Why the Affordable Care Act is worth fighting for

Readers of my posts know that I am a passionate advocate for the Affordable Care Act, or Obamacare if you prefer.  It isn’t that I have a pollyannaish view of the law itself, or the tortured political process that produced it — far from it. The ACA is an imperfect law, created by imperfect people through an imperfect process, with imperfect results. After almost 34 years of experience in Washington advocating with Congress and federal agencies, no one needs to tell me about the difficulties involved in successfully legislating and implementing the kind of sweeping changes required by the ACA.

Yet, I will continue to fight for successful implementation of the Affordable Care Act, warts and all, and against efforts in Congress or by the states to undermine, block, defund or repeal it.  Here’s why:

First, my employer, the American College of Physicians, supports the ACA, and I am professionally obligated and personally committed to doing everything I can do to advocate for the policies established by our Board of Regents.  If I was unable or unwilling to advocate in support of the ACA, I would seek different employment.

Second, and more to the point, I am proud to work for a physician organization that has championed the cause of universal health insurance coverage for more than two decades now, and which today views the ACA as the best chance this country has had to ensure that nearly all Americans will have access to coverage.  That the College would be in favor of a law that has the potential to expand coverage to up to 95% of all U.S. resident should have come as no surprise to anyone who has followed ACP policy.

In May, 1990, ACP said that, “A nationwide program is needed to assure access to health care for all Americans, and we recommend that developing such a program be adopted as a policy goal for the nation. The College believes that health insurance coverage for all persons is needed to minimize financial barriers and assure access to appropriate health care services.”

In 1992, the College editorialized in the Annals of Internal Medicine that, “No one should go without medical care for lack of money.  As physicians, we struggle daily against the chaos of illness and injury, whether in the context of clinical, laboratory, or administrative practice.  We try our utmost to restore or to preserve health, yet the lack of access to care for many Americans increasingly frustrates our best efforts.  In this issue of Annals, the American College of Physicians proposes a plan to ensure high-quality care for everyone.”  The editorial was accompanied by a policy paper that proposed specific policies to achieve universal coverage.

ACP later went on to support the Clinton health care plan, and after that plan failed to get through Congress, promoted incremental steps to expand coverage. Then, in 2002, ACP proposed its own plan to get everyone covered through tax credit subsidies to buy private health insurance plans offered through state marketplaces and by expanding Medicaid to everyone below the federal poverty level (sound familiar?), phased in over seven years.  ACP’s plan was the basis of bipartisan legislation introduced in consecutive Congress’s by Senators Jeff Bingaman (D-NM), Steve LaTourette (R-OH), and Marcy Kaptur (D-OH).  ACP’s proposal was updated in 2008 to recommend giving the states more options to develop their own plans for universal coverage.  Then, in February, 2009, ACP called on newly elected President Obama and the 111th Congress to “provide affordable and accessible health care to all Americans.”   On January 15, 2010, ACP offered Congress detailed recommendations on the bills making their way through Congress to deliver on President Obama’s commitment to enact guaranteed coverage for all Americans, which later became the Patient Protection and Affordable Care Act (Affordable Care Act).  One month before the ACA became law, ACP issued a statement of overall support for the bill, citing the many specific policies in it that were aligned with the College’s own policies.

The version of the Affordable Care Act that passed Congress a month later was almost identical to ACP’s own proposals, going as far back as 2002, to expand Medicaid to all persons at or near the federal poverty level, to require that large employers provide coverage, and to provide tax credit subsidies for people to buy qualified coverage through state-run marketplaces.

So why, then, do I fight for the ACA?

Because it is the position of the American College of Physicians — developed over many decades of analysis, and consensus — that every American should have guaranteed access to health insurance coverage, no matter where they work or live or how much they earn.

Because universal coverage is a moral and medical imperative.

Because the ACA comes close to providing universal coverage.

Because the ACA’s key policies, including tax credits to buy qualified health plans and Medicaid expansion, are identical to the College’s own proposals.

Because if the ACA fails, we will have turned our backs on the tens of millions of our fellow Americans who are at greater risk of living sicker and dying younger, simply because they lack health insurance.

