Marc S. Shiffman, M.D.: Insurance companies the problem, not the new health care law |

Marc S. Shiffman, M.D.: Insurance companies the problem, not the new health care law

While I found most of Mr. Fanning’s commentary on health care to be thoughtful, I actually had difficulty getting through his first two paragraphs, as he teetered closely to the very demagoguery that he identified as part of the problem. Let us look at those two paragraphs.

The Affordable Health Care Act (“ACA”) does not create a “massive new entitlement.” Social Security in 1937 and Medicare in 1965 were massive new entitlements. The ACA expands existing entitlements and establishes a means by which more Americans with existing health problems can obtain insurance, through insurance pools funded in large measure by the Feds and run by the States. Nor will the ACA cripple the already buckling Federal budget. All financial analyses of the ACA, whether partisan or non-partisan, have concluded that, at worst, it will add a very small amount to the budget deficit over the next 10 years, in return for providing a number of services that Americans want: insurance for children with pre-existing conditions, coverage for 22 -year-old college graduates who have starter jobs that may not provide health benefits, annual wellness exams for senior citizens, and elimination of the doughnut hole for seniors’ prescriptions, etc.

It is simply inaccurate to claim that private, for-profit insurance companies are not the problem. It is insurance companies who are rationing health care in this country. I have worked in health care delivery for 30 years, in solo and group practices, in private and academic practices, in care delivery and in training medical students and residents, with institutions both great and small. I have watched the steady erosion of health care in this country, as doctors and patients are given fewer and fewer choices in providing and obtaining optimal health care, unless the patients are willing to pay for it themselves – after they have already paid the insurance company’s premiums, deductibles and co-pays. Medicare sets rules. Insurance companies start with those rules but then modify them in order to curtail benefits and reduce reimbursement rates to physicians for services rendered, relying on guidelines of whatever self-proclaimed expert panel the insurance company can find. Trust me, Mr. Fanning, insurance companies are the biggest of the many problems in our health care industry.

As for the decision of Florida U. S. District Court, let us not get into politics, but rather stay with the facts. The judge threw out the entire ACA on the premise that the personal mandate clause is inseparable from the rest of the ACA. As a lawyer friend of mine has explained to me, since substantial provisions of the ACA have already gone into effect, and the personal mandate does not go into effect until 2014, it is unlikely that the Florida federal court decision will stand on appeal. That being said, the Supreme Court will take up the ACA next term and my same lawyer friend tells me that the Court will probably strike the personal mandate clause next spring, but uphold the remainder of the Act. Insurance companies will then have 20 months to figure out how to preserve their profits, because, in 2014, pre-existing conditions will no longer be a viable excuse for insurance companies to deny coverage. (Have you noticed that your insurance premiums have sky-rocketed this year? That is because insurance companies are hedging their bets and gouging patients now, anticipating that the ACA will affect their profits in the future. And, let’s face it, profits are all that matter to insurance companies.) A likely compromise may be that, if Americans refuse to purchase insurance in the first three or six months of 2014, they will be relegated to pool coverage, like Cover Colorado, for perhaps a three-year period. Then those patients will be brought back to standard insurance opportunities.

The rest of Mr. Fanning’s commentary is quite good. The example of the “death panels” scare illustrates quite clearly what happens when we argue with emotion and groundless rhetoric rather than the facts.

We have some of the brightest minds in the world working in health care in this country. We have the most advanced technology. We have dedicated physicians who want to do right by their patients. Yet, as a society, we barely rank among the top 20 of equally developed nations, graded on any number of health parameters. Why is that? Can we not learn from those other nations who manage to keep their general populaces healthier than ours? Of course we can. But, first, we need to acknowledge that our system is broken on many levels and, second, we need to engage in factual discussion. Ignore the facts, and we will just be mindlessly yelling at each other again. We are perilously close to having our broken system become a national disaster. Mr. Obama saw that, and tried to at least put us on a different road. The ACA has strong points and weak points, but it is a start – a start that our self-absorbed congressmen and women did not have the courage to make. When Medicare was enacted in 1965, it, too, was deemed a disaster. It has proven to be the best health care plan this country has, and it is still being modified after 45 years. If we do this right, maybe in 20 or 30 years Americans will look back on the ACA as a positive turning point in health care. Let us take the ACA, apply the facts, modify the Act as necessary to achieve our goals, and use it to improve health care in this country.

Marc S. Shiffman, M.D. is a physician with Summit Internal Medicine in Frisco.

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