Tag Archives: Obamacare

Politics are Ruining Our Future and Will Keep Us in Purgatory!! Obamacare Is A Political Nightmare That’s Not Going Anywhere. Is there A Solution?

35628362_1581684245294562_5252791796676689920_n

Some conservatives are unwilling to accept the status quo. They are pushing back against congressional inertia and conservative fatalism as they urge Congress to roll back the Obamacare regime.

I was disgusted last week speaking with a friend who is a very powerful strategist in the Democratic Party. She agreed with me when I suggested to her that the Democrats would Never sign off on either an immigration or health care plan until after the midterm election. I sensed this after the President signed an Executive Order reversing the separation of illegal immigrant children from their illegal parents as the Democrats, especially Ms. Pelosi and Mr. Schummer asked him to “pen”.

How can we make any progress at all when there is no cooperation between the parties and the administration? I am truly frustrated and wonder when we all are going to wake up and make these Senators and Representatives to “do their job”! They all only care about their own reelection models…. and impeaching the President. How have we sunk so low, so far??

Congress is still wading through the swampy waters of Obamacare. Congressional Republicans, who ran against Obamacare through four election cycles, have spent most of the past year running away from it. But they are finding the law hard to escape.

Democrats who once shied away from Obamacare now can’t stop talking about it. They are blaming Republicans for the next round of premium increases that will become finalized in the weeks leading up to the November elections.

Republicans will justifiably respond that Obamacare is a mess they didn’t make. Voters may nevertheless hold them accountable for not cleaning up that mess, despite years of campaign promises.

Congress should keep those promises, according to a group of conservative policy analysts, state-based think tanks, grassroots organizations, and GOP governors and state legislators. Tuesday, a group of them announced support for the Health Care Choices Act, a proposal that would repeal Obamacare entitlements and replace them with grants to states to finance consumer-centered reform.

The plan is innovative and bold. The ill-fated bills Congress considered last year kept the federal structure of Obamacare with relatively minor modifications. For example, those proposals modified the federal tax credits that are at Obamacare’s core; the Health Care Choices Act would repeal them. And while last year’s bills would have reduced federal spending on Medicaid coverage of able-bodied adults, the Health Care Choices Act would scuttle the Medicaid expansion policy entirely.

The proposal resembles the successful welfare reform of the 1990s, which repealed the individual entitlement to cash benefits and replaced it with grants to states to assist the needy. The Health Care Choices Act does the same thing with health care, but on a much grander scale. It would repeal an open-ended federal entitlement program expected to cost $1.6 trillion over the next decade and replace it with a block grant. It is welfare reform on steroids.

Block grants are not blank checks. Like welfare reform, which required states to implement policies to encourage work and reduce dependency, the Health Care Choices Act would require states to pursue two important goals: reducing costs and increasing health care choices.

States would be required to spend a portion of their federal allotments on meeting the medical needs of the sick without saddling the healthy with exorbitant premiums. Other stipulations would prevent states from using the money to expand Medicaid or to warehouse the poor in state-contracted managed care plans. States would have to provide low-income people assisted through the through the block grant, as well as Medicaid and State Child Health Insurance (CHIP) recipients, the option of applying the value of their assistance to the plan of their choice. Think of it as school choice for health care.

The new money would be provided through the CHIP statute, which, unlike Obamacare, includes permanent restrictions on the use of funds for abortion. Within those broad guidelines, states would design their own programs, determining who is eligible for assistance and what they’re eligible for. They would be released from Obamacare regulations on essential health benefits, age-related premium variation, and the requirement that insurers enroll the sick and healthy in the same insurance pools. Repealing these regulations would allow states to repair or ameliorate much of the market dislocation Obamacare produced.

In short, the Health Care Choices Act would dismantle two of Obamacare’s pillars and weaken the third: Obamacare’s individual entitlement would be abolished, the employer mandate (like the individual mandate) would be repealed, and federal insurance rules would be diluted.

Some conservatives look at the proposal’s health care reform donut and complain about the hole. They have particularly faulted the plan for not repealing Obamacare’s pre-existing condition rules.

A Republican reaction to last week’s Justice Department motion in a lawsuit that seeks to invalidate these rules is instructive. Democrats attacked the Trump administration – and Congressional Republicans – for opposing pre-existing condition protections.