Oh, and one more thing:, this is personal.  I have spent my entire professional life fighting to expand coverage for the uninsured, only to see it fail, time and time again, because of unrelenting political and ideological opposition. I first started working as an advocate for internal medicine at the American Society of Internal Medicine in January, 1979.  Since then, I have seen the cause of universal coverage fail under successive administrations and congresses.  I have seen it fail despite all of the well-meaning reports and commissions that challenged us to do better.  I have seen it fail as the number of uninsured has grown, year after year, decade after decade. I lived through the debacle of President Clinton’s failure to achieve universal coverage, and then I saw it put aside for another 16 years, until President Obama vowed to try again.  I lived through the contentious debate preceding the ACA’s enactment in March, 2010.  I am living through the ongoing political wars to block, defund, or repeal it.  I am living through the challenges created by the law’s troubled implementation.

But if I have any influence whatsoever, I am not going to watch it fail this time, not when we are so close to providing affordable coverage to nearly all Americans, the  moral and medical imperative described by the American College of Physician almost a quarter century ago.

Bob Doherty is senior vice-president, governmental affairs and public policy, American College of Physicians and blogs at The ACP Advocate Blog.

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  • ninguem
  • John C. Key MD

    I do not believe that Mr. Doherty can find any physician, or politician for that matter, left or right, who does not support access to needed healthcare for all. Though I have long favored universal coverage, I feel that the deformed and deadly mongrel that is the PPACA needs to be put out of its misery as soon as feasible.

    The fact that Mr Doherty states that he supports the PPACA because (1) his employer wants him to and (2) because he supports universal coverage despite the fatal flaws of this bill, clearly and vividly demonstrates how our major medical organizations– including the ACP, the AMA, AAFP and others–no longer represent the needs and ideals of their members, but have merely become part of a monolithic medical-industrial-pharmaceutical-governmental complex that works for its own aggrandizement and longevity.

    It’s widely believed across the political spectrum that the PPACA will collapse under its own weight without major and early course corrections. While one might forgive an ideological president for pledging his undying support for the bill “as is”, one would hope that the staff of our professional organizations would take a leadership role in correcting and reversing the flaws rather than blindly going over the cliff while crying “I’m for it because I’ve always been for it.”

    • Rob Burnside

      Precisely, Dr. Key. “Now is the time for all good men and women…” to go where they’ve rarely gone before. Finally, after fifty years of dithering, there’s something to work on!

      • Judgeforyourself37

        Perhaps this will precipitate a Single Payer System, such as Medicare for All. Why are we the last nation to realize that health care is a right, not just a privilege?

        • Rob Burnside

          I have a tough time with the ‘right” definition, but health care is certainly essential to all the other rights and therefor carries the same weight.

          • CPO_C_Ryback

            20% of USA adults still smoke.

            What “right” do they have to make the lives of others worse?

  • Ron Smith

    I’m sorry Bob, but just because you or the ACP, AARP, or any other ‘group that claims it speaks on behalf of the people and for their better’ it just ain’t so. It reminds me of what I think when I hear a commercial that says ‘doctors recommend…’ All I can think is that they didn’t ask me what I thought!

    ACA is a failure. Even the Congressional aids are being told not to trust the information they put into the system. Just look at the lead article on Newsmax today. Lipsticking this POJ isn’t worth your time or mine.

    Respectfully,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • Rob Burnside

      With all due respect, Dr. Smith, the ACA is only a failure in the minds of those who oppose it. Really, it’s a “work in progress” and will very likely be improved over the coming years. Eventually, you’ll see things differently. Why not start right now?

      • johnfembup

        With all due respect Burnside, most people who oppose ACA today do so because they have come to realize it is a failure – a failure in its conception, a failure in its design and now a failure in its implementation.

        As to “work in progress” – I would not knowingly see a physician who is a work in progress. Would you? Would anyone? Why must I accept ACA as a work in progress that appears unlikely to deliver on its promises in my lifetime?

