OP-ED

I Oppose Obamacare. I Support the Affordable Care Act.

Today, more than three years after being signed into law, and more than a year after surviving a Supreme Court challenge, the Affordable Care Act, more commonly known as Obamacare, finally begins to fulfill its promise. Most of this country has long since taken sides, despite appalling gaps in popular understanding of what the law means, what it does, and what it doesn’t do.

Let me admit that I’ve never had particularly warm feelings toward President Obama. I think his foreign policy is a mess. The trillions in debt that the U.S. has run up over the past 5 years will hurt my generation and future generations, and if Republicans can be faulted for their fantasy that the federal budget can be balanced exclusively through spending cuts, Obama has sustained the Democratic fairy tale that raising taxes on “millionaires and billionaires” is all that is necessary to pay the skyrocketing bills.

On multiple occasions during my time in government, the President had no qualms about squashing science and scientists for political convenience. He is a perpetual campaigner, preferring theatrical gestures to the backstage grunt work of governing. And for all of his rhetorical gifts when preaching to the choir, he’s been one of the least effective persuaders-in-chief to have held the office.

And so, naturally, I oppose Obamacare. I oppose a government takeover of health care that includes morally repugnant death panels staffed by faceless bureaucrats who will decide whose grandparents live or die and make it impossible for clinicians to provide compassionate end-of-life care. I oppose the provision in Obamacare that says that in order for some of the 50 million uninsured Americans to obtain health insurance, an equal or greater number must forfeit their existing plans or be laid off from their jobs.

I oppose the discarding of personal responsibility for one’s health in Obamacare. I oppose Obamacare’s expansion of the nanny-state that will regulate the most private aspects of people’s lives.

It’s a good thing that Obamacare, constructed on a foundation of health reform scare stories, doesn’t exist and never will.

Instead, the Affordable Care Act (which I support) is based on a similar law in Massachusetts that was signed by a Republican governor and openly supported by the administration of George W. Bush. It achieves the bulk of health insurance expansion by leveling the playing field for self-employed persons and employees of small businesses who, until now, didn’t have a fraction of the premium negotiating power of large corporations that pool risk and provide benefits regardless of health status.

The ACA discourages irresponsible health care “free riders” and provides support for people of modest means to purchase private health insurance in regulated open marketplaces. It tells insurers that in exchange for new customers, they can no longer discriminate against the old and sick and make their profits off the young and healthy. Finally, the ACA rewards physicians and hospitals for care quality and good outcomes, rather than paying for pricey tests and procedures that may or may not improve health.

The ACA has flaws. Since it doesn’t do much to narrow the income discrepancy between different types of physicians, it may overwhelm the capacity of primary care as millions of uninsured patients look for family doctors for the first time. The ACA’s provisions to discourage overuse of unnecessary medical services are limited and probably inadequate to the scope of the problem. But it’s worth noting that these problems all predated the law. We don’t have enough family physicians and other primary care clinicians, specialists make too much money in comparison, and overdiagnosis and overtreatment are already rampant today. That the ACA takes on these issues at all is a small victory of sorts.

It’s interesting to consider the counterfactual exercise of what might have happened if Mitt Romney had captured the 2008 Republican Presidential nomination and then narrowly defeated Hillary Clinton, who was the odds-on favorite for the Democratic nomination in that year. No doubt affordable health care would have been an important focus of that hypothetical contest, with Romney successfully linking Clinton to her husband’s failed 1994 reform plan that makes right-wing objections to the ACA look insignificant by comparison. Once elected, a President Romney would have felt compelled to advance national health reform, and would have naturally modeled his proposals on his Massachusetts plan. We might have ended up with a conservative law that looked much like the Affordable Care Act, only this time criticized by the left for being too administratively complex and not generous enough in providing coverage for all.

A farfetched scenario, you say? Perhaps. But it underlines the need for people of all political persuasions to set aside the overheated rhetoric about Obama and Obamacare and focus on making the ACA work, starting today.

