entire Affordable Care Act? Is that the future we want?

Bob Doherty is Senior Vice President of Governmental Affairs and Public Policy, American College of Physicians and blogs at The ACP Advocate Blog.

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  • Steven Reznick

    Doom and gloom plays big with us physicians. I have been hearing it in the physician lounge for the last thirty years.  If the Supreme Court declares all or part of the law unconstitutional I am sure patient care will go on, doctors will find a way to be compensated and we will find a way to prescribe affordable meds to our patients. I guess those considering joining an ACA or implementing changes to their practice as a result of this legislation may want to wait until the Supreme Court issues its findings

  • Vikas Desai

    The supreme court will not overturn this bill fully, conservative or not. Too many things were put in place in regards to insurance companies and other entities in preperation for 2014 when all the provisions were set. I hope they “patch” like they do with the SGR, Obama did the right thing in questioning the supreme courts power, if they do overturn it, it will be a gross misuse of power, and will have a negative impact on the judicial system. 

    • Scott Lancaster

      Please explain the “gross misuse of power” argument you are presenting. The 3 co-equal branches of government work as a check-and-balance against each other. In the case of the ACA the question is did the executive branch over-reach with the proposed law, and did the legislative branch pass a piece of legislation that is unconstitutional. The job of the judicial branch is to review laws that are constitutionally ambiguous and decide if they should stand. If the SCOTUS decides that the law is in fact constitutionally flawed, they are doing their job by throwing it out. Yes, they could find just 1 segment of the bill flawed, but then you have to ask if the law can stand at all without it (the mandate). That is not an overreach, that’s the way our system was designed. If people don’t like it we can always seek to amend the constitution to make allowances for a mandate if you like. The POTUS using his bully-pulpet to time after time go after a co-equal branch of government shows a total lack of respect for the system we have. He is not a king, not a supreme ruler. 

  • pitch1

    I welcome the day when all medical patients in America can once again be responsible for their own health; which of course includes paying for a competent doctor and treatments rendered. This will first require that our monetary system is restored to a sound and reliable system.  Without this first step, America will continue to slip over the cliff no matter what our fraudulent make believe Prez and his band of race baiting thugs propose.  This is by far the “only way” to acheive the optimum level of medical competence for the most numbers of patients.  Any person that assumes and believes that someone else in our vast bureaucratic quagmire of Marxist madness can dictate and provide competent medical service is not only totally lacking in IQ, but a fool of dynamic magnitude!  This is an undeniable axiom of life.  There is nothing; I reiterate; “NOTHING” that the government of the USA has ever been involved that has been profitable or ever once provided a superior service.  As an example: my local Post Office is literally falling down and I feel unsafe even entering the building.  Our AMTRAK TRAIN service is absolutely deplorable and has never turned a profit: yet our fraudulent make believe prez wants a fast train to hell and back paid for by retarded citizens and our GSA spends “OUR” money like drunken sailors and even Der fuhrers secret service incompetents solicit WHORES while on the Government payroll clock.  America’s make believe Prez and his staff of thugs is totally and irrevocably out of control… Every competent doctor in America is cognizant of the simple fact that insurance of any KIND in no way assures one of timely and expert medical service.  REPEAL SOCILAIZED MEDICINE TODAY…America is BROKE and BROKEN and cannot afford more fraud, corruption and deceit in any segment of our society, especially our Medical System….The only chaos for honest and caring doctors will be if Der Fuhrers Marxist medical fraud is not struck down as unconstitutional…

    • Molly_Rn

      Hello Mr. Racist. I am shocked that you have 11 likes as you are outrageously so far right that you are off the planet. Americans today cannot make enough money to afford healthcare due to the 1% who have almost all of the money. You need to get some serious mental health help. I am stunned that this blog accepts your crap. Free speech is something that I firmly believe in, but you have nothing really constructive or instructive to add to the conversation. Perhaps the White Power movement could use your advice. 

