Unintended consequences means a behavior or circumstance determines the outcome with different results than intended. The US people have spoken. They are envious of the promise of socialized healthcare as is promoted in other countries like Canada. Americans’ fantasy of Canadian style, “healthcare for all,” is, in actuality, a two tiered system. One tier is the government owned and run system with all its delays, costs and access issues. The other tier is the direct patient pay system for people who want their care now and are willing to pay for it(except where it is outlawed or otherwise unavailable.) Any medical service covered under the provincial health insurance plan cannot be purchased privately on Canadian soil. The only other option for Canadians is to come over the border to the US and pay directly for their procedures here; which they do frequently.
The people elected a congress and a president who made this their goal. The “stakeholders” were at the table with lobbying money and powerful political favors. These groups included the politicians in Washington, DC, American Hospital Association(AHA), pharmaceutical industry(PhRMA), Health Insurance Industry, big business, American Medical Association(AMA), information technology industry (HIT), American Association of Retired Persons(AARP), union leaders, and others. Notably missing were practicing physicians and actual patients. Each powerful entity got their paid politicians to write their own part to get their “buy in” figuratively and literally. Congressed passed the legislation, in the dark of night, without everyone reading the whole 2,800 page law. Remember congresswoman Nancy Pelosi selling it to America saying, “But we have to pass the [health care] bill so that you can find out what is in it.”
The intended consequence that America thought they wanted was a socialized government taxpayer sponsored health insurance safety net for all citizens. What America got was the Patient Protection and Affordable Care Act(PPACA), or “Obamacare.” Instead of the government owning and operating the healthcare system, as in Canada, it is sold out to private corporate interests but ruled by government law, as in fascism. Hospital owned accountable care organizations(ACO) will dominate the landscape. The government intends this broad stroke will save everyone money by increasing layers of healthcare administration 100 fold. Even the supreme court violated the consitution by enforcing that each citizen be mandated to buy a health insurance policy that must conform to government specs. Congress exempted themselves and their cronies from Obamacare and they kept their “Cadillac” health plan that taxpayers pay for. Government uses taxpayer funding for Medicare and Medicaid. Now they are subsidizing federally qualified healthcare centers to accept government plans as private competitive practices can’t afford to accept them.
The unintended consequences of PPACA/Obamacare are now becoming evident. The program costs will be much higher than expected and are unfunded, having no base in US economic reality. It increases the price of each insurance policy. Every citizen must buy an approved policy from an appoved vendor or be penalized with a “tax.” Less citizens will be insured due to increased policy costs and administration. They will just pay or ignore the IRS tax penalty as it is cheaper than a $20,000+ government approved insurance plan. Care will be rendered by huge hospital centric ACOs that know nothing about efficiency, economy, cost-savings or the practice of personal Hippocratic medicine. Hospital ACOs are investing millions each in development in hopes of “shared savings,” from Medicare, Medicaid and private health insurance plans. Government organization history clearly shows that these savings bonuses will never materialize. Medicaid ghettos are forming where only government supported federally qualified health centers can fiscally survive.
A Canadian style two-tiered system is forming and so, similar access issues, cost issues and care delays. One day soon US citizens may elect to cross the border and pay for their surgeries and treatments in Mexico. Americans, too, will be forced to chose between government promises of taxpayer funded hospital ACO impersonal healthcare, or the ever-present direct patient pay model since the beginning of recorded time. When will the government learn to first do a small scale experiment of a concept before committing unending streams of taxpayer and borrowed dollars?
Best wishes for good health,
Craig M. Wax, DO
Family physician, Editorial Board of Medical Economics
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Independent Physicians For Patient independence @IP4PI