To stanch the political bleeding, Senate Majority Leader Mitch McConnell declared, “Everybody I know in the Senate – everybody – is in favor of maintaining coverage for pre-existing conditions.”

McConnell’s colleagues pointedly did not race to the microphones to distance themselves from their leader. Nor are scores of House and Senate conservative incumbents campaigning on a promise to repeal the popular pre-existing condition requirements.

The message is clear: repealing that requirement does not enjoy anything like majority support even in a GOP Congress. For some conservatives, that is reason enough to leave Obamacare in place. If Congress can’t pass a perfect bill, they argue, then it shouldn’t pass anything at all.

A growing cadre of conservatives is unwilling to accept the status quo. They are pushing back against congressional inertia and conservative fatalism as they urge Congress to roll back an Obamacare regime that continues to raise costs and constrict health care choices.

They view the Health Care Choices Act’s repeal of Obamacare’s entitlements and devolution of power from Washington to the states not as the final word on health care reform, but as an essential component of a broader effort. Expanding health savings accounts is part of that effort. Promoting innovative approaches like health-sharing ministries and direct primary care is another. Trump administration regulatory proposals to allow small businesses and independent contractors form health insurance purchasing groups across state lines also are part of it, as is its plan to expand the sale and renewal of short-term, limited duration policies.

Conservatives who back the Health Care Choices Act prefer real progress to theoretical perfection and the inaction it induces.  They also argue that it is politically better for Republicans to confront Obamacare than to be blamed for its failures.

Republicans are stuck in a Nash equilibrium on Obamacare repeal. Conservative firebrands, Republican moderates, and congressional leadership – each for very different reasons – are content to make Obamacare repeal the new balanced budget, something they talk about to mine money and votes from their base, but never seriously pursue.

The millions of families and thousands of small businesses suffering under Obamacare deserve better.

Obamacare Faces New Life-threatening Conditions

Opponents of the Affordable Care Act have been busy. In the midst of several headline-making events on other issues, the Trump administration has instigated two major efforts to effectively do what Congress could not do earlier this year — repeal Obamacare.

The result is a laundry list of warnings for all health care consumers, not just those who buy insurance on the ACA exchanges. Here’s a closer look at the latest changes to the health insurance marketplace:

Expanding association health plans

The administration issued new rules on Tuesday that expand the use of what’s known as association health plans. They allow small businesses and self-employed individuals to buy health insurance collectively through what’s loosely defined as an industry association. By pooling together, members can buy insurance for less expensive group rates, the way employees of large corporations do.

Association plans have been around for a long time, but under the ACA they were restricted. The new rules loosen some of these restrictions and expand the reach of these plans. At the same time, these plans are exempt from many of the protections under the ACA, including coverage of the 10 essential health benefits such as maternity and mental health services, hospitalization and prescription drugs.

In addition, the new rules allow association plans to sell insurance across state lines. States regulate health insurers, and for the most part, insurers must adhere to each state’s regulations for the consumers they serve in those states. But under the new rules, association plans can choose which state they want as their regulatory jurisdiction. That means they could conceivably choose a loosely regulated state as their home base.

Association plans have seen their share of scandals in the past, largely due to this state regulatory confusion.

The new rules aren’t a surprise. The Trump administration has been calling for the expansion of association health plans as a way of offering more options outside of Obamacare and a way for small businesses and individuals to have access to more affordable group insurance.

But advocates worry that the move is a return to the bad old days before insurers had to adhere to standard regulations that protected consumers from paying insurance premiums, only to find coverage wasn’t there when they needed it.

“The new rule will allow groups of businesses to band together to buy insurance across state lines, which will be bad for small firms and their employees because it will lead to higher premiums, unbalanced risk pools and lower-quality insurance,” said John Arensmeyer, founder, and CEO of Small Business Majority.

In addition, the provision may encourage a new batch of healthier people who can get by with skimpier coverage to sign up for association plans instead of the ACA exchange plans. That could leave more sick people in the exchanges without the benefit of younger, healthier people balancing the risk pool. According to the Congressional Budget Office, 6 million people are expected to enroll in expanded association health plans.

If you’re considering one of these plans, many of which are expected to be available in September just before the 2019 ACA open-enrollment period, be sure to read everything you can get your hands about the plan as carefully as you can. You’ll want to be sure you understand any limitations in coverage so you can determine if the plan is right for you.

