What the [Un]affordable Care Act Has Already Accomplished

G. Keith Smith, M.D., http://www.aapsonline.org/

Lest we get too excited about all of the bad news surrounding the unworkability of what I call the Unaffordable Care Act (UCA) or ObamaCare, we should remember that this law has already achieved much of what its architects intended—if you agree with me that the purpose of the law was to:

  • line the pockets of certain connected cronies
  • create an industry-wide consolidation in the insurance and hospital business
  • inject mass chaos into the already dysfunctional medical marketplace
  • generate fear amongst physicians such that many would succumb to the hostile takeover offers of the rich hospitals
  • implement the most egregious breach of patient confidentiality by collecting private health information and records

If this was the purpose, then the bureaucrats would declare their efforts a success even if the whole thing is repealed at this point.

The UCA is crony capitalism at its finest. How would you like to own a company whose product people are forced to buy? Sound like a money-maker? How about electronic medical records? While there was a limited market for these products, the mandatory purchase made many of these software giants unfathomably rich. The principal of Epic, one of the largest manufacturers in the Health Information Technology (HIT) sector, was one of the authors of UCA. And let’s not forget health insurance. Insurance stocks soared when “Robed Roberts” ruled on the constitutionality of UCA.

Think about the Medical Loss Ratio: How well do you think large insurance companies are able to comply with this regulation when compared with smaller insurance companies? The amount they can spend on overhead is 20% of $5 billion compared with, say, 20% of $5 million. This makes staying in business tough for the smaller players. The industry consolidation that will result is what Jim Epstein from Reason magazine calls the smoking gun of government corruption and bribery.

Requiring electronic medical records has the same effect on small hospitals that the medical loss ratio has on the smaller insurance companies. These systems are simply too expensive for many of the smaller players. That makes it easier for the big hospitals to buy out their smaller competitors.

Removing lifetime limits and exclusions for pre-existing conditions may sound good. But it is like forcing companies to sell insurance on houses that are already on fire. What do you think this will do to the premiums of everyone else buying insurance from that company? The high prices and chaos that will result from UCA are intentional, in my opinion, so that we will all beg Uncle Sam for relief from the crisis the government has intentionally caused, the relief taking the form of single payer. Remember “don’t ever let a crisis go to waste”? Four or five big insurance companies will then divide the country up, like wolves, and extract their premiums from unwilling taxpayers, rather than willing customers in a competitive market place.

Physicians know what past government interference has accomplished in medicine and are fearful that a complete takeover is imminent. Many understandably want to cut their losses and mitigate their risk, so they seek secure employment. This, of course, is exactly the chute the central planners want to see the sheep doctors ascend on their way to complete control or slaughter. Employed doctors, after all, will be much easier to corral than independent patient advocates. Employed doctors are much more likely to betray confidential patient records than independent ones. And when the interests of the patient and the employed doctors’ bosses are not aligned, on which side will we likely find the doctor employees?

The health exchanges are currently collecting confidential patient information, and in order to demonstrate “meaningful use” doctors will soon be required to betray their patients to an IRS that promises confidentiality, even while it admits to targeting those with whom it differs politically.

Even if UCA or its most unworkable parts are repealed, tremendous effort will be required to repair the damage.



Author / Contributor bio:

gk_smithDr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990.  In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Oklahoma, owned by 40 of the top physicians and surgeons in central Oklahoma.  Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.

In 2009, Dr. Smith launched a website displaying all-inclusive pricing for various surgical procedures, a move that has gained him and the facility, national and even international attention.  Many Canadians and uninsured Americans have been treated at his facility, taking advantage of the low and transparent pricing available.

Operation of this free market medical practice, arguably the only one of its kind in the U.S., has gained the endorsement of policymakers and legislators nationally.  More and more self-funded insurance plans are taking advantage of Dr. Smith’s pricing model, resulting in significant savings to their employee health plans.   His hope is for as many facilities as possible to adopt a transparent pricing model, a move he believes will lower costs for all and improve quality of care.

Dr. Smith resides in Oklahoma City, Oklahoma.


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