    • Ron Smith

      I will continue to think and believe that ACA is a failure. Healthcare is clearly not going to be more affordable, accessible, or anywhere near the quality that Americans have been used to. There will be many more uninsured as a result of this social engineering experiment. Even the constructors of this mangled mess are running from it. Why do they exception themselves and their ‘friends’ in the unions from the law that they think is so great?

      Respectfully,

      Ron Smith, MD
      www (adot) ronsmithmd (adot) com

      • Rob Burnside

        If your primary objection is the unions, you may well be surprised to learn I agree with you on that one, Dr. Smith.
        We need to know more. Was it a compromise? I suspect it was, because it’s usually the only way that controversial legislation gets passed. Like any other law, the ACA can be altered, and most likely will be, but let’s finish the test drive before we hop out of the car.

        • EE Smith

          The ACA has already been altered many times, but not by the usual process by which laws are normally altered (Congress, i.e. the legislature). Obama has just decided to give his favorite donors and buddies a break, and voila, it’s been done. All of the exemptions he’s been handing out like party favors to his supporters, the one year delay on the mandate he’s given big businesses (while refusing to give mere citizens a one year delay on the individual mandate), the rest of the 19 amended, delayed, or repealed components… and instead of the law being amended through Congress, it’s been done via royal edict.

          I think the law should be imposed exactly as it was when it was passed and signed into law. Let’s “test drive” the actual product we were sold, and then if there are changes to be made let the legislature make them in the proper fashion. Because I think that if the peoples’ representatives had to go back to their home districts and explain to their electorates that they had just given several favored classes such as unions and big business a break that they’re not willing to give the ordinary people who elected them, that would be a bit of a reality check on the whole process.

          • Rob Burnside

            No one says this baby’s pretty, but the fact that it was born at all is a major miracle. We can argue over paternity, but what’s the use? The kid’s here.
            It’s now up to us to raise it well. To mold it into something we can be proud of. Something that works for all concerned. Impossible? I don’t think so. At any rate, it behooves us to try.

          • EE Smith

            Oh come on. If Bush had rammed a massive and highly divisive piece of legislation through Congress with not a single Democrat vote, no support from anywhere outside the Republican party, would you be demanding that it was now the job of all Americans to get behind it and make it work?

            Seriously.

          • Rob Burnside

            I see your “seriously” and I’ll raise you a “perhaps,” as in perhaps this was a case of the lifeguard needing to get the drowning victim ashore before
            starting CPR. Going all the way back to President Nixon, it’s clear to me that the concept of national health care couldn’t be resuscitated any other way.
            Once saved, the patient can begin to heal. That’s what we need now more than anything else. Then, sensible modification can begin.

          • EE Smith

            We had to destroy the village healthcare system in order to save the village healthcare system? ;)

            No, I do see your point, and it is a valid point, for someone with your opinion. My opinion is obviously different, but there ya go. At least you seem to have the best interests of patients at heart, as opposed to many proponents of the ACA who seem be more excited about the chance to give capitalism and individualism a kick in the balls or about the opportunity to grow their own power and influence in the vast medical-industrial complex that they’ve lost sight of the fact that the goal was to bring actual health care (not health insurance) to the largest possible number of Americans.

            For the record, as snarky as I may seem towards you, you and Margalit are my favorite bleeding-heart liberals on this blog: intelligent and principled. If we had to go to a single-payer system, I’d want you two in high policy positions to keep the other bastards honest, because I think that you would.

          • dontdoitagain

            Margalit is one of my favorites too. Margalit and I are apparently on opposite sides of the political spectrum, but she is as you say “intelligent and principled”. I must be “bi-partisan” at least in Margalit’s case.

          • Rob Burnside

            Best back-handed compliment I’ve ever had, but I don’t think I’m a true liberal–I enjoy the WSJ too much! However, I also read the NYT, daily when I can. Two great newspapers, two great traditions, and we need both in order to prosper. Margalit can navigate, I’ll steer. There’s a place waiting for you in our cabinet, Dr. Smith.