A threat to preexisting condition coverage — and more

Tuesday’s announcement comes on the heels of another potentially devastating blow to the ACA. Earlier this month the Justice Department announced it would not defend the law against a lawsuit brought by the attorneys general of Texas and 19 other states.

The suit claims that because the newly enacted tax law eliminates penalties associated with the individual mandate, the ACA requirement that most Americans carry health insurance is no longer constitutional. In addition, the suit contends that consumer insurance protections under the law also aren’t valid.

Since then an outcry has been heard from health care advocates, insurers, congressional Republicans and most recently a group of bipartisan governors from nine states. The protest is focused on the provision in the ACA that requires insurers to provide equal coverage and the same premium rates to people with pre-existing conditions as they provide to people without previous health problems.

The requirement applies to all insurers, not just those in the exchanges, and polls show most Americans — including many who don’t support Obamacare overall — want to preserve it. Even Senate Majority leader Mitch McConnell famously said, “Everybody I know in the Senate, everybody, is in favor of maintaining coverage for preexisting conditions.”

Still, the Texas court case would potentially eliminate many more ACA provisions, including the premium subsidies so many exchange customers rely on, essential health benefits and Medicaid expansion, said Eliot Fishman, senior director of health policy at Families USA. That said, Fishman believes the court case will take time, so consumers who are planning on signing up for exchange coverage for 2019 at the end of this year should not be dissuaded from doing so.

Health warning-Obamacare is in legal peril once again! Many legal scholars are dismissing a new case. Don’t listen to them.

Noah Feldman wrote that one shouldn’t turn your back.  Could key portions of the Affordable Care Act be declared unconstitutional – years after the Supreme Court upheld them? The Trump administration’s Department of Justice has just filed a brief saying so in a suit by several states that aims to take down the whole program.

Most mainstream legal commentators think the government’s arguments are unconvincing. But it’s crucial to remember that this was exactly the reaction of the same set of people in 2010 when the original argument was made against the individual mandate by libertarian law professor Randy Barnett. Just two years later, five justices of the Supreme Court embraced Barnett’s argument.

Given the excitement for judicial activism building among conservatives, the Trump administration may have more than a 50 percent chance of success.

Just in case you haven’t thought much about the individual mandate and the Constitution in the last six years, let me provide an update and a brief refresher. The update is that, in 2017, Congress passed the Tax Cuts and Jobs Act. In the law, Congress repealed the tax penalty associated with the individual mandate that everyone has health insurance.

In other words, the ACA still says you have to have insurance. But if you don’t, nothing happens to you. You may remember that the Obama team was worried about the interaction between the individual mandate and the popular ACA provisions that say insurance companies can’t refuse to cover anybody because of pre-existing conditions and can’t charge you more if you are already sick.

The theory went something like this: If you aren’t compelled to buy insurance when you’re healthy, but you’re allowed to buy it when you find out you are sick, then only sick people would buy health insurance. That, in turn, would create a “death spiral” for insurance under the ACA, as insurance costs went up.

Crucially, President Barack Obama’s Department of Justice relied on this argument in trying to convince the Supreme Court to uphold the individual mandate. This death spiral doesn’t seem to have happened yet, however.

Now comes the new constitutional challenge to the ACA, filed by a group of states led by Texas. Their argument begins with the fact that, when the Supreme Court upheld the individual mandate, it did so in a very strange way. The five conservative justices all agreed that, under the commerce clause of the Constitution, Congress did not have the authority to make people buy insurance.

Their reasoning was borrowed from Prof. Barnett, who had proposed in his article that while the Congress has the power to regulate existing commercial activities, it can’t force people to undertake a commercial activity they are not already engaged in. This was the famous broccoli hypothetical: the conservatives argued that the commerce clause wouldn’t allow Congress to pass a law requiring everyone to buy and eat broccoli, even though Congress could lawfully regulate broccoli prices.

Despite this conclusion about the commerce clause, however, Chief Justice John Roberts joined the four liberals to uphold the individual mandate on the ground that it was a tax and therefore fell within Congress’s separate taxing power. The other four conservatives were clearly frustrated with Roberts, but his vote carried the day.

The states are now arguing that once Congress repealed the tax penalty for the individual mandate in the 2017 law, no more constitutional authority exists for Congress to keep the individual mandate in place. The Supreme Court already excludes the commerce clause, and now the tax rationale is gone. Trump’s Department of Justice has agreed with this claim.