  • brian

    The “chaos” that will come from striking down the law is worse than the “chaos” that the law has already created??!
    taking an already overly complicated and messed up system and making it EVEN MORE complicated… this is supposed to help??
    ACA didnt come close to addressing real problems in healthcare.  Striking the law down may be the ONLY chance we have at congress cleaning the slate and trying again…. maybe this time, they might actually listen to doctors and real healthcare workers instead of health insurance companies and Pharma.

    of course… it’s a pipe dream to believe any real reform is possible in our government.

  • John C. Key MD

    I’m sorry, but I cannot understand why any physician is naive enough to fall for the ACA “benefits” praised in this post.   There is no free lunch, let alone “free medical services”.  I am still waiting to see the first governmental medical program that is beneficial to anyone other than the bureaucrats hired to run it. 

    • Vikas Desai

      Out of all insurance companies, medicare is by far the best one, the way things are, medicare benefitting themselves is much better than handing the ball over to united health care, aetna and the others and watch them score record profits year after year while providing worse and worse service. What other industry becomes more expensive and worse every year outside of medical health insurance? 

  • Margalit Gur-Arie

    Well, the Mayans did predict that the world will end in 2012….

  • Douglas Peterson

    Gee, from reading this, you’d think Americans had no medical care before the government stepped in to save us all. It’s shills like this bureaucrat who have screwed up the balance in the first place, but he must not have read about the 40% of doctors who might retire once Obamacare fully kicks in, how the whole system is doomed to fail due to the hidden costs, or how 15 bureaucrats just like him are going to be deciding who lives and dies when they publish their criteria. Funny how he doesn’t express any concern about the half trillion dollars subtracted from Medicare which also decreases health care services to help pay for this abomination.

  • JeffPT

    Oops Mr. Doherty, not exactly a crew of head bobbers in agreement with you! Sounds like your feathers are a bit ruffled with that piece of paper we fondly call the Constitution standing in your way. Sorry but that’s what it all comes down to.

  • Steve

    More scenarios:  Mrs Jones bought insurance with ABC Health Care to cover her daughter Wendy.  Wendy has congenital heart disease.  Mrs. Jones has been paying for her HMO coverage for 3 years.  Mrs Jones took Wendy to see her pediatric cardiologist.  Two months later, Wendy gets a huge medical bill regarding Wendy’s treatments.  The ACA prevented HMOs from denying coverage for preexsting medical conditions.  ABC retroactively denied all of Wendy’s medical care.  The cardiologist has no choice but to require Mrs. Jones to pay for all of the medical care that was retroactively denied. 
    Phil Coffer has COPD and has smoked for 50 years. He has Medicare and he wants to quit, so he goes to his doctor.  Under the ACA, smoking cessation is covered with no copays or coinsurance.  With the ACA gone, Mr Coffer now has to pay out of pocket.  The ACA protected out of pocket medical expenses are now payable.  If Mr Coffer has commercial insurance with XYZ Insurance, his coverage is terminated because his COPD and smoking is a preexisting condition.
    As someone who has been fighting the HMOs for 20 years, the HMOs hate the ACA.  Politial leaders who fight to get the ACA overturned, in my opinion,have to be paid by the HMOs in the form of huge campaign contributions as a means of getting the law overturned.  Parts of the law need changing.  The majority of the law is good for the patient and not good for the HMO.
    Well, those that hate the ACA will sing a different tune when they find themselves without the benefits that the ACA provided if the law is struck down.  While many hate obamacare, they dont see the damage that the HMOs cause to doctors, patients, and our children.  Im a patient, a coder, a biller, and a manager.  I see it everyday. 
    While people ridiule him, Michael Moore was on the money with SICKO!

    • David R

      ACA allowed my kids insurance to double overnight because they did not write the preexisting part very well. On top of my increase. Both combined have left me and my child in a very bad financial place.

      I am disgusted when I see Obama flying his family everywhere and anywhere to play while me and mine suffer because of his poorly written legislation.

      This law was rushed through too fast and needed to be studied more. It is terribly flawed.

