Obamacare and WIC: When others pay the bills

Michelle Obama recently wrote an opinion piece in the New York Times discussing her pet project of childhood obesity. Discussing the Special Supplemental Nutrition Program for WomenInfants, and Children, known as WIC, she criticized the House of Representatives for considering a bill that would allow white potatoes to be included in the list of foods that could be purchased with WIC funds.

One can debate the nutritional benefits of potatoes. Potatoes are complex carbohydrates and provide nutritional benefit if eaten boiled, rather than as French fries or potato chips. And in moderation. Apples or oranges eaten in excess also deliver a load of sugar and calories. This is about more than whether or not we should eat potatoes.

The larger point is, what is the role of the government in deciding what we are allowed to eat? The WIC program has “food packages,” defined menus of products that can be purchased using WIC dollars. That’s all fine and good, steering WIC recipients toward healthier foods. But what happens when the “approved” food item is unavailable in the store or is not tolerated due to taste or other dietary issues?

Such a situation was recently described, where a mother purchasing baby food discovered that the store was out of her usual and “WIC approved” item. Her child would not eat the only other WIC approved baby food on the shelves, leaving her to purchase an “unapproved” baby food as her only choice. The cashier did not allow her to purchase the “unapproved” jar of baby food without WIC permission, unless she paid for the items herself.

Beyond food, what happens when government agencies decide what type of health care is approved? Obamacare insurance plans have essential benefits that must be provided. What about unessential benefits? Who decides what is unessential? Stories abound over insurance companies denying coverage for cancer care or other serious conditions. Or limiting provider networks much like WIC limits food choices. Health care can also be limited through wait lists, as we continue to learn through the unfolding VA scandal.

Think these are isolated situations or simply examples of private insurance company greed? Obamacare already has a built-in rationing provision called the Independent Payment Advisory Board (IPAB) that will determine which tests, procedures, or medicines are covered under Medicare. Much like which brands of baby food can be purchased through WIC, the IPAB will decide what Medicare will and will not pay for. This already occurs in other countries, such as the United Kingdom, where the government decides which treatments it will pay for.

Rationing health care can and should be discussed and debated. Given that health care is a resource with a finite supply and infinite demand, some type of rationing is necessary. But who decides? Should this be the choice of individuals or the government?

As we are learning with WIC, the VA, or Obamacare, when we let others pay our bills, we also let those others decide what they will pay for. The expression, “He who pays the piper calls the tune” is fitting. The Healthcare.gov website initially referenced “free health care” but deleted that reference as nothing is really free. There are many hidden costs within Obamacare such as copays, coinsurance and deductibles. But another hidden cost is limited choice.

Benjamin Franklin told us, “They who can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety.” The temporary safety of allowing someone else to pay for our health care or food bills comes with a price, namely the liberty to choose and make your own decisions. That may mean Mrs. Obama telling WIC recipients that they can’t eat potatoes or the VA telling veterans that their line for medical care is long and may even lead to a dead end.

Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor.  This article originally appeared in WND.

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  • QQQ

    The courts need to do their job and send the Affordable Care Act back to
    Congress to be voted on again. When the law was voted on in the first
    place the people in Congress did not know what was in the bill in the
    first place so how can a court presume that the language used in the law
    was intended to mean something else by Congress. At the time it was
    being voted on by Congress, Nancy Pelosi stated that we would find out
    what was in the law after it was a law. Now that we are finding out what
    is actually in the law we are being told that what was in the law is
    not what was intended to be in the law. Whether it is due to poor
    wording or whether it was what the law was intended to say, the courts
    will have to apply the law as it is written. If changes need to be made.
    the law needs to be sent back to Congress to be voted on again. People
    in big daddy government were so anxious to push the law through that
    they not only did not read the law and know what they were voting for,
    they used a procedure called reconciliation to get it to pass the Senate
    with a simple majority vote rather than the 2/3 vote required to pass a
    bill into law.

    Barack Obama has made several changes to the law on his own without
    sending it back to Congress. The law is unconstitutional because it
    imposes a penalty on American citizens for not buying a product. Even
    though the Supreme Court ruled it was a tax and not a penalty everyone
    knows that it was intended to be a penalty and that it is a penalty. It
    violates the First Amendment protection of religious freedom and the
    free exercise of religion. It exempts some people on the basis of race
    and religion but does not exempt others so it discriminates on the basis
    of race and of religion. The entire law is flawed and needs to be
    scrapped. The courts do not have the authority to re-write the law
    claiming that what is written in the law is not what was intended by the
    people who voted for it in the first place.

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

    At times like this I fondly remember the humorously dismissive discussions about broccoli when the ACA stood in front of the Supreme Court, and how we were told that mandating that you buy health insurance is not indicative of the government eventually mandating that you buy broccoli (and eat it too). It didn’t take that long, because our government is no longer representing the people of this country.
    Elections are just a popularity contest between equally qualified professionals to see which ones get hired by big corporations to further their global interests. The corporations don’t really care who wins. They just want an entertaining show to be put on, hence all contestants are generously funded with corporate money.

    As to health care needing rationing, I don’t think it does need any such thing. Yes, the resources are finite, but so is the demand of a finite number of citizens, with a finite lifespan, and a finite number of organs. The only thing that is infinite here is the greed of corporations, and our own stupidity.

  • guest

    Huh. Well, society is footing the bill for patients to receive expensive ophthalmological services from specialists who make multiples of what a PCP makes, for comparatively less stressful work.

    Perhaps we should all insist that healthcare dollars be spent in a more efficient and equitable way, so that PCPs have the time that they need to provide cost-effective care for their patients….

  • Karen Ronk

    I seem to remember stories about kids not eating the “approved” foods in schools and the foods going into the trash. These types of programs are always deeply flawed – with the best of intentions of course.

    • rbthe4th2

      Then they aren’t hungry enough.

      • Karen Ronk

        Not the point at all. Wasted money. Wasted government money – no wait, our wasted money.

        • rbthe4th2

          Excellent point. Thanks for adding that.

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