The states say that without the individual mandate, the whole ACA should be struck down as unconstitutional. Trump’s Justice Department didn’t go quite that far. But it did say that the ACA provisions on pre-existing conditions are so linked to the individual mandate that it should now be struck down.

Legal observers are pretty upset about this — but not all for the reason you’d think. Some are focused on the strange circumstance that Justice is arguing that the law is unconstitutional. It’s not supposed to work that way. The executive branch is supposed to argue in favor of the constitutionality of laws currently on the books.

That’s bad, without a doubt. But it seems less worrisome than the possibility that courts, including the Supreme Court, might actually adopt the Trump administration’s view and strike down the ACA provisions on pre-existing conditions.

Legally, I don’t think that would be the right decision. I don’t think that the repeal of the penalty means that the no-penalty individual mandate is necessarily unconstitutional, since there is no sanction for violating it, so it isn’t really much of a law at all.

And even if the no-penalty mandate were unconstitutional, it doesn’t follow that the mandatory coverage provisions need to go. They are logically separate from the individual mandate. The mandate may have been thought been necessary to make those provisions work in practice, but it turns out that, so far at least, they are operating without it, and the death spiral hasn’t happened.

But it is entirely possible that five justices would follow the chain of formal logic laid out by the states and adopted by the Justice Department. The best argument in favor of that position is that the Obama Department of Justice told the Supreme Court years back that these provisions were interlinked – “inseverable” in legal jargon.

There is, therefore, a real and indeed significant chance that the most popular part of the ACA could be struck down. You may have thought that the whole ACA-and the-courts topic was over. But as it turns out, it keeps coming back, like a figure from a horror movie. Don’t turn your back.

And look at all of the campaign “idiots” who are experts on health care and declare that their State will have better healthcare by adopting Medicare for All. Don’t they know that Medicare is a Federal program that States can’t themselves change? And how are they going to pay for it if the prediction that Medicare and Social Security programs will be out of money by 2026-2034?

Let’s talk more about Medicare for All!

The Biggest Losers

I ended the last blog hinting about the losers in this new health care program and was encouraged to pursue this discussion while reviewing two articles.

But let me first set things straight, as a strategic planner, the reason we are where we are is due to the lack of real research and planning. As much as I am not a President Obama fan, I really believe he and years before, Hillary Clinton, really believed what they were proposing was a good thing for the American people. I only object to the method that was chosen and the politicization, the lack of real research and planning with people in the know.

I comments in this last paragraph were further strengthened when I read the comments by the Speaker of the House discussing the Republicans mistakes and the lack of ability to overturn the health care law and the need to modify it and make it work. It was interesting to read that House Speaker John Boehner inadvertently revealed that repealing Obamacare “isn’t the answer,” and that “Republicans also need to offer a replacement.”

I also object to Harry Reed and Nancy Pelosi being so arrogant and closed minded in not allowing a non partisan discussion and resolution of difficulties to result in a bill which can “get the job done” efficiently and effectively for all the American people.

This has become a political ping-pong ball and shows that our elected officials really don’t care about Middle America especially and also points to the necessity for term limits.

Jonathan Bernstein wrote that“ The challenge is that Obamacare is the law of the land. It is there and it has driven all types of changes on our health care delivery system. You can’t recreate an insurance market overnight…. So the biggest challenge we are going to have is—I do think at some point we’ll get there—is the transition of Obamacare back to a system that empowers patients and doctors to make choices that are good for their own health as opposed to doing what the government is dictating they should do.”

This is interesting to me due to one of my previous blogs and the strategy that needs to be embraced- getting over the repeal idea and instead find ways to make the law work.

Think about the question that I posed at the end of my last blog-Who are the Biggest Losers? Byron York in his latest Op-Ed piece notes that Obamacare losers are harder to discern. I think not! He finally noted that “The plans being offered through the exchanges in 2014 appear to have, in general, lower payment rates for providers, narrower networks of providers, and tighter management of their subscribers’ use of health care than employment-based plans do.” The Congressional Budget Office (CBO) said “These features allow insurers that offer plans through the exchanges to charge lower premiums (although they also make plans somewhat less attractive to potential enrollees).”