  • John Ballard

    Head bobber here, folks but I’m accustomed to being in a minority. 
    For the record, I think PPACA as a terrible piece of legislative sausage and falls far short of what it could be. But like the second-hand car that furnishes “reliable transportation” is not nearly as glamorous as a new one with all the latest safety equipment and a shiny finish, Obamacare is the most important piece of legislation since Medicare and Social Security. Like those who said of the president “I hope he fails” there are many who want to kill PPACA.  (And for the same reasons, I suspect, that most of those same people wanted Barack Obama to fail.)  They may or may not succeed in killing this legislation but if they do — and there seems not to be any constructive alternative to curbing the avarice that passes for health care in America — it may be two or three generations before another opportunity will be politically viable. 

    I can only say that anybody who imagines that the economic train wreck that passes for American health care is either living in a bubble or has been the beneficiary of that fairly large majority of citizens blessed with good health or covered by good insurance or both. That is a large majority of the population for certain. No question about it. 

    As long as insurance premiums continue to be tax advantaged for both individual and group insurance and most people have jobs (eight or nine percent UNemployment = Ninety-plus percent EMPLOYment) there will be plenty of opposition to rocking the boat. Portability is not a problem except for those leaving a job. Co-pays are not a problem for most people, cuz most people don’t get sick. And besides, lots of jobs have PTO when you don’t feel good. The list of reasons why change means stuff is about to get worse, not better, is long indeed. 

    But some of us have seen what happens to that minority of Americans (yes, Virginia, they really are Americans) who live out their lives without anything more than emergency care, which often means “stabilization and discharge” instead of what insured people would consider baseline care. ACA has features intended to appeal to insured people, but its main purpose is to include everyone, including those not now covered by insurance.

    Medicaid, you say? The safety net for the poor? Please, don’t let your ignorance show. If you think Medicaid furnishes adequate health care for those who need it you really are out of the loop. Way out. Your bubble is too tough to pop so I won’t even try. 
    There is one word for that position: delusional.

    Carry on, now, naysayers. I’ve had my say.

  • Mike_stevens

    In the eyes of Obama, the Affordable Care Act is a success. It will cause chaos whether or not it passes the Supreme Court’s judgement. If the Court strikes it down, it will cost us perhaps millions of dollars, severe inconvenience and time lost during which real, working solutions to the health care challenge could and should  have been implemented. If it is not struck down, it will cost us TRILLIONS of dollars and lead us to an ineffective socialist  medical system that will be even worse, for more people, than what we have now!
    I am hoping the Supreme Court has the integrity and responsibility  to support the Constitution and strike down the ACA.  As a nation we will have to “pay the piper” and personally I’d rather do it NOW, when we have less to lose, than LATER when change back will seem even more insurmountable.

    • John Ballard

      Please explain to me about the “socialist  medical system” you fear.  Nothing in ACA even comes close unless you want to ascribe the multiple ACO experiments (27 now approved), all of which are private sector constructed, conceived and driven. The closest we have to anything “socialist” is the VA — government-owned and operated facilities staffed by a range of medical professionals on salary — funded by tax money. And all that I have read leads me to believe that despite a few systemic problems, the VA has an excellent system with respectable outcomes and at a much more economical cost per patient than the private sector. 

      Medicare and Medicaid are serviced totally by private sector providers as well. (And I seriously doubt any non-profits can be found among them unless you want to claim a few big hospitals.) One of the principle weaknesses of US health care is the lack of reliable, well-staffed community clinics. Now THAT would be a step in the direction of socialist health care, but there is so much private sector political influence a deeper, better-run collection of community clinics is nothing but an intellectual concept.

      Forgive me for returning to this thread after saying I’ve had my say. But sometimes when I see blatant ignorance I just can’t help myself. This socialism rubbish really gets under my skin.

      • David R

        ACA drives the price up on personal insurance so people will be forced into a single payer system, government run program.

        ACA cuts medicare this year but he is shifting money to it so seniors do not worry about it until after they vote. There will be a two year window where benefits are cut. This helps his cost estimate.

        In the long run the cost overages will be crazy with the ACA.

    • Molly_Rn

      Mike, are you a healthcare professional or just a right wing crank like David Behar, calling anything even remotely rational about healthcare Commie or socialistic. You are part of the problem not helping to solve the problem. You are stuck in a politicized state where you only see black and white and can offer nothing constructive to say.