Kenny Lin is a family physician practicing in Washington, DC. He is an associate editor of the American Family Physician journal and teaches family and preventive medicine at Georgetown University School of Medicine. You can follow him on his blog Common Sense Family Doctor, where this post first appeared.

Livongo’s Post Ad Banner 728*90

21
Leave a Reply

10 Comment threads
11 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
11 Comment authors
Darrellm25Jim BcmiMichael Anthony Recent comment authors
newest oldest most voted
Darrell
Guest
Darrell

Uh, I admire the passion but Obamacare and AFordable Care Act is the same thing. They toss a few crumbs to the peons while your gov’t enjoys great cadillac coverage – because it doesn’t apply to them. And, the personal quesitons should be enjoyable to all.

Jim B
Guest
Jim B

Obamacare IS the Affordable Care Act ! They are one in the same. How can you be a MD but not know that it was Nicknamed Obamacare by the masses. They even did an on the street on jimmy kimmel and like you 9 out of 10 people said the same thing that they liked the affordable over the obamacare act BUT they are one in the same.

m25
Guest
m25

Sighing a little here…

I think Kenny gets that. He’s making a point about the connotations associated with each “name.”

cmi
Guest
cmi

As a small business owner, there are some actual facts I now have in hand. I just received the premium costs after the plan is “upgraded” to comply with Obamacare. Our company is small but growing, about a dozen people. Our insurance premiums are going up 42.5%, this is an absolute fact as I have the quote from one of the largest carriers in the country (Anthem). This is a high deductible plan, where the employee or employer pays the first $5,000 to $10,000 in costs directly each year (meaning most employees will never use the insurance to pay for… Read more »

Michael Anthony
Guest
Michael Anthony

I’m not a Republican or Democrat ObamaCare was made Law, but not one Republican in the House voted for it. And if I’m correct only the House can access taxes. Obamacare was unconditional per the Interstate Commence laws, but made a tax after it was passed into law. Interesting interruption… Some claim the majority wants Obamacare, but than again the majority of the house is against it, and the Republicans (in the house) were voted in by the same pool of “citizens” that voted in the majority of Senators, so maybe we the people, like checks and balances. Pelosi said… Read more »

John Riley
Guest

Under Obamacare, we will be offered with insurance exchanges which will be divided under 4 categories, bronze, silver, gold and platinum. Each of these tiers will limit out-of-pocket expenses for individuals to $6,350, and to $12,700 for a family of two or more. At the same time, insurers will have the freedom to choose their “in-network” number of doctors and hospitals. Bronze plans will have the lowest premiums, but will cover only 60% of out-of-pocket costs. Platinum plans, on the other hand, will charge the highest premiums, but will cover 90% of out-of pocket costs. With similar plans competing against… Read more »

Boris Katz
Guest

Dear Kenny, I am aware that reducing cost of healthcare is not a simple task and as rightly pointed out many countries have tried with mixed (at best) success. And I do not know a single magic solution to this challenge. But I would bring the attention to several points: 1.There are three parties involved in healthcare: patients, physicians (clinical) and bureaucracy (insurances, government). All three are necessary, but the bureaucracy tends (and it does in case of healthcare as well) to serve its own interests instead of what it was originally created for – patients and physicians. Just two… Read more »

Boris Katz
Guest

Without going into details, there are two problems with the healthcare in this country:

a) it is unreasonably expensive;
b) many people do not have the needed access to it.

Just by looking at the above, why one would try to address the second issue (as Obamacare/ACA does) without properly addressing the first one first?

Kenny Lin
Guest
Kenny Lin

Dear Boris, I couldn’t agree more with you that health care in America is much too expensive. But nowhere in the world has anyone figured out how to tackle the problem of health spending increases in a systematic way – even countries with nationalized universal systems that have global budgets for health. At best, some countries have figured out how to slow the rise of spending growth, but it outpaces economic growth nonetheless. To those of us in the U.S. with good health insurance and access to care, this is a concerning but ultimately academic problem. To everyone else, lack… Read more »

Matt
Guest
Matt

Well said.

m24
Guest
m24

Quite interested to hear your version of the news, Mark. Instead of gaping incredulously, why not elaborate?

