Sunday, February 03, 2013

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?


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.



fboness said...

"As one of the Heritage Foundation’s fellows wrote: “If Americans could attain the current level of health for a lower total cost, the resources saved could be used for some other beneficial purpose, and U.S. economic well-being would undoubtedly improve.”

Why is that controversial? Why is that "spewed"?

DrWes said...

fboness -

"Why is that controversial? Why is that 'spewed'"

(1) Because it is an assumption and (2) the reference is made completely out of context by an unknown source.

But then again, such thorny issues like that are not requred when marketing, I guess.

Anonymous said...

fboness -

Politicians often tout that savings in one area can be spent on something else. The "Peace Dividend" comes to mind.

The problem is that the 'resources saved' don't really exist. They're not real money - just dollars that we don't have but now don't have to borrow. In other words, the savings result in less borrowing, not an account full of extra cash.

Money we didn't borrow doesn't spend the same as extra cash we have lying around.

Anonymous said...

You can track me back in time and know before anybody (practically) I was saying that the insurance lobby was the devil...


Medical Quack said...

Oh please not the Heritage foundation..they are still looking for the magic algorithm with a #3 carrot hanging out there for code that can solve this problem..not going to happen as they are so digitally illiterate and Algo Duped. They are from a lost generation and I used to write code so there's no mystery here on what an be done with both linear and non linear data and the second is always a stretch and belongs in science as that's what they do. In August of 2011 I checked in on the Heritage site and see for yourself, looks like a gaming site:) Don't feel bad though as former HHS Leavitt was sucked in here too. Don't count on the Heritage Foundation for anything reliable and they are not along but seemed to be more Algo duped than most.

Anonymous said...

I just can't see the phalanx of rising boomers who refuse to believe in their own mortality accepting the inevitable rationing. I also doubt they will accept a suggested cut off age of 75 when any intervention beyond palliative care will be deemed cost prohibitive and therefore futile by the powers that be.

Anonymous said...

ACA is generally a technique to shift revenue from wealthier parts of society to pay for healthcare for the lower income, uninsured. Tax on high income earners, tax on high income earners investment income, excise tax on medical devices (not even used much by the target expansion population), squeezed provider and hospital financials, and tax on "cadillac" employer provided health care plans to offset the costs of "lesser plans" to fit the affordable mantra. How again is this not a socialist approach?

W.O.R.M. said...


We now live in an era dominated by ideologues in a top down hierarchy, who are blinded by their own visions. Emanuel's views are merely a percolation of perhaps some grand vision into the health care sector of our society. Reason and credibility be damned. Another example of this can be appreciated in the writings of another medical "thought leader", Eric Topol. A brilliant cardiologist and researcher? Yes. But his prophecy is one of a vast mobile network of human beings transmitting their physiometric data 24/7 to their doctor or some data repository. I can see it now. 300+ million Americans blithely going through their daily routines hooked up to an iPhone with iRectalprobe adaptor. Just where does his Venn diagram intersect with reality?
The same can asked of Emanuel.

These people need to be challenged to prevent the irrevocable destruction of American medicine. God help us if we don't.