          • dontdoitagain

            The immigration “reform” that GW [in]famously said he would see at the signing springs to mind. Republicans and probably a lot of otr (other than republican) citizens didn’t like that. We said so loud and clear. I’m a republican and I call them as I see them. The ACA is a purely democrat morass. If it were a republican “Law Of The Land”, like the dems are now trying to claim, I would be just a dead set against it. It’s a bad law! There is no way around it.

          • Judgeforyourself37

            Really, now Dontdoitagain???? Check it out. The ACA IS a Republican plan and was, a few years ago, endorsed by the “right wing ?think? tank, the Heritage Foundation.

          • J.L. Creighton

            Stop trying to disown it. If you think it’s a failure, go ahead and admit that you failed, but don’t try to pin it on the party where not one single person voted for it. That’s just embarrassing.

          • Judgeforyourself37

            Rob, maybe this will spark some more interest in a Single Payer System as they have in other developed nations. I would, as would many physicians, like to see a Medicare for All type of system.

          • Rob Burnside

            Eventually, I think we’ll have our own version of this, though it may take awhile.

      • dontdoitagain

        What *I* find strange is all this anger about unions. I’m in a private sector union and trust me, this law is just as bad for us. I make a little over 23 dollars an hour. My boss pays an additional $9.95 PER HOUR for medical coverage. If I don’t work FULL time, I lose that coverage and all the money I paid into it. This cost IS going up. My boss can’t afford any more, so guess who makes less money in the future?

        Apparently we got a deferral for the “gold plated tax” for a year or so. The only thing that is “gold plated” about our health insurance is the COST! Our insurance is no better than any other cheap insurance, but we can’t opt out so they charge us a fortune. I get 2/3 of the money my boss pays and health insurance gets 1/3 of my income. I pay taxes and other assorted fees out of my money. My net this year? Around $25,000.

        Those of us who work construction are laid off in the winter? Our insurance stops, so guess what? That’s right, we get the “uninsured tax” or we get to pay our entire unemployment benefit for health insurance. Sound like a deal?

        There are a lot of good things about the union, and a lot of bad ones. Just quit thinking that the health insurance debacle isn’t hitting us too.

        Maybe you should specify the PUBLIC SECTOR unions. There are no taxpayers (employer who pays the bill) at THAT bargaining table. My boss has to make a profit to stay in business. The PUBLIC unions don’t have to worry about that so they get it all their way.

        BTW I DO worry about my boss making money. As long as he is making enough money to keep him happy, we all get to keep our jobs. He can shut the doors any time he wants to. It doesn’t work like that in the public sector. They could give a blank less if the taxpayers (employers) are broke. We the people can’t seem to shut the doors.

        • Rob Burnside

          You pack much meat, but as a former public sector employee and union member, I have to tell you the rest of the story, or some of it at any rate. Many public sector pensions are small, and without COLAs, while many public sector employees are prohibited (de jure and de facto) from participating in Social Security. Furthermore, as a result of SS changes during the Reagan years, public sector retirees are penalized for having a public pension–which they are, by law, required to have! As an example, I qualified, through work before and after the fire department, for a Social Security pension of approximately $1,400 per month. I am penalized $1,000 per month (60%) because I have a public service pension of approximately $2,000 per month, without a COLA, for which I spent twenty years on my belly crawling through some of the worst environments you can imagine. The net result: I have to work until I croak. Whereas, the Social Security pension I lawfully earned ($1,400 rather than $400) would
          give me a day of two at the beach prior to my demise. And the fact that many public sector pensions are not properly funded is not the fault of the participants. We were never able to compel the city to make the minimum annual contribution, though we tried, mightily. The courts wouldn’t back us up–ever. If public sector employees seem jaded, greedy, and out of touch, at least you now have a better understanding why–they’ve been marginalized, and are all too frequently blamed for problems they haven’t caused and cannot solve with “givebacks.”

          • dontdoitagain

            Thanks for your service. Don’t you get something like 3% per year based on your final year of salary? You get to keep your health care benefits for life? There is a retired fire dept employee in Los Angeles who gets $400,000 per year (allegedly). So you get to take early retirement, keep most of your salary and your health care. Sounds good to me.

