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The Risks and Perils of Obamacare
Paid for by the above named doctors, Dr. Farid Naffah, Warren, Ohio 44484
Many of those who cheered in March 2010,when the Affordable Care Act was signed intolaw, continue to be bamboozled by its promise. Asdetails of the plan have emerged, however, a largenumber of people have changed their minds,realizing that what was pledged is anadministrative and fiscal disaster, bringinghigher health care costs, a severe physicianshortage, and the rationing of medical services.In brief, a recipe for mediocrity.If all you know about Obamacare is that itwill provide insurance to 32 million Americanswho don’t have it; that patients with pre-existingconditions may not be excluded from coverage;that certain screening procedures are offeredwithout co-payments, and that children mayremain on their parents’ plan until the age of twenty-six, you would have no reason to fear oroppose it. Sadly, that is exactly where the ObamaWhite House wants you to be: in sheer ignoranceof the innumerable provisions that make up the2,700 pages of the law. A law that directs you toproviders you may not choose or even like, thatforces you to pay more for the services youreceive and that decides what level of care issuitable for you. Most disturbingly, it is a lawthat subjugates your doctors’ judgment-and theirlivelihood-to bureaucratic authority. Thosewhom you have come to regard as the guardiansof your health will have other motives than topreserve or improve it.If the Affordable Care Act is not socializedmedicine it will of necessity lead to it, by theexercise of regulatory mechanisms and fiscalpressure. Medicine will no longer be a liberalprofession, but a government job, where yourphysician’s desire to excel in the delivery of carewill cede its place to the fulfillment of government imposed requirements, theadherence to imperious rules and the fear of retribution.In a first phase, Obamacare eliminatesprivate physicians and consolidates the practiceof medicine around hospital institutions.President Obama once promised “If you like yourdoctor, you can keep him.” What he omitted tomention is that, sooner or later, your doctor willgo out of business.The Affordable Care Act prohibits physiciansfrom owning hospitals and implements measuresto cripple and bankrupt their practices. Drasticcuts in reimbursement and a slew of newregulations have already led to the closing of many free-standing facilities or their acquisitionby neighboring hospitals. Regulations haveescalated to the point that full compliance hasbecome virtually impossible. Physicians’ officesare raided on a massive scale and systematicallyaudited to recover monies allegedly paid inwrongful billing. Impropriety is quicklyadjudicated and called fraud to justify the hugefines which are then imposed. The intimidationand the resulting financial strain often leadphysicians to close their practices. Auditorsentreated with that task are compensated with agenerous portion of the fines they collect, leavinglittle doubt as to their incentives. This is absurdin any free society but many physicianscapitulate, in fear of retaliation. Those whocontest the ruling do so at their own expense and,when victorious, can only hope to recover thefines they paid.That state of affairs, buttressed by mediasensationalism and its unrelenting attack on themedical profession, unfortunately lends credenceto the notion that physicians are somehowresponsible for Medicare’s fiscal insolvency, aridiculous notion, but one that furthers theObama administration’s agenda to strip them of practice ownership and make them employees.Many have already resigned themselves to thenew fiscal reality and hasten to avert theinevitable collapse. As they quietly surrendertheir practices for a hospital job, often inbitterness and depression, they put a pragmaticface on their decision. They soon find themselvestrapped into roles they never wanted or feltprepared to assume. They become demoralized,sometimes rancorous, as they enter a worldruled by bureaucrats who, generally, don’t have afraction of their education, their training or theirexperience. Yet, a hospital CEO typically earnsnorth of a million dollars, sometimes severalmillion. Other administrators are also generouslyremunerated but an internist can only hope for a$150,000 annual salary.Medical education and training is an arduousand lengthy process, requiring anywherebetween seven and thirteen years after college,and its cost is exorbitant. Few students faced withthe prospect of a career under Obamacare willsacrifice their youth to study medicine, whileincurring a greater than $200,000 debt. First yearearnings are often higher for MBA and law schoolgraduates than for primary care