Dear Dr. Hurd: When I explain what Obamacare will probably turn out to be, I tell people it’s similar to either an HMO or the free clinic. I said people who have money will have HMO-like insurance. Everyone else will get the free clinic type of care.
Do you think this is somewhat accurate?
Also, why aren’t doctors speaking up about this? All my doctors have said that Obamacare is a disaster!
Reply: We won’t know what health care will look like until a few years after Obamacare takes effect. Since nobody who passed the law (or supports it) appears to have read it, you could not count on them to provide an accurate prediction of the law’s impact even if they were intellectually honest (which they’re not).
What we know for certain is that Obamacare will take everything that’s wrong with health care as we know it, and make it worse. It was sold on the false promise that you can “keep your health insurance now if you like it.” This would be like the government nationalizing automobiles, computers, cell phones or haircuts, placing untold restrictions on all these goods and services — and then claiming, “We’re not going to change anything. We’re just going to make sure everyone gets them now.”
The reason health care is such a mess is that government increased the demand for health care by passing Medicare and Medicaid, all those years ago, and also providing employers with tax incentives to pay for most of the health care of employees. These factors led to more demand for health care than would have otherwise been the case, just as government subsidies for any other product or service would have done the same thing. As a result, it created a third-party payer system in which most patients are not responsible for most (or even any) of the costs of their medical care. This took the consumer incentive out of medical care, driving up costs since someone else (either private insurers or government) would be picking up the tab. This is why Medicare and Medicaid skyrocketed in cost over five decades (still skyrocketing today), and private insurance became more and more expensive as well.
The basic problem with Obamacare is not that it initiates socialized medicine. The problem is that it took a partially socialized system and seeks to push or force everyone into the public one. Superficially, it’s true that the law does not force people to abandon their existing health insurance. But by making health insurance even more expensive than it was before, it will push more and more people — perhaps ultimately all — into the HMO-like or free clinic-type of medical care you mention. It won’t happen over 24 hours, or even a year, but I don’t think health care as we know it now will resemble what we have 10 years, or even 5 years from now. What you’re telling your friends is basically accurate.
Why aren’t doctors speaking up about this? That’s my question too. Doctors are busy and preoccupied. But so are lawyers — and lawyers never hesitate to make sure any legislation passed benefits them. Why don’t doctors do the same? The American Medical Association is bargaining away its profession in hope of keeping it. This never works. Too many doctors are complacent. While they don’t like the third-party system of health care, they fear losing it. Losing this third-party system would mean having to go out into a marketplace, striving for excellence, and being limited in what they charge by what the market will bear (i.e., what patients are able and willing to spend). I suspect a lot of doctors — especially ones involved with hospitals — worry about medicine becoming a marketplace for this reason. It’s sad, but true, and probably one of the dirty little secrets of medical care as we know it.
Other doctors don’t feel this way at all. They’re perfectly willing to compete in a marketplace. The problem is, for their whole careers they have never known such a thing. It’s kind of like the theory of clinical depression: learned helplessness. Doctors have been trained, by the system as we know it and ultimately by the government, to expect a third-party payer system. They cannot visualize anything different, and might even fear something different. Patients are the same. That’s why Obamacare passed, even though a majority apparently oppose it. Most sense that the only alternative to Obamacare — and this includes Medicare, ultimately — is a private marketplace. People are afraid of it, and they dig themselves deeper into the hole of socialized medicine. Obama did not create this scenario; he merely cashed in on it, gleefully so.
A few doctors are out and out socialists. I don’t think most are, at heart — although some nurses and certainly most social workers, psychotherapists and the like are outright socialists. Doctors are much better than that, but they’re either afraid or suffer from the passivity of inertia. Yes, even moral cowardice. They will be the ones who pay the greatest price for continuing to let the bulldozer of “compassionate government” run over their rights. Doctors will pay the price, along with the rest of us — presuming we plan to be patients one day.
Just as doctors are the primary victims of Obamacare, they can also end up being our salvation. When and if enough doctors get fed up with socialized medicine, they will fire the AMA and take matters into their own hands. They will find innovations to turn medicine into a free marketplace and demand that state governments and the federal government get the hell out of the way. It’s still possible — but not until doctors wake up and take charge of their destinies. As long as they keep rolling over, the political sadists in Washington DC stand ready to enslave them along with their patients.
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