Marketing Obamacare

"We Can Be Healthy and Rich" says one of the Affordable Care Act's principle architects and cheerleaders, Dr. Ezekiel J. Emanuel in today's New York Times opinion section.  While Dr. Emanuel is certainly entitled to his opinion, we should require that his assumptions be bolstered by facts, not assumptions spewed forth by Councils and fellows from the conservative think-tank Heritage Foundation.

But the Affordable Care Act is proving anything but affordable to Americans.  As more and more details of the Affordable Care Act come to light, we (the people) have to wonder who stands to get "healthy and rich" as a consequence of the law.

Exactly who's "we," Dr. Emanuel?

Is "we" the patient?
Is "we" the country as a whole?
Or is "we" the sculptors of the Affordable Care Act?

If "we" meant the patient, then the accompanying editorial entitled "A Cruel Blow to American Families - Millions of dependents may suffer because of the I.R.S.'s reading of the health care law" in the same section of today's New York Times wouldn't have had to be written, right? Don't you recall one prominent legislator suggesting the details of this convoluted legislation didn't have to be read?

Yet here we are.

If "we" meant the the country, then cost concerns would have been a major element of the Affordable Care Act.  But is wasn't.  It was another expansive entitlement program to insure an additional "30 million people" while still leaving many to fend for themselves.  It created over 118 new government agencies with more smoke an mirrors and middlemen in medicine than ever before: pharmacy benefit managers, coders, programmers, administrators, checklist monitors, and doctors as data entry personnel. It used the Internal Revenue Service as its collection agency, in part because a funding source was required and secondly, so their additional ranks would not be counted in the budget mark-up for the cost of the bill.   Lower costs for care delivery?

Please.

But then, that was never really the purpose of the Affordable Care Act.  The Affordable Care Act is to make sure that health care is "affordable" to insurance companies.  Insurance companies, after all, saw the aging of America as their big cost crisis.   They were threatened with having to pay for all those older Americans from their shrinking cash reserves.  So they came to the "table" of health care reform and helped, with plenty of cash in hand, to sculpt the Affordable Care Act.  Thousands of pages of legislation that wove through tax laws and Social Security laws and instantly (and magically) appeared before Congress.  And as things progressed, it became clear to those who care for patients that the new law of the land is a crafty vehicle that shifts the risk of insuring America's health from the companies designed to distribute that risk (insurance companies) to the very people charged with caring for patients: doctors and hospitals.  And hospitals, left with declining revenues from their empowered government payer will turn to the last source of revenue available to them: their patients to offset their loses.   And pay they will: like never before.

So when we read fluffy opinion pieces in the New York Times about how "we can be healthy and rich," remember who stands to get so.

It sure won't be the patients.

-Wes