physicians, withfour or five fewer years committed to the study of their discipline, and their quality of life iscertainly more appealing. They don’t workevenings, weekends or holidays, and rarely, if ever, do they have to face a lawsuit.It should therefore come as no surprise that,according to a recent survey, nine out of tenphysicians currently dissuade their childrenfrom pursuing a career in medicine. Thedesirability of a medical career is nowhere betterreflected than in the plummeting number of applications to medical school during the lastgeneration. The quality of medical education willundoubtedly decline and the AAMC (Associationof American Medical Colleges) predicts that bythe year 2025, there will be a physician shortageof 160,000. What that means is that nearly one of five people will have insurance coverage but noaccess to health care. The reality is probably evenbleaker, as disillusioned physicians, by then allemployees, will have cut their hours, become lessefficient and less productive, lost their desire forexcellence and taken early retirement.When health care is not accessible, many willhave to go without it, suffer or die. Whenphysicians cannot be found in their offices and agrowing population who demands care cannot beserved, emergency rooms will be flooded,crowding out the critically ill, and lines will format their doors. Those who were around in the late1970s will remember with bitter nostalgia thelong lines that formed at gas stations during theCarter years.What happens when a physician’s practice isacquired by a hospital is that the cost of healthcare soars. So much so that you will quickly longfor the days when a mammogram and a screeningcolonoscopy entailed a small co-payment.Hospitals are compensated by Medicare andprivate insurers at rates far higher then themodest payments made to private physicians. Forexample, a routine visit which runs seventydollars at your private doctor’s office will costover $120.00 when that office becomes part of thehospital outpatient department. Anechocardiogram, which costs $373.00 in acardiologist’s office may bring in $1,600.00 whenthat office enjoys the hospital outpatientdesignation. A colonoscopy, reimbursed at a flatfacility fee of $350 in an ambulatory center, easilyreaches three times that amount when chargesare itemized under the hospital label.In today’s economic reality, most patientswith private insurance have large deductibles,ranging from $2,000 to $5,000 dollars. Theincreased cost burden incurred by hospitalbilling becomes the patient’s responsibility untilthe deductible is met and, even after that, co-payments remain considerably higher. Insurancepremiums will therefore continue to rise, toaccommodate the higher charges, and will set thestage for rationing. There just isn’t enoughmoney to go around.Yet even so, Obamacare will continue forcingphysicians out of their practices, by pressuringthem to join accountable care organizations(ACO), and that will effectively dismantle thepatient-physician relationship. The ACO is a newgovernment-imposed structure, a group of physicians, in charge of delivering care to acertain population of patients. Its stated goal is toimprove quality, by the fulfillment of presetcriteria, and cut cost, by coordinating careamongst physicians and eliminating waste.ACO’s indeed have a financial incentive incutting cost as they retain a portion of thesavings they realize. Accordingly, physicians willfind themselves in the uncomfortable position of denying care in the name of fiscal responsibility.Their obligation to their patients may becompromised by their loyalty to the group andthe pressure to save may overtake thecommitment to heal. Inferior care will rear itsugly head and frown upon unwilling partners inthis new pact of negotiable morality.We will thus have established a newstandard, one that the government will hail asthoughtful and well proportioned, that hospitaladministrators will label as coordinated andaptly delivered, and that regulators andaccreditation agencies will honor as compliant.Regardless, the rest of us will recognize the newstandard for what it really is: medical mediocrity.Contrary to what its name suggests, thePatient Protection and Affordable HealthCare Actneither protects patients nor is affordable. It onlyprotects a new mammoth bureaucracy created toenforce the law by pilfering precious healthcaredollars. Innumerable agencies and boards willrise to administer those changes, i.e. provideinsurance coverage to residents of each state,including illegal immigrants, and no fewer than16,500 new IRS agents will be hired to monitorabidance by the law. Hundreds of billions of taxpayer dollars will be seized from the Medicarefund and squandered to support the newbureaucracy, seriously