With each passing day, more is discovered about the Affordable Care Act (ACA, Obamacare) confirming all of our worst fears about this law. The majority of discussion regarding Obamacare has been concentrated on issues involving implementation, such as state health insurance exchanges or Medicaid expansion.
It has also focused on the crushing financial implications of the law, such as the 18 new taxes created by the ACA, or the dramatic rise in healthcare insurance premiums, or the projected $2.7 trillion price tag. This narrative is understandable because the majority of people doing the reporting are pundits, talking heads and policy wonks.
The missing piece in this narrative is the havoc that this law is creating in the lives of so many patients. Despite minimal implementation of the ACA thus far, the effects on many patients is already devastating- something very much under-reported.
Last month we learned that cancer clinics were turning away Medicare patients as a result of cuts brought about by the sequester. The cuts would result in a decrease in Medicare reimbursement to these private clinics by as much as 28%. This has forced these clinics to find alternative treatment facilities for these patients, which in some cases may be thousands of miles away from their homes. This is tantamount to a death sentence for some patients, for whom travel is not possible because of both economic and health reasons.
The creation of high risk pools for patients with pre-existing or expensive medical problems was touted as one of the achievements of Obamacare (Pre-Existing Condition Insurance Plan, PECIP). It has never lived up to its expectations. The predictions were that by this time, over 1 million people would be participating, but it stalled at about 100,000 because this coverage was more expensive than anyone had anticipated. And further enrollment was halted because the money ran out. Now it appears that the shortage of funds may jeopardize the continued coverage for those patients currently enrolled.
The GOP leadership in the House of Representatives, sensitive to the needs of these patients, introduced HR 1549, which would transfer money from other ACA programs into the PECIP. President Obama however, threatened a veto if this bill reached his desk. He apparently has little concern for these patients and if it means that they need to be sacrificed in order to proceed with continued implementation of the law, then this may be the price that needs to be paid. Try telling that to the patients though.
Only a small portion of the ACA has been implemented to date, and yet the healthcare of hundreds of thousands of Americans has been jeopardized as a consequence of politics. Unfortunately, this is the harbinger of things to come. The ACA places the Secretary of Health & Human Services at the center of the new healthcare bureaucracy. With Kathleen Sebelius answerable to the President and in charge of the 159 new agencies created by the ACA to “police” the healthcare system, could anyone be so naïve as to think that politics will not play a major role?
The country got a taste of such politics in healthcare over the past several years with the attempts on the part of the US Preventative Services Task Force to restrict cancer screening. First they called for less stringent breast cancer screening, by recommending that routine mammography for women be initiated 10 years later than has been the standard of care up until now (age 50 instead of 40). Then just a year later, they released their recommendations that routine PSA screening for prostate cancer in men was no longer indicated. These recommendations did come from physicians, but not by the experts who take care of these problems, and who would be the best sources of information. Instead, they came from a government panel of medical bureaucrats, who were more concerned about saving money than saving lives.
When Sarah Palin warned us that there were going to be death panels resulting from Obamacare, she was criticized and humiliated. But she was not entirely wrong- just inarticulate.
There are no panels that will pronounce judgment over individual patients. But as long as the government continues to be a “player” and a referee in healthcare, there will be decisions that are made purely on the basis of politics, which will ultimately have an impact over whether patients receive life-saving treatments or not. The track record so far does not look promising.
Hal Scherz is the President & Founder of Docs4PatientCare. He is a full time pediatric urologist at Children’s Hospital of Atlanta and a clinical associate professor of urology at Emory University.
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