The health care analyst, Bob Laszewski, questions who is harmed and points out that “when carriers converted their old policies to Obamacare-compliant policies, it was typical for the insurance company to increase costs about 35%” and “That increase could come in the form of higher premiums, more co-pays and deductibles and narrower networks.” This is what we are seeing in that enrollees are facing higher premiums and higher deductibles, which add up to a total higher cost, as well as a narrower choice of hospitals, doctors and prescription drugs than they had before. Therefore, what we are finding is that health care is becoming a more expensive and troublesome system.

Rick Newman in his article in The Exchange (April 25, 2014) points out that there are three subsets of people whose policies were canceled and then are the posers under the Affordable Care Act (ACA): people who are self-employed, those over 35, those who are white, or some combination of all of these three.

The biggest losers to ACA are the people who lost their insurance coverage but are unlikely to qualify for subsidies through one of the exchanges, which require an income of less than $47,000 for an individual or $95,000 for a family of four. Some of these people who lost insurance coverage report paying twice as much with deductibles of $4,500-$7,500 or more. It was interesting that Mr. Newman pointed out that it so happens that these groups so impacted negatively tend to be Obama’s political opponents.

Do the insurance companies lose? In a previous blog I pointed out that WellPoint was planning to increase their premiums and now I read that CEO of Aetna, Mark Bertolini, stated that their premium increases would range from low single digit to double digits, based on its first quarter earnings. So the insurance companies never lose. The have to make a profit and usually the profit is much larger than the proposed profit margins that the committees and government departments are demanding for health care facilities.

Ethan Rome (The Truth About Health Insurance Company Profits: They’re Excessive) reviewed health insurance company profits and went on to further review the American trade group American Health Insurance Plan’s (AHIP) focus on profit margins which he thought was misleading when they quoted 4.4%, and designed to protect their massive income by shifting attention away from their return on equity — a key measure of profits as a percentage of the amount invested. “That return is a phenomenal 16.1% as of today. By that measure, health insurers are ranked fourth highest of the 16 industries in the health care sector. They also deliver a higher return for investors than cellphone companies, beer companies, mortgage companies, life insurance companies, TV broadcasters, drug store companies or grocery stores.”

In May 2011, the New York Times reported “the health insurance industry is enjoying record earnings while millions of Americans get less medical care. Wall Street investors are delighted with the industry’s profits, and to health insurance executives, that’s all that counts. Insurance CEOs want investors to buy their stock and keep share prices marching higher, and that’s exactly what has happened. To achieve excessive profits, insurers are happy to gouge consumers and small businesses, do little to rein in medical costs and spend billions of our premium dollars on lobbying, secret political activities, bloated executive pay and stock buybacks.”

How about the greedy doctors? Are they losers? In the beginning and for quite a while they will lose as they have for years as their reimbursements (what they are paid by the insurance companies and the government, i.e. Medicare and Medicaid) are further discounted. But they will not be able to keep their offices open unless they become employees of the hospitals, universities or convert to boutique type practices. The boutique practices will charge patient fees to become practice members and or start to do procedures that they are not trained for and for which the complication rate will be high. But the added income will be necessary to maintain their overhead expenses.

Having insurance policies that include $5,000- $7,500 deductibles means that almost all health care needs, office visits, tests and surgery will be out of pocket expenses. How does the new plan then encourage good health care behavior and encourage preventative care?

Yes, the uninsured, if they fulfill the requirements for the government subsidies, will get coverage, but who will take care of these patients and cane you change their “bad” behavior? Will we have enough doctors to provide care and what type of care will be provided? I will discuss these topics further in future blogs.

Let us also consider who is in control of the ACA and what their history predicts. These are the same government systems that have control of the problematic Medicare, Medicaid and Veteran health systems. Remember what we have been hearing about concerning the Veteran Administration Health Care problems in the last few weeks. Long waiting times, poor care, lack of care, deaths, suicides, etc. What then can we expect for the future control and management of the ACA?

Let’s Look at the Equation Again

This past week I was interested in a front-page article in our local paper-Rural healthcare lags behind. What does that mean and how does the Affordable Care Act (ACA) affect areas like the Eastern Shore of Maryland as well as other rural areas of this State and around the country?

There are other areas in similar to the Eastern Shore of Maryland where the rural population consists of a large Medicare and Medicaid patient population needing health care.

