Well, now that ObamaCare is kicking in, many folks are sniveling from the
rude awakening ass reaming they’re getting, and with good reason. The Affordable Care Act is anything but, and they’re realizing that they’re the ones being forced to pay for Sandra Fluke’s vagina.
But while I knew that I had opposed ObamaCare from the start (I’ve written plenty about it – all you have to do is do a search), numerous people I know squealed like stuck pigs at my very mention of the fact that giving government control of your health care will result in nothing but ungoodery, so I thought I’d ask an expert.
Alex is not an expert on the law. He’s a doctor – one who worked his ass off to get where he is, and who continues to work his ass off to make a living.
Alex is someone I’ve known since I was in high school, and although he had already graduated college when we met, we got along famously, especially since I wound up getting accepted to and attending his alma mater – the Johns Hopkins University.
I asked Alex recently to answer a few questions for me via email about ObamaCare, because I wanted to get a doctor’s perspective on this law. What follows are Alex’s unedited replies to my questions in essay form. I only made minor grammar and spelling changes, so the replies are his – unaltered and true.
My name is Alex Omura. I’m an anesthesiologist in a group practice of 28 physicians in Missoula, a town of about 80,000 folks in the mountains of Western Montana. Our group covers the operating rooms in our two hospitals and three surgery centers, and includes several folks who specialize in pain management and critical care medicine. Like most of our members, I grew up somewhere else and ended up here in the mountains. From New York City public schools, I went to college at Johns Hopkins University, then Albany Medical College, internship at the Mayo Clinic and then back to AMC for anesthesia residency. I finished up in Seattle with a fellowship in regional anesthesia at Virginia Mason Clinic. After 13 years of school I was ready to get to work…
…And pay off the mountain of debt I had accrued. Back then the interest on subsidized loans was 8 percent, interest on private loans was 12 percent, and student loans were not tax-deductible like they are today!
When I took my first real job in Great Falls, MT in 1996, I thought I had died and gone to doctor heaven! I was in solo practice with a bunch of great folks, and we had zero managed-care penetration, about which I had heard so many bad things in training. Even though I had to go further into debt with a big bank loan to pay rent and eat for the first 6 months, I was finally billing a real salary (not the $1.27 per hour we calculated we made as physicians in training!)
One thing I noticed right away was that all the other docs pissed and moaned about Medicare. I thought they were a bunch of whiny redneck anti-government crybabies.
It took a couple of years to realize how right they were, and how wrong I was.
Now we have ObamaCare, which was rolled out by Montana’s own senator Max Baucus, who famously called his own law a “trainwreck” and is curiously not seeking reelection. Anyone who has ever heard Max speak knows he probably didn’t actually write such a complicated law, but must have been chosen as the sacrificial lamb at the end of his political career.
(Holy drunken legisleech, Batman!)
I really did try to read it, but the full law has more pages than “Atlas Shrugged,” and it is written in legalese. Even the provisions in which I was really interested I could not find, as the index is useless and does not reference page numbers. There was no directory to locate a subject or keyword, so I guess Pelosi actually was telling the truth when she said “we’ll just have to pass it to find out what’s in it.”
Well, we’re now starting to find out what’s in it. The first thing people noticed is that their health insurance premiums have doubled! So much for Obama’s promise that it won’t cost anyone “one dime.” I guess technically he wasn’t lying as the cost is more like $7,450 annually for a family of four.
I should have gone to law school…
The rate hikes were predictable, because insurance companies are no longer allowed to offer folks in good health lower premiums. The law forbids different premiums for preexisting conditions like obesity or cigarette addiction, so those who are in good health are subsidizing those who are not.
The next thing I noticed about ObamaCare was that every hospital in the country was strongarmed into purchasing an Electronic Medical Record (EMR) system by 2013 or face steep cuts in Medicare reimbursement. EMRs have been around for decades, and the good ones have sometimes improved patient care when implemented correctly. They are very expensive, however, and usually only cost-effective at very large institutions like the Mayo Clinic. For them to be implemented at every hospital in the country is ridiculously expensive, but if they shared a standard database it would provide easy access to patients’ medical records anywhere they went for care.