  • DavidBehar

    Dr. Bob: Imagine you are really sick, and you need expensive care. Under the ACA you are dead, just like all the European really sick people allowed to die to save a few bucks. Example? Princess Diana. No EMS. No trauma supervisor. No telemetry. No Jaws of Life. No helicopter. No trauma center. No trauma team. So it takes 45 minutes to get her out of the car. She is talking for 30 minutes. Then it takes an hour and half to travel the 4 miles to the medical center at Midnight, with no traffic? Why? Untrained morons are doing street CPR on a chest trauma victim, accelerating her exsanguination.  Her Golden Two Hours were spent in the streets, with a top hospital 5 minutes away. What chance do ordinary people like us stand under the Commie Care that you support?

    If you continue to support Commie Care as you do in this article, try to not age. Try to not get injured. Try to avoid getting sick at all.

    This article shows the hostility of organized medicine, including the AMA, a Commie Care collaborator, to the most basic interests of the clinician.

    • sFord48

      DavidBehar:  Imagine you are sick and you need expensive care.  You don’t have enough money to pay for quality care.  You end up in the emergency room.  Example?  
      Edith Isabel Rodriguez, who died on the emergency room floor.  Or 
      Esmin Green, who died on a hospital room floor.  Or 
      Anna Brown whose doctors had her arrested for trespassing, who died on the floor of a jail cell.

      We ordinary people only stand a chance if some big heroic rescue can save out lives.  I would rather have the everyday care that makes a big difference in my life now than that big buck rescue.

      You don’t seem to understand the meaning of the word communism…my guess your comment is a partisan rant.

      • DavidBehar

         “You end up in the emergency room.  Example?  
        Edith Isabel Rodriguez, who died on the emergency room floor.  Or 
        Esmin Green, who died on a hospital room floor.  Or 
        Anna Brown whose doctors had her arrested for trespassing, who died on the floor of a jail cell.”

        You are making my point about Commie Care. The government now totally controls the ER, with its bullying of doctors, forced labor, at the point of a gun, mandated services for free, and denial of procedures by government contract clerks, most of whom are uneducated members of minorities and vote Democratic. These are the same constituents who brought about the housing crisis, after forcing bank loans to crack heads. Your scenarios will apply to everyone under Commie Care. And there will be no recourse, unless you have some Democratic political connection, or are a union big shot.

        At least your cases had an emergency room. In other places, emergency rooms have closed after bombardment by the government from all directions, regs, litigation, denial of access to care, forced free labor, fraud investigations, accrediting standards that are gold plated, outright refusals to pay for services rendered, and reduction in fees. That means that crash victims had to roam the skies or roads to look for an open ER. Thanks Commie Care for the open ER search after massive injuries in a crash.

        You are quite naive. Try to not age and ever need Commie Care. Commie Care is cheap care. No more expensive procedures for you.

        • Molly_Rn

          OK you have proven that you are a little on the nutty side of life with your “Commie Care”. Are you a physician or nurse or RT? Or are you just a right wing crank?

    • Molly_Rn

      Sorry DavidBehar, the fact that Princess Diana was treated at the scene is because that is how their EMS works. They do not scoop and run like the US EMS. She bled out. She was mismanaged but it is not because of cost, but because they have a different way of doing things that didn’t work for her. You know nothing about the French system works and obviously nothing about the US system where people die every day to save a few bucks. 

  • MarcGarfield_DPM

    Hmm… HIPPAA is still wreaking havoc amongst doctors, most recently via 5010 claims disruptions.  We are staring down a diagnosis system revision (ICD10), that is estimated to cost a small practice 80K, when the average small practice owner is making $130K.  Doctors are being penalized without recourse for improper documentation of electronic prescribing (despite properly utilizing eRX and paying 10X the cost of an Rx pad to comply as part of the “stimulus bill”).  And, I am to believe the ACA will benefit my practice, How many times do we have to fall for this?