            I agree with you that it isn’t YOUR fault that the city mismanaged your funds. But, how is it MY fault? Do you see the problem? I had nothing to do with it, but *I* and others like me, must make it up in the form of higher taxes.

            If my “pension” fund dries up, what do I get? Nothing. What are the taxpayers on the hook for (contractually liable is how they put it) if my retirement funds are misspent? Nothing. That’s the problem.

          • Rob Burnside

            You’re welcome, truly. No COLA here, though it’s fairly common, as well it should be. There’s little work available for a retired firefighter. We’re “damaged goods,” like retired miners– knees , lungs, and backs shot, or nearly so, after twenty years. Many go for thirty because of this, and wind up dying of stress-related illness in their mid-sixties. I think the LA urban legend must be just that, though I suspect LA fire service retirement benefits are pretty good. Healthcare, yes–a boon– but a boon to be taxed soon. And now, after Detroit, no more guaranteed pensions. We’re all paddling the same canoe, if it makes you feel any better. We did try our best to require our employer to meet minimum obligations all along, but that didn’t happen–no help at all from the courts–and as a result, many funds are underfunded. I do see your problem but it’s our problem too, and It ain’t pretty!

  • NewMexicoRam

    Another example of double-speak.
    We are going down the way of Rome, into the history books as another failed experiment as a nation.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    It’s amazing to see how quickly the English language is evolving. I understand and strongly support universal availability of medical services to all people without exception, but what does “coverage” mean?
    It most certainly doesn’t mean affordable and equitable care for all. So maybe the graph below explains what, and for whom, and with whose dollars, we are providing “coverage”….
    Or maybe read this Forbes piece http://www.forbes.com/sites/robertlenzner/2013/10/01/obamacare-enriches-only-the-health-insurance-giants-and-their-shareholders/

    • johnfembup

      Margalit, the kaleidoscope of so-called experts, pundits , and health policy leaders have for years failed to carefully distinguish between medical care (“services”) and medical insurance (“coverage”). Worse, those same people have routinely mixed up those terms within the same articles, sometimes within the same sentence. It’s no wonder that the public is confused.

      The chief problem in the U.S. is access to medical care. The chief obstacle to obtaining medical care is its cost. If medical care were not expensive, medical insurance would not be expensive. Insurance is a subsidiary problem, not the fundamental problem.

      Yet Obamacare pretends to solve the medical access problem with an insurance mechanism. Does that make sense? Only if one does not understand that medical insurance is not the same thing as medical care.

      The nation is in for a rough ride.

      • ErnieG

        I agree completely. This is the key to understanding medical care and seeing the limitations in order to expand it. I repeat–medical care is expensive– why? What are the mechanisms for this? Expanding insurance will lead to more of the same, bankrupting this country. All great countries and nations fall, and I believe this will lead to the fall of the US.

      • Rob Burnside

        John, Even those who see the ACA as outright failure can recall that progress (ie: “success”) comes from failure more often than not. The Wright Brothers, Alexander Graham Bell, and Abraham Lincoln are obvious examples in our history. There are many, many more. This is not a NASA moonshot, not by any stretch. Given it’s difficult birth, how could it possibly be as perfect as its worst critics seem to require? There’s work to do. We can either roll up our sleeves or thumb our noses. I’ll take “Door Number One” any day. And you’d rather curse the darkness?

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          You know Rob, I’m thinking that in order for progress to come from failure, the failure needs to be the right kind of failure. The Wright brothers were not the first people to try to fly, but their first step and its failure were different than what came before them, and that’s why it lead to success. The question seems to be whether the ACA is a Wright brothers type of failure, or someone sticking feathers on their arms and plunging into an abyss.

          • Rob Burnside

            Good point, Margalit. I’m hoping the former, as I’m allergic to the latter. If I sneeze, will I be covered?

        • johnfembup

          As to “work in progress” – I would not knowingly see a physician who is a work in progress. Would you? Would anyone? Why must I accept ACA as a work in progress that appears unlikely to deliver on its promises in my lifetime?

          btw, why was your earlier comment deleted? Is it a work in progress?

