Obamacare’s Three Biggest Deceits

And the five fixes that could begin to set things right again

When a supposedly “compassionate” physician runs out of “other people’s money” due to problems with an ill-conceived national health care law — a law rammed through by a Democrat-controlled Congress against the American people’s better judgment — and his patient tragically dies, who is at fault?

It’s a trick question, so don’t try to answer it. Everybody knows that whenever anything goes wrong with a liberal social program like Obamacare, it’s the Republicans’ fault.

This is not new. During the Cold War, apologists and academics claimed that Marxism really worked in theory; it was only in practice that it screwed up the economy. You can hear similar things said about Cuba today.

Well, Obamacare didn’t even have a theory. It was a witch’s brew of cost shifting and giveaways to special interests — and now the sick chickens are coming home to roost.

A North Carolina cardiologist named Pradeep Arumugham recently wrote to the Charlotte Observer about the unfortunate death of a patient. He had failed to provide this patient with a defibrillator because he (the doctor) claimed it cost too much, supposedly $50,000 to $80,000. (The actual cost of the device and facilities is less than $30,000.)

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The patient purportedly made too much to qualify for Medicaid in North Carolina and didn’t qualify for Obamacare. So whom did the doctor blame? North Carolina Republicans, of course — for not volunteering to cover Medicaid patients at a sufficient level to address the gap in the federal rules.

He could have just as well blamed Democrats like Nancy Pelosi and Harry Reid for enacting a thousand-page health care law without reading it. He could have blamed them for trying to finance their supposed “compassion” by shifting the costs of federal largesse to the unfortunate bumpkins in the state legislatures — who don’t have the luxury of shifting their costs to our children and grandchildren — through deficit spending.

It’s a mistake to try to make public policy by anecdote, particularly tragic ones such as this. But what else could the patient and the doctor have done?

The patient could apparently have applied for Social Security Disability Insurance and qualified for Medicare. Or the physician could have approached the companies that make these expensive devices and the local hospital.

As a cardiologist, I have gone to bat for patients in similar situations and succeeded. One patient without insurance needed two heart valves urgently replaced. After I offered my services free of charge, Medtronic donated two mechanic heart valves; the hospital waived collection of its fees. That man today works for the U.S. government, is still my patient, and has a wife and two daughters.

One could put the blame for the tragic death in North Carolina just about anywhere. But that’s not the way to make public policy.

There is no “free lunch” — and the larger tragedy is that Obamacare was built on three lies about how it would reduce health care costs to make it less expensive for society to help those in need. It has done just the opposite. Here’s how:

1.) Obamacare’s proponents claimed more preventive services would save money.
While personal prevention certainly saves money — keeping up good health habits like eating right, getting regular exercise, and not smoking — many preventative and diagnostic health care services cost more money than they save.  Remember, those tests and procedures have to be paid for even if they show you are perfectly healthy.

2.) Proponents claimed replacing ER and other uncompensated or under-compensated care with insurance coverage would save money.
There are really two lies here. The claim that emergency rooms cost more is often an accounting gimmick. If they treat your non-emergency case last (after you’ve waited 12 hours), the marginal cost is probably close to zero. With full-blown insurance you also get more than emergency services, and you (or someone else) pay more.

3.) Proponents claimed moving to electronic health records (EHRs) would save money, not cost money.
That claim may take another decade to prove or debunk, but these are fiscal fantasies, essentially. The British enacted them five years ahead of us and now have abandoned EHRs due to cost and safety concerns.

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We wanted to believe these claims because most of us want everyone, rich or poor, to have access to basic health care. (If someone else is paying bill, who wouldn’t?) But wishing, or cost shifting or finger-pointing, won’t make it so. “I was all for Obamacare until I found out I was going to have to pay for it,” said a progressive young woman in one of my favorite quotes about the program’s failures.

We must get rid of the waste, fraud and abuse in our crony-capitalist health care system. These five positive steps could fulfill the promises originally made to the American people.

1.) Require true price transparency and neutrality.
Post the price for each procedure and service, plus the best information on its utility. Restore price competition to the health care sector so consumers can make informed decisions.

2.) Take out the frills that Obamacare forces health insurers to include as a giveaway to special interests.
If a service cannot meet a cost-benefit test, and consumers won’t pay even a fraction of the true costs through meaningful co-pays, don’t force them into basic insurance packages. If any private company did that, it would be a violation of the anti-trust laws. Remember Microsoft?

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3.) Stop subsidizing other countries’ health care systems by overpaying for drug prices.
Drug companies should not be permitted to charge a higher price to privately insured Americans (or to Medicare and Medicaid) than the lowest price charged to any of the “developed” countries in the OECD. Perhaps we should even get a discount for buying as much as we do. Americans should not have to pay the lion’s share of the costs of drug research and development while some foreigners pay only the incremental costs of manufacturing the pills.

4.) Allow insurance companies to compete across state lines.
Any policy that qualifies under federal standards — and qualifies under the laws of at least one state or D.C. — should be available for purchase in every state the company wishes to offer it. Interstate commerce and a huge market is what made America an economic behemoth, able to bring down prices and raise living standards. Why should health insurance be run like the Department of Motor Vehicles, with different rules in every state?

5.) Fulfill President Obama’s earlier promise: If you like your doctor, you can keep your doctor, period.
A simple rule will just about get us there. Require any insurance company to compensate out-of-network physicians and providers with at least 80 percent of the amount they pay in-network physicians. That may not cover the full costs of going out of network in many cases, and the patient will have to make up the difference — but your insurance plan will no longer be a “closed shop” where your insurance is worthless unless you use the physicians or hospitals they tell you to.

That may work fine in Cuba, but it wasn’t what we were promised here.

Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, is CEO of Foxhall Cardiology PC.

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