imperiling the treatmentof seniors. And if that were not enough, the lawimposes scores of new taxes and tariffs onindividuals and businesses, most of which willhit the middle class.Furthermore, patients are far from protected.In fact, their rights are trampled upon as newparadigms are applied to the management of their health and they are forced to pay forservices they find morally reprehensible.Supporters of the bill, including ourcongressional representatives, were dangerouslymisinformed about its contents and itsdevastating effects. The president and his alliespreached that universal coverage was a moralissue but were careful to avoid discussionregarding the methods they would use to achieveit and the bleak future those methods portend onthe quality of care, not to mention the economy.They wanted you to believe that just because theidea was good, the bill was sound.We would like to remind those ferventbelievers that support of the Arab Spring alsoseemed honorable and lofty but its executionproved foolish and calamitous. Those naiveenough to trust the unfailing wisdom of government surely remember that sub-primelending allowed many to achieve the Americandream but led to the largest financial crisis inrecent history. Misplaced generosity ushered theway to collective insolvency. Not only did thebeneficiaries pay dearly but society went downwith them. The plan was ill-conceived, itsprosecution bungled. Similarly, not only will thehealth care law fail to bring good medicine to thenewly insured, it will deprive everyone else of thequality care they have so far enjoyed.“If what Romney and Ryan say aboutMedicare is true, how come our plan is endorsedby the AMA (American Medical Association), the‘national’ American Hospital Association and,most importantly, the AARP (Association of American Retired Persons)”, challenged Vice-President Biden in a recent campaign speech inFort Myers, to an innocent and cheering group of supporters. Were they to infer that thoseorganizations, perhaps by virtue of their names,are somehow the defenders of our rights, theguarantors of our morality? AARP is in thebusiness of selling insurance and expects largeprofits from Obamacare’s onslaught on MedicareAdvantage plans. Hospitals, the big winners inthe Health Care Act, will see their coffers swell asdoctors become their employees and patients paymore for services. Even catholic hospitals haveembraced the law, while the Catholic Church issuing the federal government over it. As to theAmerican Medical Association, far fromrepresenting physicians, with fewer than 17%holding membership, it survives on governmentfunds. Mr. Vice-President, we are not stupid.In her address at the Democratic NationalConvention, Health and Human ServicesSecretary Sibelius declared that, for Democrats,Obamacare was a “badge of honor”. But if it is sowonderful, why have so many companies andorganizations been exempted from it? SecretorySibelius’ words betray her true sentiments, forthe passage of the Affordable Care Act was purelya political victory, achieved solely by one party,without a single vote on the other side of theaisle. Such a political victory was hardly a way tobring the country together. It is fiscallycatastrophic, the ruin of Medicare as we know itand, what is worse, the harbinger of the mostdreaded consequence in a country where healthcare has been the envy of the world: medicalmediocrity.Last year, Ohioans voted by a two-thirdmajority to opt out of Obamacare. Today, thatmajority would be even greater. By 2015, whenthe law is fully implemented, ACOs haveburgeoned around the country, to which patientsare assigned without their knowledge, the IPAB(Independent Payment Advisory Board) isrendering decisions on the care to which you areentitled, and doctors are totally demoralized, fewif any, will want the law upheld. The law must berepealed. Unfortunately, that will be impossible if President Obama is elected to a second term.
DR. AMINE ABDUL-AALDR. MARISHA AGANADR. HOWARD AMESDR. BAHAA AWADALLADR. AMY AWAIDADR. RONY AWAIDADR. JEAN CAIRNSDR. FERNANDO G. CHAVESDR. CHRISTOPHER C.CHUIRAZZIDR. MICHAEL T. CILETTIDR. LAWRENCE D’AMICODR. ERNEST DEPASQUALEDR. DAVID J. DUNCHDR. PAUL D. GATEWOODDR. SHARON GEORGEDR. PAUL N. GOULDDR. STEPHEN E. HELMSDR. ROBERT G. HELWIGDR. WILLIAM J. HELWIGDR. LORI HEMROCKDR. RONALD N. KHOURYDR. JAMES H. KONDOLIOSDR. DESAI G. KRISHNARAODR. KAPIL KWATRADR. RICHARD J. LOGESDR. MAZEN MAHJOUBDR. HEBA MIKHAILDR. PAUL MUSSELMANDR. FADI NADDOURDR. FARID NAFFAHDR. ROBERT NAPLES, SR.DR. PATRICK PATCHENDR. JAMES E. PORTDR. JOSEPH POTOCKIDR. MORRIS PULLIAMDR. ROBERT REDLICHDR. RAMONA SHETHDR. SANJAY SHETHDR. JEFFREY B. SUTTONDR. JOHN D.VANCEDR. FRANK VERESDR. ZACHARY VERES 

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