          • Rob Burnside

            You don’t have to accept anything John. I’m merely suggesting that you work to change whatever you dislike. And I’m unsure why my comment was deleted. It must have hit home is all I can logically conclude. That’s as good as a dozen “up” votes in my humble book. Thanks for asking.

          • johnfembup

            “I’m merely suggesting that you work to change whatever you dislike.”

            Exactly what I’m doing, Burnside. Exactly what I’m doing.

          • DoubtfulGuest

            “As to progress coming from failure – I would not knowingly see a physician who intends to progress from her failures. Would you?”

            I would and I have. I see your points about the ACA, but I’m not sure the doctor analogy is the most applicable here. They’re people…

          • Mandy Miller

            True, dat. “Good decisions come from experience, and experience comes from bad decisions.”

          • johnfembup

            Point taken Doubtful. You’re right, I don’t expect perfection from my physician nor do I expect perfection from Obamacare.

            But I do think that a physician who performed over a period of time like Obamacare has performed over the past 4 years, would probably have his license revoked. I would not willingly see that physician.

          • J.L. Creighton

            What makes me laugh is that these people think that the fact that the ACA has failed so miserably so far, is going to convince us that we need the same government that can’t even get a functional website up and running, to be in complete control of 100% of our healthcare system, via single payer.

        • ErnieG

          Strawman argument. I really don’t think most critics have problems with ACA because it is not “perfect”- the ACA is problematic because it is a large gargantuan bill which moves American medical care into CorpMed, does nothing to lower costs, and makes physicians into employers of CorpMed. Granted, all these things were occurring before ACA, but this pushes things further into that direction. It has nothing to do with “we hate change”, etc.

          • Rob Burnside

            Ernie, “Scarecrow” was my favorite Oz character because he needed a brain (on Monday mornings, I know how he felt). But I think we need “heart” more than anything else right now. And the other “H” word, too–hope. If nothing else, passage of the ACA shows us change is possible. That should encourage supporters and detractors alike.

          • EE Smith

            Ah. A vintage 2008 Hopenchanger. Most of the young people I know have peeled those posters off their bedroom walls in disgust by now.

          • Rob Burnside

            Youth is impetuous, isn’t it? We’re supposed to be setting the proper example according to what I’ve always understood. I think it’s an 07 “Hoppy” anyway, Dr. Smith, from before the fall.

        • NewMexicoRam

          You don’t put something out for the masses until the testing shows it works. The Wright brothers didn’t have commercial flights before the plane flew.

          • Rob Burnside

            Yeah, but… I think the most important test has been passed–the legislation itself. Everyone thought it unpassable, undoable, impossible. As for all the rest, it’s a bit like Charles Lindberg taking off for France, isn’t it? We’ll find out when we arrive, or not. Again, I recall one of my favorite quotes about us from the late eighteenth century: “Americans are the only sailors who put to sea in a storm.” We haven’t changed very much in 200 years. Part of our charm, I suppose. Hopefully, we have enough fuel to land safely on the other side.

          • NewMexicoRam

            You’re kidding, right? Just because something passed in a very partisan manner, that makes it workable? The insurance cancellations aren’t over, and the national wail will crescendo come this next fall when the private corporations start to cancel policies. I predict we will see no less than 50 million cut off from their employers’ plans at that point.

          • Rob Burnside

            No Mex, you’re conflating. I’m suggesting the mere existence of the law is more than a minor miracle, desirable or not. Let’s hope the disaster you foresee is headed off at the pass, as I think it will be. There’s time, though Congress seems to revel in broadbased brinksmanship these days. They want to give us our money’s worth in entertainment value, or so it often seems. We’ve had it with the drama, and they appear to realize this at long last. May your prediction be averted!

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Medical care is expensive, and in large part it is expensive because of the tangled web we built around it, which includes an incomprehensible insurance mechanism to finance it. Medical care is intrinsically expensive, as it makes strides to be more effective, and this is something we should be prepared to absorb. What I find objectionable is the feeling of entitlement that CorpMed including insurers have regarding their “share” of profit from all this, and I am not begrudging fair profits for those who contribute to advances in medicine.