Mark Jones
Guest
Mark Jones

Well, for starters, death panels don’t exist. Look it up on snopes http://www.snopes.com/politics/medical/over75.asp

Obamacare is about insurance, not a takeover of healthcare.

Kenny Lin is either an complete idiot or a fraud.

Boris Katz
Guest

When insurance becomes mandatory, heavily regulated and paid by taxpayer’s money plus conditions are set to make it harder for private practices – it is to a great extend takeover.

I would also advise you too stay within civilized limits towards your opponents. Rudeness shows your weakness.

m24
Guest
m24

Dear Mark:

1-Have to second Aurthur in part here. You should really, really read the entire piece. The “I support the ACA” part is kind of important.

2-Seconding Boris here: no need to be rude. From what I’ve read of Kenny’s writing, he’s quite far from being an idiot.

3-THCB readers are not your average bunch. No one here thinks death panels exist.

Adding this one to your reading list from Peter Ubel:
https://thehealthcareblog.com/blog/2013/01/11/the-independent-payment-advisory-board-why-it-is-so-difficult-to-kill-the-death-panel-myth/

Kenny Lin
Guest
Kenny Lin

Yes, m24, I’d hope that most if not all THCB readers know that death panels are a myth, but as of one year ago 4 in 10 Americans still believed that they were part of the ACA/Obamacare: http://thehill.com/blogs/healthwatch/health-reform-implementation/258753-poll-four-in-10-believe-in-health-law-death-panels

That statistic may go a long way toward explaining why the law remains so unpopular.

And thanks for complimenting my writing and linking to Peter Ubel’s very intelligent post.

Aurthur
Guest
Aurthur

2- “quite far”…which way:

Normal —– IQ 85-115
Deficient —- IQ 71-84
Moron —— IQ 51-70
Imbecile —- IQ 26-50
Idiot ——– IQ 0-25

Just kidding.

Aurthur
Guest
Aurthur

Four in ten believe the law was repealed which may explain why the Act has any favorability.

http://washington.cbslocal.com/2013/08/29/poll-44-percent-of-americans-unsure-if-obamacare-is-still-a-law/

Mark Jones
Guest
Mark Jones

Spoken like it was read from the teleprompter at Faux News.

Wow, do you actually believe this?

Aurthur
Guest
Aurthur

Mr. Jones. Apparently you only read the first part of the article (the hook) without enjoying the second cutesy part where Dr. Lin turns heel and extols the virtues of socialized medicine.

“The ACA has flaws. Since it doesn’t do much to narrow the income discrepancy between different types of physicians,”

Yep. Let’s pay PCP from St Kitts medical school the same as a pediatric brain surgeon from John Hopkins or some lesser school like Georgetown
.

Kenny Lin
Guest
Kenny Lin

Dear Aurthur, Thank you for taking the time to reading the entire post, which I hope makes clear that I do not believe in death panels or any of the other myths I called Obamacare. I’m curious about your definition of “socialized medicine.” Is it when the government owns the medical facilities and salaries the doctors? Then the U.S. military medical system, the Veterans Health Administration, and the Indian Health Service are all socialized medicine. Or is it when the government subsidizes health insurance that is used to pay private doctors and hospitals? Then Medicaid, Medicare, the Federal Employees Health… Read more »

Aurthur
Guest
Aurthur

Mr. Lin, You raise interesting points. I should admit my causal manner in tossing around the words “social medicine” was inappropriate. As a rationalization, however, I will point out the irrational, knee-jerk, reactions most folks have to seeing or hearing the accurate term or terms many times shuts down the minds of emotionally driven readers and listeners. Socialized medicine would involve government owning the means of production, which, by my definition, at least for now, is not an accurate description, yet. So let me rephrase my comment to “you extolling the virtues of communistic medicine and are well on the… Read more »