  • bhavin h jani

    Just watch

    More Govt involvement and “free” stuff for doctors and patients is not the answer. 
    No scare tactics please, lets tough it out and work it out 
    Change the mindset of young folks so that they do not get dependent on their parents and then later on Medicare
    It will bankrupt us
    The above video shows Dr Annis’s words have come true
    So Obamacare is going to make things worse even if it looks good now

    Bhavin H Jani MD

  • Cherie Binns

    Dogherty brings up some excellent points that I am sure most of us have never thought through to the degree that he relates here.  The fact that we’re two years into this and some are benefiting while others scramble is not seemingly taken into account.  From the other side, our private pay insurance continues to rise in cost exponentially the past three or four years (to get ready for the influx of persons with lower insurance coverage and payments?).

    Yes there is a mess here but don’t fix it by throwing out the baby with the bathwater.   Have we no one who can sift through the debris and remove the onerous portions of this while saving those that are most beneficial?

  • Joseph Mansen

    The current Congress has already passed multiple bills thru the House that address many of these situations ie. Pre-Existing Conditions. If the law is struck down the House will be able to pass these to the Senate for their immediate consideration. For more information you can contact Dr. Tom Price, a Representative from Georgia.

  • MFrank4

    Its a little known secret that there is a Doctor Caucus in the House of Representatives (21 doctors in all, including Ron Paul) that have been working hard crafting legislation to replace Obamacare. Many bills have already passed thru the House and are sitting on Harry Reid’s desk waiting to be voted on in the Senate. As long as Dems have control in the Senate, these bills will never be brought to the floor. The ONLY way to fix this situation is to vote Obama and the Democrats out of power in November. There is no other way.

    • FleetwoodJack

      Do you have legislation i.d. numbers on the many bills “sitting on Harry Reid’s desk?” I’m sure they offer a viable alternative to ACA, but the ones I found were only about repeal.

  • scott vish


  • dmz1234

    Needless to say the insurance companies have already raised their rates in anticipation of the ACA going through. Why have you not addressed attorney’s fees, demanding a cap on the percentage of monies recouped of their win when trying malpractice cases, a cap on puntative damages awarded by juries, etc.; these are the major reasons insurance costs so much. Are you also an attorney? The astronomical sums of monies won by attorneys, are then passed on tot he hospitals and the consumers.  Litigation has always been the vehicle that fuels so many escalating costs in our society.

    What of the “death” panels deciding a 75 yr. old dosn’t have enough “life years” left to warrant a CABG procedure, especially if he / she is extremely active? Do you tell your patient the operation is “off” and sorry but no, you can’t pay for the procedure from your own pocket even though you have the resources to do so? What and how would you tell the 82yr. old that  dialysis fees will no longer be covered and will the they be allowed to pay for them privately? Get hospice and go home and die. Can they afford to and still pay for food, meds, utilities, etc? 

    I could go on and on, but you get my jist; the physicians I speak to at the hospital are NOT in favor of this bill., nor am I.

  • katerinahurd

    Do you think that the ACA restores the concept of health as a social good?

  • Molly_Rn

    Healthcare should be a right of citizens of a first world civilized country. We stand alone in ignorance with our outdated healthcare system. Although far from perfect the ACA was a step in the right direction. This isn’t just altruistic pie in the sky. Healthy citizens can work and pay taxes and be productive. Please don’t mention Ron Paul; he is an idiot. He invented his own certification probably because he wasn’t smart enough to actually pass the real boards. Republicans work for the rich and powerful. They certainly don’t have actual physicians in mind when they do everything they can to defeat any real progress in healthcare.

  • David R

    Imagine if our president and DEMOCRAT law makers had not
    shoved an unconstitutional law down the throats of the American people.


    Imagine if DEMOCRAT law makers had listened to the 1000′s of
    people who called and wrote emails voicing their disapproval of Obamacare.

    Imagine a world where my healthcare (single dad of one
    child) had not increased by 130 a month because DEMOCRATS decided they knew
    what was best for me.

    Imagine a world where I could still DRIVE (not fly) to
    Disney World with my 6 year old but can’t now because I have to pay for
    Obamacare’s increased costs. Don’t worry though; Obama’s kids will enjoy all
    the vacations they want this year.