        • johnfembup

          Margalit, you cite “an incomprehensible insurance mechanism”.

          Well, at least that’s all better now.

  • May Wright

    I have a hard-line neo-con relative who as recently as this Thanksgiving was arguing that Bush’s invasion of Iraq and Afghanistan were the right thing to do, and that our occupation will succeed in bringing true democracy to these countries eventually BUT we just have to give it a little more time (and more money, and more American lives). He has blinkers on, where he refuses to acknowledge like many of my more moderate Republican friends do that noble as our goals might have seemed to them at the time, the whole thing was just an abject failure and we need to admit that, cut our losses, and call it a day.

    There should be no shame in admitting that something you thought was a good idea at the time isn’t working out as you had hoped it would. The shame should be in pigheadedly plowing forward, regardless of the collateral damage being done and the fact that it will all be in vain because you’re not on the right path to achieving your goal anyway.

    • Rob Burnside

      Well-put, May. The “American Experiment” continues. We’re all a bunch of Type-As, descended from other Type-As who came here for something better. We often spin our wheels and move off in a wrong direction, but eventually, we get it right almost every time.
      Probably because we’re perpetually dissatisfied with status quo. The shoe fits in healthcare, too! The important thing is to keep moving, forward if possible. I suspect you might agree.

  • Chip Lohmiller

    The passage, rollout, and implementation of the ACA has thus far perfectly lived up to its expectations. Physicians accustomed to government medicine are no doubt unsurprised.

    From meaningful use to healthcare.gov, we are seeing what happens when well meaning folks try to apply private sector velocity and effectiveness to a VA sector bureaucracy and unaccountability.

    I have tended to naively believe that policy leaders were intentionally engineering a controlled implosion of our current system with a loftier goal in mind (single payor). After getting a glimpse behind the scenes at who is actually pulling the strings, I was giving too much credit. Implosion, yes. Controlled, no.

  • SarahJ89

    OMG. Big hug. Really? In a business call? Things really *are* worse than I thought.

  • southerndoc1

    The question is why doesn’t the ACP think its physician members are worth fighting for?

  • Thomas D Guastavino

    Did anyone notice that while all our attention is being diverted the ACA there will be more significant cuts in Medicare for 2014? I’m sorry. We physicians are a bunch of saps who have allowed our altruism to be used against us.
    My grandfather once taught me, “Never get involved in a fight over a shrinking pie”

    • Dr. Drake Ramoray

      Ultrasound guided Thyroid FNA reduced by 50%. The upcoming bipartisan plan keeps the 2% sequester reduction in place till 2023. Perhaps at our next staff meeting Ill let all my employees know there pay is frozen for 10 years and see how that goes over.

      • EE Smith

        The way the government treats physicians is why so many lay people can’t work out why all the big physician organizations are so gung-ho about wanting MORE big government control of their industry.

  • buzzkillerjsmith

    A bit early to say pro or con, isn’t it? I mean most of it kicks in big time next year.

    That said, I’m not optimistic. Strap yourself in. Could be quite a bumpy ride.

  • EE Smith

    I was just reading a piece in the WSJ that made that same point:

    “A charitable reading suggests that ObamaCare’s net enrollment stands at about negative four million. That’s the estimated four million to five and a half million people who had their individual health plans liquidated as ObamaCare-noncompliant—offset by the 364,682 who have signed up for a plan on a state or federal exchange and the 803,077 who have been found eligible to receive Medicaid.”

    And this is with the one+ year delay he granted businesses with >50 employees. Wait till they start losing their policies — conveniently AFTER the 2014 elections.

    I can’t see this ending well.

    • Rob Burnside

      “In the kingdom of the blind….”

