Obamacare

Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.
C. S. Lewis

The train wreck that is & will be Obamacare has started.  American are now required by law to purchase health insurance.  And not just any health insurance, either.  Americans are required by law to purchase health insurance that’s approved by the federal government.  Oh, sure, you have your choice of 4 levels of coverage in the federal health care exchanges, and you still (for now) have the option of private insurance, but the things covered by health insurance are regulated by Uncle Sam.

What does that mean?  Well, for one, it means that President Obama lied to us when he said ‘…if you like your plan, you can keep your plan‘.  Instead, existing plans in parts of the country are being cancelled because they don’t meet the requirements of the ‘Affordable Healthcare Act’.

In Alabama, for example, Blue Cross had to cancel the majority of its individual plans as being non-compliant.  Reporter Bethany Wales found one individual whose plan for a family of four would go from about $520/month to over $1,000/month.  Other customers would pay 2-3 times as much for the coming year.

In New Jersey, more than 800,000 people who purchase their coverage on the individual or small business markets will have their coverage impacted.

And in Nebraska, nine companies have notified the state they’ll stop selling health insurance policies.  Most of these companies only have a small share of the market, and it probably isn’t worth making changes to their policies in order to comply with the various mandates of Obamacare.

So, we can ‘keep our plan’ if we like it, huh?   Well, according to NJ State Senator Joe Vitale, that was a bit of a nuanced promise.  ‘The president said he won’t tolerate benefit plans that don’t meet the basic needs of our citizens,” Vitale said.  Of course, it’s hardly the government’s job to determine what my ‘basic needs’ are, when it comes to my health insurance.

At the same time he promised we could ‘keep our plan’, Obama promised we could ‘keep our doctor’ as well.  Not so fast!  In Connecticut, United HealthCare sent pink slips out to thousands of doctors.  While these cuts apply to Medicare Advantage patients rather than anything directly under Obamacare, it shouldn’t take any stretch of the imagination to see other doctors being cut from ‘ACA’ plans.

What else do I expect from Obamacare?

Longer wait times for non-emergency surgery.  It’d be one thing, maybe, for a bit of a wait for elective surgery.  A nose job, for example, is rarely (if ever) a life or death situation.  But waiting on some surgery, even non-critical, can cause further complications later down the road.

Less new technology being developed.  One of the provisions of the ‘Affordable Care Act’ is a 2.3% tax on medical devices.  So what is a ‘medical device’?  Well, according to Snopes,  a medical device is “an “instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article” — including “any component, part, or accessory” — that meets certain requirements. The device must be:

(1) Recognized in the official National Formulary, or the United States Pharmacopeia, or any supplement to them;
(2) Intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease in man or other animals; or
(3) Intended to affect the structure or any function of the body of man or other animals.The device must also “not achieve its primary intended purposes through chemical action within or on the body of man or other animals” and not depend “upon being metabolized for the achievement of its primary intended purposes.” Sec. 4191(b)(1) limits the definition for purposes of the tax to devices intended for humans.Under what is commonly called the “retail exemption,” the tax provision does not apply to eyeglasses, contact lenses, hearing aids, and any other medical device determined by Treasury to be of a type that is commonly purchased by the general public at retail for individual use. “
Such a tax is going to make it less profitable for technology to be developed.

Less modern medical equipment availableAs of 2010, the US had about 7900 MRI machines, or 25.9 machines per million people.  Our neighbor to the north had 222 machines- about 6.6 machines per million, and the UK (in 2011) had 304, or 4.8 machines per million people.

Health insurance companies are also being limited to a 15% profit margin.  Any ‘excess’ profits are returned to the consumer.  So what happens if there’s an uptick in illnesses for a few years- a pandemic on the order of the flu pandemic of 1914?  A massive increase in need for healthcare, and suddenly the company doesn’t have anything to work with!

Restaurant chains are also being forced to provide, on their menu, information regarding calories, fat content and other nutrition information.  It’s certainly not to say this information should be kept private, but why require it?  If there’s a demand for it, consumers can ask!  A pizza restaurant could easily have tens of thousands of combinations of toppings- just 8 toppings gives you over 40,000 possible pizzas!.  Will they be required to provide information for each possibility?

This isn’t to say that there shouldn’t be some changes made to how people in need get access to health care.  My wife’s friend has a number of different health issues, including cystic fibrosis & fibromyalgia. She’s unable to work, and relies on a policy through the state which pays very little for the equipment she badly needs.  I agree we can provide for things like that, or a serious car accident, or cancer.  We can & should help those who can’t provide for themselves.  But we also need to create an environment in which that number is as small as possible.  And we need to limit such assistance to the critical situations, not every sniffle, not every headache.  Raise the deductible, prices for health insurance will drop, and people will learn to make smart decisions about when to visit the doctor, and when it’s best to stay home & take care of themselves.

Is there a chance that Obamacare could still be overturned?  I’m aware of two possible paths for it to be taken off the books.

The newest suit comes from Oklahoma, where the Attorney General, Scott Pruitt, is filing suit based on the subsidies, fines & mandates the act brought about by the Act.  According to research from Jonathan H. Adler and Michael F. Cannon published in the Case Western Reserve Journal of International Law, subsidies under ACA were only provided to those receiving their insurance through state exchanges.

The other suits, from Texas and from the Pacific Legal Foundation challenge the Constitutionality of Obamacare on the grounds that revenue generating bills must originate in the House, rather than the Senate (Article 1 Section 7).  However, it’s possible that such challenges would have to overcome precedent which has given the Senate the ability to levee taxes.

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