Isn’t this why ACA was designed? The article describes these areas as challenges of providing health care where the patients are very sick and the resources, which are very scarce. These areas are lacking health care providers contributing to health disparities that include higher rates of heart disease and obesity and lower life expectancy. The author, Megan Brockett, compares the situation is akin to a “Third World country.”

Maryland is especially problematic in that in the national 2014 County Health Rankings released by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, found that five of the 10 least healthy jurisdictions in Maryland are considered partially or completely rural by federal standards and three others in the bottom 10 fall under the state’s broader definition of rural. The article further points to the lower rankings in health care outcomes.

The experts and advocates link the disparities to the scarcity of health care providers in these rural areas and the decreased access to care. The ratio of primary care providers to residents is horrible from a best-case scenario of 1 in 1,056 – to the worst case of 1 to 2,915.

“As a result, people living in rural areas often have to travel long distances for health care, a disincentive to getting even the basic preventative care they should be receiving.” Now add the additional burden of high deductibles, where the patient has a higher out of pocket expense in their health care.

Ms. Brockett goes on to point out that the rate of specialty care providers is worse in the rural areas through out the state. And the effects are seen regularly in the clinics around the state.

Much of the campaign to improve the situation centers on efforts to recruit and retain health care providers to practice in these rural communities and the workforce shortage in rural areas is the biggest barrier to care.

This article is so interesting to me, a specialist practitioner, who practices in one of the state’s rural areas. I have had my billing agency beg me to move my practice out of the rural area to increase my reimbursements by 17-20 %. This is true in a state, which is so backward in that they have demographic areas that pay the physicians at a lower rate than a county/ areas 30 to 45 minutes away. Why would any new physician graduating with a debt in loans of on average of $325, 000 want to practice here where they may never be able to pay back their debts?

Do we get a break in malpractice premiums or practice overhead in the rural areas? No and No.

So, why would any new practitioner want to come to one of the rural areas in Maryland or in any rural area in the US?

Nothing will change regarding the practitioner to patient ratio to acre for the additional enrollees until the educational costs and tort reform is reality.

Another article appeared in The Week magazine, April25, 2014, Page 12 by Daniela Drake-Why doctors are so unhappy. It is a summary of her review in The Daily Beast, starting with the quote “Being a doctor has become a miserable and humiliating under taking.” She states something those of us who went into medicine 20-30 years ago, that “caring for the sick used to be the country’s most prestigious and admired professions.” However, today an emotion that I feel almost daily, that America has declared war on physicians and yes I continuously attempt to discourage others from entering the practice of medicine.

Not only primary care physicians, but also all physicians toil thanklessly in a hectic, unsatisfying profession, which is dominated by the insurers, politicians and their agencies, and malpractice attorneys. We physicians work long hours cramming in more patients than reasonable, 20-30 per day because of regulated fees and the cost of filling out insurance forms, which averages $58 per patient. Right now without all the added enrollees secondary to the ACA the average patient visit lasts 12 minutes. What information, what type of diagnosis can be made in that short period of time?

It is amazing to me that no one challenges the “salaries” that actors or professional athletes make, however they try to make doctors feel guilty when they make money. Do you think that it costs nothing to run a practice with electronic medical records. computers, specialized staff of nurses, billing personnel, etc.?

Patients question and try to make doctors feel guilty about changing their practices to boutique or concierge type of practices. However, more and more physicians will need to convert their practices to this type of practice as the government further discounts physician’s reimbursements and deductibles rise or face bankruptcy or early retirement.

Affordable health care will add more bureaucracy and pressure to cut costs and make it more expensive to maintain their practices. Health care providers, doctors, nurses, nurse practitioners, physicians and the hospitals will be losers in the future of the new system. Who are the other losers? I will delve deeper in the “losers” of ACA or Obamacare. Can you think who will be the “Biggest Losers?”

Doesn’t anybody care except the perceived “rich” doctors?

Again I say, wake up America! We need to have a system that understands what it takes to have a truly affordable health care system that is sustainable and fair to all.

Does the Affordable Care Act Work?

Today is Easter Sunday, which is a time of reflection and renewal for those of the Christian faith. Easter is also a time when we reaffirm family traditions and break bread with our friends and loved ones. I’m hoping that everyone had a wonderful Sunday no matter what your religious beliefs and what holidays you celebrate.