That is not what happened. The council that decided how to spend the $19 Billion we borrowed to implement EMRs had only one industry representative – Obama’s “Medical Record Czar,” who by chance (Nicki: yeah, I’m sure) just happened to own the largest EMR company, and was a major donor to Democrats and Obama. She successfully lobbied against a standardized database, causing each of the half-dozen other competing EMRs to be incompatible. Sorta like Betamax versus VHS. In our small community the hospitals have different EMRs so a patient’s health information is not even portable across town!
The good news is the Medical Record Czar is now on Forbes Billionaire’s list! This is crony-capitalism at its finest!
The bad news is that many of the EMRs are terrible, very expensive, and may be harming patients. Our hospitals would have never spent the millions of dollars to buy these EMRs, which are ridden with bugs and poor programming. When the representatives from the EMR companies were on hand for the introduction, they told us to be very careful using these systems, because they had noted increases in morbidity (injury) and mortality (death) in other hospitals after these systems had been rushed into place.
You will not read about this in any newspaper article, but it is something every healthcare worker knows. These systems are not just record-keeping devices, but they also control medications, nursing orders, diets, lab studies, billing, and just about every facet of a patient’s care. Most EMRs are Windows-based and have the same issues with stability as the PCs in your home. I have spent hours some days talking with tech support trying to fix some bug, malfunction, or program error. This is all time away from patient care. When you walk around the hospital nowadays you rarely see a nurse at a patient’s bedside; they are usually cursing at their computer screen at the nursing station. I know several physicians in our town who were so disgusted with just these early implementations of ObamaCare, that they closed their offices and either retired or went to part-time practice. Each of those offices employed 5-10 folks, who then joined the ranks of the unemployed.
Since the rollout of ObamaCare, both our hospitals have started operating in the red and are instituting layoffs. Prior to this they were both financially solvent. What is very worrisome is that here in Montana our labor costs are low, we have almost no managed care, and the population is relatively healthy. If our hospitals are losing money, I can’t imagine how inner-city hospitals are doing!
One chronic problem for hospitals and physicians is that the largest single payer in the country is Medicare, and it reimburses on aggregate only about 85 percent of what a hospital spends to take care of a patient. All the other government programs like Medicaid, SCHIP, Tricare, etc. reimburse at similarly low rates. Over 50 percent of hospital patients are covered by one of those government insurances, and the rates are fixed by the government at ridiculously low levels. Imagine trying to run a business where YOU have to pay half your customers instead of them paying you!
To make matters worse, many of the highest paid folks in a hospital or medical office are not care providers such as doctors or nurses. They are paid (often at the VP level) to make sure the facility complies with the thousands of pages of federal regulations from Medicare! Mind you, some of these regs are good, like requiring gloves and masks to be worn; others are flat-out killing patients!
One of the federal programs called “Pain is the Fifth Vital Sign” aims to eliminate pain in all our patients, often with aggressive narcotic usage.
Sounds reasonable, right?
Only problem is that some level of pain if actually the body’s safety mechanism following an injury or surgery, and if you try to completely eliminate it with morphine, many patients will quit breathing. We call it “Dead in Bed.” This federal mandate has probably killed more people than cholera, and yet is still with us!
There are many examples of federal meddling in healthcare. Not all are killing patients, but they are all frustrating and require time and a lot of resources for compliance. I am the President of a surgery center in our town, and when we have committee meetings, 90 percent of the agendas deal with compliance with various government regulations. Those same meetings used to discuss improving patient care!
No wonder physician satisfaction is at all time lows! Almost none of my colleagues are encouraging their children to pursue careers in medicine. (Nicki: So what happens when we get low on doctors?)
Is ObamaCare all bad? Of course not! There are some bright spots. Even Mussolini (Nicki: technically, it was Hitler, but we get the point) made the trains run on time. Insurance companies are expected to make out like bandits now that everyone is required to buy their product. Drug companies are expected to make an additional $35 BILLION just during the first decade of ObamaCare!
Medical Record Czar and Obama contributor Judith Faulkner is worth $2.3 BILLION!
Besides feeding the usual beneficiaries of crony capitalism, ObamaCare is like any other socialist redistribution of wealth. Those folks who are eligible for subsidized healthcare will be getting something for free – something they didn’t earn, while those who had their insurance premiums double and their payroll tax increased are paying the bill. Doctors and hospitals are getting screwed!
It is really so simple that a 4 year old can understand it.