  • Steven Reznick

    Did anyone at the ACP actually read the bill before it was passed? Certainly no one in Congress did. We all support access to care and applaud efforts to provide access to all Americans. What we would like is a dialogue on what exactly is the best method to do this before voting on a 5000 plus page document that no one read.
    The parts of the current law that are flawed should be changed. That doesnt necessarily mean you are opposed to ACA or Obamacare. It just means you want a system that actually provides quality and access rather than provides mouthbuggy and extra income for policy wonks, insurers, equipment manufacturers and pharmaceutical companies at the expense of patients

    • dontdoitagain

      Don’t forget that Ms. Nancy said we could pay down the deficit with the ACA. I’m still trying to figure out how that can be? Is she talking about the fines the IRS is going to levy against people who can’t afford the insurance? I know she SAYS that medical care/insurance (not sure which she is talking about) is getting cheaper, but it isn’t.

      How is adding layers of well paid federal employees and IRS agents, not to mention increased taxes on medical devices going to “bring down the cost” of medical care?

    • hawkeyemd1

      Very true. Too often it seems that if anyone questions the bill, any part of it, they are accused of hating the administration… “If you don’t love every part of the law you must hate sick people.” For most docs I know that isn’t true at all, but it doesn’t mean we don’t have serious, quite valid concerns with large parts of it.

  • EE Smith

    How do the people of Ohio feel about the fact that most of their Obamacare plans won’t allow them access to the Cleveland Clinic?

    “This law is not just about a website or insurance.”

    Or patients, apparently. But as long as Big Government, Big Insurance, and their various hangers-on are happy, well that’s all that matters! Seriously, plebs, who cares if you’re not allowed access to the top-notch medical institutions your old insurance policy gave you access to … the fact that The Center for Medicare Innovation scored a Community Primary Care Innovation (CPCI) grant will more than make up for it!

  • doc99

    I need a car too, but I would never buy a used Yugo.

  • Thomas D Guastavino

    The government can’t “fix” anything. Ultimately the only way in life to prevent being abused is to develop the power to walk away. Our so-called physician leadership has clearly given everyone else involved in healthcare, especially the government, the impression that we will continue to provide care no matter what.
    So be it. I have already found a nice growing pie and as soon as the medical pie shrinks to a size to small for me I will be gone.

    • psychomd

      OK poor choice of words. What I meant was that the gov’t temporarily hold off on decreasing medicare payments to physicians (like in a crisis mode). I suppose really not important given the shrinking pie that is being eaten by private industry. I am always astounded how non physicians in private industry can make so much more money than the the physicians administering the care. It is hard to believe. But healthcare cannot go on without us as you say. I am baffled in the same manner how with all this going on that there are no physician groups that go on strike if you will.

      I agree the government can’t fix it. But it seems like it is worse than not fixing it. They are fostering the problem with the ACA by allowing private industry to have a field day with medical cost. Our physician leaders have been so utterly disappointing. I share your sentiments. I wish you luck. We may be both walking away. I am also trying to figure out an exit strategy.

      • Thomas D Guastavino

        First, The “temporary” Medicare fix can be used to help your decision making as to what to do in the future. Medicare fix-budget deal with additional governement spending-continued quantitative easing-higher stock market. (See how to determine which pie to feed on)
        Second- The best quality and cost control in the private market has always been open and free competition. The evil alliance between the government and the ACA blunted that.
        As stated, most physicians believe in health reform, just not the type of reform being shoved down our throats.

  • Rob Burnside

    No need to apologize. I think the more we “talk,” the more the public understands, and that’s important. I hope we can both get a few days at the beach. If it’s the same beach, we’ll hoist a few.
    Just one more thing: paid firefighters must respond, volunteer firefighters don’t have to. There’s a huge difference right there, if you think about it. Best to you! And keep writing. You write very well.

  • J.L. Creighton

    One contributor to our earlier discussion of whether healthcare was a right (http://www.kevinmd.com/blog/2013/12/health-care-business-time-choice.html ) made this observation:

    ‘…your “right to healthcare” would be much like your “right to bear arms”. It would mean the government couldn’t ban you from seeking healthcare, it wouldn’t mean that the government will guarantee you “free” healthcare any more than the second amendment guarantees that the government will give you “free” guns.’

    Rights in the constitutional, American sense are more of a list of thou-shalt-nots for the State (they can’t do this, they can’t do that, they can’t stop you from doing the other) than an ever growing list of goods and services we are entitled to force others to give us for free.

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