It brings to mind an article that Dr. Ben Carson wrote and appeared in today’s Opinion section of our local newspaper: Recovering America’s exceptionalism. He reflects on the famous French historian Alexis de Tocqueville, who came to America to study our nation. He concluded his American analysis by saying, “America is great because she is good. If America ever ceases to be good, she will cease to be great.” Interesting observation. Our we seeing the degradation of our greatness??

Dr. Carson delves into religion, slavery and history. He further discusses the wisdom and goodness of learning from our mistakes. He finds it “disturbing in the pursuit of goodness the turning of a blind eye toward corruption, much like the Romans did before the fall of their empire.” He is concerned regarding scandals that been characterized as “phony scandals” based on politics and “tells you a great deal about the loss of honesty in our society.”

So, how does this discussion fit our discussion of the Affordable Care Act? “The fact that one party is willing to use its majority status to cram a health care bill down the throats of the minority party and the American people and then refuses to acknowledge the obvious illegitimacy of a bill passed largely on the basis of false information provides a barometer on the lack of importance placed on virtue in our society today. How can such a society in any way claim to be good?”( The Sunday Star, April 20, 2017, Page A7).

My son this weekend, after a number of frustrating discussions with me, his mom and his friends, asked the question-What is really wrong with “Obamacare”? It really seems like such a great idea. My very intelligent wife then pointed out reality to the younger generation, who will soon see the obvious errors of the Bill. She realized the fallacy of the design when she was notified of her huge jump in our health insurance premium as well as the more than doubling of our deductible. She is now considering the delay in many of her doctor visits and diagnostic tests/exams.

Interesting and it brings up the major topic of discussion of this weeks blog. Read on.

Normally I appreciate and respect the opinion of Donna Brazile, appearing many times in our local opinion section of our and I’m sure many other newspapers.

In her article “Health care works on many levels” she tries to point how well the ACA works for the enrollees. As she ends her rant, she states “Numbers do not measure the ACA’s sign-up success. As a result of the Affordable Care Act- Obamacare- illnesses are prevented, people have a greater security in their lives, more money in their pockets (because insurance companies can’t make a profit higher than 20 percent), and families have a parent or child with them because a disease was cured. These are the true measures of success. And that is priceless” (The Star Democrat, April 9, 2014, Page A4).

My problem with these comments and the whole process is what we are really seeing in our medical practices. That Middle Class Americans are really being missed or made to bear the burden/cost again of the “real” health care solutions. Also, the numbers may really do measure the sign-up failure and the failure of the bill/law itself. We need to evaluate the breakdown of the enrollee numbers carefully.

Our President, when he first got into office, stated that he was going to protect the middle class of America. However, the middle class enrollees have had their insurance premiums increased by double digit percentages as well as have had huge increases in their deductibles, as I cited with my wife’s experience. They then are delaying their routine follow-ups for primary as well as specialty care as well as diagnostic tests and even surgeries. How does this prevent illnesses, give people a greater security in their lives or more importantly, keep more money in their pockets? In fact with the increase in deductibles, as seen by examples of $ 4,500 on average, they are now paying more out of pocket portions toward their health care bills. I was pulled aside by one of my”former”patients,who wanted to apologize for having to cancel his routine cancer post operative exams. He explained that his deductible of $5,000 made it very difficult to see me as well as his primary care doctor. Again, this is reality not media hype!

To the rich, this probably will never be a problem or a concern for this group. The poor, who is the only group that this program will help, are not going to contribute to the sustainability of the system. Paying $66-$110 toward their health care insurance coverage does little to cover the costs of health care. Unless health care system pays very little to the doctors and nurses who are given the job of caring for the increased numbers of patients that are going to seek care. Also, the statistics show the enrollees represent a sicker portion of the patient populations. This represents a more costly group of enrollees to treat. Yes, the government is going to subsidize this group of patients, but where are we going to see evidence of sustainability? We do need to see evidence of young, healthy enrollees who can afford the huge premiums and deductibles to assist in sustaining the health care system.

So, Chris, my son with the questions, read on as I attempt to point out the problems with the ACA. But unlike most of the people that object to the Bill and try to repeal the Bill, let us see if there is a way to make it work and provide what the President really wanted- a valuable health care program for all. Is there anything wrong with this goal? No, as long as the population for which it serves realizes the limitations and what is required by all of the enrollees. Look to the British health care system and their problems!