    Just imagine.

    • Molly_Rn

      The word is Democratic, just as the opposition is the Republican party not Republic party. Enough with the insults all ready. The Democrats didn’t win the fight over healthcare, they lost. The Republicans called the shots and many of the ideas that you undoubtedly hate were from the Republicans (who only hated them later because our black scary president endorsed them.) Healthcare prices are still determined by health insurance companies who by and large are run by Republican loving CEO’s. How in the hell do you think the Democrats of the President control the price of gas??? The oil companies do and they are supported primarily by the Republicans and they are out to make as money as they can and screw the common person. You are so mixed up on who has power and who doesn’t. I was one of the thousands who wrote in asking for universal single payer healthcare for all that gets rid of the health insurance companies who only take our money and then try to provide us with as little health care as possible. The health insurance companies do nothing to improve healthcare in this country, NOTHING.

  • considerations

    I have recently been to Europe where they have national health care services. I’m a registered nurse and in  my opinion the average citizens appear healthier over there. I think we if we can pay for wars and lots of foreign aide we should consider that charity begins at home and make universal health care coverage a priority. It’s not socialism it’s Christianity, it’s love and concern for our own citizens.  I don’t mind to help pay for other people to have health insurance. I would much rather do that than provide aide to Africa for health care problems, or any foreign country. We should take care of our own first.
          People have fears that health care would not be as good and that they would have to wait a long time for care. However, better a little slow than never, which is what happens to so many people, or they don’t get care until they are acutely ill, Some people fear you would be denied care when you were old, but perhaps we would come to our senses a little bit. I work in a nursing home and I have some patients who get as many as 19 medications in one med pass.
    We should make people comfortable as they decline, but really it’s not pleasant to have one’s decline drug out over 10 years. We need to learn how to balance, our respect for life with an acceptance that death and old age is inevitable, and it’s not the time to fight nature tooth and nail. An example, we may spend thousands of dollars placing a patient in rehab for strengthening, when they are weak due to lung cancer that has spread through out the body. I have seen them die before they even finish their course of physical therapy.  Another place we waste moeny is to pay for patients to receive hospice care while they are in a nursing home. That is sort of double dipping. It just takes using good jusgement, to decide what is appropriate and what isn’t. When the profit motive is removed, much of the waste will stop.
       Some people say that it would be a mess because America doesn’t seem able to make a government program work efficiently. That’s a valid fear. We would just have to learn how. We could study the countries who have successful programs.
        One thing I don’t agree with in Obama Care, is to make people buy insurance. That’s like living in lala land. Most people who don’t have insurance, don’t have it because they can’t afford it. When people are faced with a choice of food, shelter, or even trying to put something aside for retirement versus paying out hundreds of dollars a month for health insurance, they take the gamble they won’t need the insurance. After all, you know you’re going to need food and shelter, but maybe you won’t get sick. I work in a nursing home and most of the staff, particularly the aides, don’t have health insurance. These are hard working people, and much of their tax money goes to supply health insurance for other people, medicare, medicaid, veteren’s insurance. They help pay for other’s health insurance, but have none themselves. This in inequtable and also foolish. Even a rancher knows, you take care of the working stock first.
       If we have national health insurance we spread the risk out over all citizens and we all help each other that way. It puts too much burden on business to expect them to pay for our citizens health insurance and provide for their retirement. Plus it ignores the obvious problem that the sickest people are the people least likely to be able to work and get health insurance. In many industries they keep people working part time, just to avoid giving them benefits, and this impoverishes our people even more.
       Let’s remember that some problems are better solved collectively rather than the rugged individual way. We won’t consider everyone providing their own army, or their own roads, their own food inspectors etc.
       Life is not good for many americans. We need to change and make things better. Our country is a great experiment in whether common men can have a decent life and not just become a supporting platform for an elite aristocracy over them like our ancestors were. Besides our bill of rights, I think we should consider it a right for everyone to have  health care, decent education, retirement, and food. A country can’t be healthy any more than a body can, if only part of it is thriving. and the rest is neglected and uncared for. We are one, and it’s still true that united we stand and divided we will fall.


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