The Supreme Court Rules that Obamacare is a tax. Hasn’t health care always been a tax?
There are so many discussion on the internet now regarding the supreme court ruling on the Obama Healthcare plan being a tax. More accurately, it is a cost, a cost that has run out of control with help from..
1. Big pharma who makes products with huge markup’s that are not designed to cure anything.
2. A health care monopoly headed by hospitals and the AMA that assures us of the image and the business of health care while making sure we pay egregious fees for anything medical performed there.
3. The insurance companies who tell us who we can go to, often make us pay more than we should, hide the profits in their organizations and make us pay more because of changes that were designed to lower health care costs that actually forced them to explode over the years.
The political debate of weather this is a tax or not is immaterial. The purpose of Obama care was to find a way to finally insure more Americans, and contain costs which are at crisis levels. Obama care is merely a first step. That first step forces everyone to take personal responsibility and insure themselves, and if they do not, they will be forced to pay for some sort of care through a funding mechanism. Those who are unable to afford insurance are supplemented. This is quite far from some of the partisan assertions that this is a government takeover of healthcare since it uses private health insurers who stand to earn a huge chunk of business as people sign up for coverage.
The reality is that everyone eventually will get sick or have an injury. This is why everyone has to be insured. Those who have not been insured were taking huge risks however if someone had nothing to lose, the hospitals made sure we all shared the pain with overall higher medical costs. This is the same logic as compulsory auto insurance since practically everyone who drives will at one time or another have an accident. Before Obamacare, states would fund hospitals for indigent care they are forced to perform. The bigger problem is that this new system, although it ensures some sort of safety net, still uses insurance carriers.
As a health care provider, I have no love for insurance carriers and the games they play. Most physicians have more staff to go after the money they owe after they reject legitimate bills. Some auto carriers are notorious for this, requiring many phone calls to finally get reimbursement from these companies. A public option would have been a much smarter route with cradle to grave coverage however it was politically impossible to pass at the time, especially since the insurance companies would never allow this without a huge fight. Medicare for all would be an even better option since there would no longer be a need for medicaid, which underpays hospitals and physicians, make up for these losses by charging others more. It is also responsible for the closure of many inner city hospitals that saw private insurance money dwindle while Medicaid business flooded their offices creating huge financial deficits and ultimately the death of the facility. Medicaid should go if a single payer system is established.
The idea of whether this is a tax or not is absurd. The reality is health insurance has always been a tax of sorts on business. In our country, traditionally, most employers insured their employees. During the last decade, the cost of these benefits has risen close to 400 percent or more. While the statistics show an increase of about 100% which is what we hear in the media, this is just the cost of the premium. Patients co payments have gone from an average of $10 – 20 to $50 or more. If you are hospitalized, they now hit you for a deductible which is usually at least $1500 or more and then they cover a percent, usually in network of between 70 – 90 percent, whereas before, you may have had a co payment of perhaps $250 per day and then they covered the costs. If you get ill, everyone charges ridiculous fees only now, you feel them, especially if you decide to go out of the network. The other part of this increase you never saw is that your in network doctor who was never paid generously is now being paid less as well. Most employers have cut back into less generous plans which still cost more than the more generous plan you once had which also figures into how much this health care tax is costing us.
So lets see, we pay a higher premium, the doctor is paid less (but his costs have risen) and you pay more out of pocket, often with your payment being higher than what the doctor gets from the insurer. The icing on the cake is that you get priced out of the better plan and network into the more inferior plan.
All this tax discussion misses the point… The Obama care is just the beginning of a long list of reforms our country needs to embrace in the healthcare system. What we really need is a paradigm shift, one where doctors look back 40 years, where primary doctors can see fewer patients and be paid for the time spend while they become more holistic and look at people and not just their symptoms, and where complementary care providers such as chiropractors are not shut out of the health care monopoly and sidelines as was done in the past. Obama care protects complimentary providers and disallows the current issue with health care provider descrimination. This is especially important because groups like chiropractors save on health care costs because they understand the musculoskeletal system. which is 55% of the body. Most primary doctors have little understanding of how the musculoskeletal works, how many symptoms of it mimick organ dysfunction and result in unnecessary tests, something we see often in our office. I do not think the medical home idea will solve this since it does not force medical trained physicians to take musculoskeletal continuing ed. If they did, there would surely be fewer procedures recommended and performed. Also, even though the medical home forces better communication between providers, it also is a lower funded system which caps expenditures, which is done properly can help control costs.
Personally, I believe in the next few years, as insurers are shown to be a larger cost driver than originally thought, we are likely to end up finally with a social style health care system, where we are covered from the time we are born. Some will oppose it, however, costs will drive us to this and yes, there will be a tax to pay for it but what is the difference between the employer paying for health insurance and the cost (tax) that goes with it or if they pay the government instead of the insurer, who has no profit motive or if you are self employed, you pay them monthly to insure yourself and your own family. Objectively, I see no difference other that Medicare has a 3 percent overhead for processing and under Obama care, insurers have a 20 percent overhead. You and I could save at least 17 to 20 percent on our premiums and have a much larger selection of doctors to choose from, while healthcare providers would have one set of rules to work with and refer their patients through. In other words, the game would end, and so would the gotcha surprises of the anesthesiologist not being in network, the use of the wrong lab, the use of the wrong facility for preventative vs. diagnostic, etc. Why any physician would oppose better collections, fewer games and less hassle is beyond my comprehension.
Single payer will have hospitals especially in the inner city much healthier because we will no longer need medicaid, the underpayment system that has closed many city hospitals include Muhlenberg near my home. It will eliminate the whims of insurers who cannot be sued for racketeering yet they have ganged up on physician groups to under pay them in the networks. By paying a little more, and eliminating out of network care, you as the patient could choose any health care provider. Doctors will require fewer employees to chase payments and private companies can administrate payments to health care providers.
Of course, this is just the beginning. Obama care a tax? Perhaps but these new laws will help level the playing field for the average person while forcing the healthiest among us to pay into the system and help keep the costs in check with some sensible rules.
Ignore the political noise, Obama care is here and the politicians who have tried to repeal it have wasted millions of your dollars with their partisan political maneuvers. If your employer paid your insurance before, it is likely they still will do. If they do not, they now may and if you are self employed, you can now go to exchanges and have better selection and transparency in which plan to choose. Is there really a downside to better coverage, more proven preventative covered services and the elimination of preexisting conditions clauses?
Since we were paying for health care anyway, who cares what we call it. At least it is a first step forward. Once the ranting about repeal has died and gone away, perhaps we can get down to fixing the paradigm, disease care and making health care costs fall in line with countries that do it better than us. Who knows, maybe we can have the worlds best healthcare system rather than be 47th on the WHO list.
What do you think? As always, I value your opinion.