Obamacare: The sequel -- Dr. Scott W. Atlas

Obamacare: The sequel

Dr. Scott W. Atlas
The Washington Times
September 17, 2010

A highly partisan Democrat-dominated Congress passed President Obama's sweeping legislation in March to shift decision-making and authority to the government and fundamentally transform America's health care in the Patient Protection and Affordable Care Act. We know many of the important aspects of the legislation do not begin until 2014. But with the expectation that Republicans will take back partial control of Congress, this might be the last chance for an agenda-driven Democratic Congress to push even more legislation onto an unwilling electorate.

We already know that Mr. Obama and the Democrats are willing to sign laws that the majority of Americans oppose. And despite continued opposition from about 60 percent of Americans, the administration continues to defy the will of the people with warnings and threats to the private sector in advance of implementing the plan's big-government mandates, coverage decrees and price controls. In this waning phase of Democratic domination, what might we expect as last-gasp overreaches in health care?

Watch for an overt use of brute force by the federal government to eliminate the viability of private health insurance.

As of January 2014, every state must establish an exchange for individuals, small groups and small businesses to buy health insurance. Obamacare already tilts the playing field toward federally controlled and defined health insurance, and instead of increasing choice for consumers, quite the opposite is accomplished. While insurance may be bought outside the exchange, exchanges are the only pathway to access the $450 billion in federal subsidies and tax credits. Only qualified health plans (QHPs) may sell coverage through the exchange. QHPs must be state-licensed and certified by the Department of Health and Human Services' (HHS) new Office of Consumer Information and Insurance Oversight as meeting an array of new federal and state requirements.

HHS Secretary Kathleen Sebelius already has confirmed that the exchanges, justified by the administration as a vehicle to increase consumer choice and lower prices by facilitating competition, will actually bar private insurers from participating unless prices are fixed at government-dictated rates. Moreover, as history has shown, even more mandates embedded in government-defined "minimal essential coverage" will be inflicted on private insurers and consumers with time-restricting choices, eliminating low-cost plans that Americans are increasingly opting to buy from private insurers.

Watch for a new "public option" to be introduced after the massive shift of Americans into existing government insurance to further crowd out private insurance, as Democrats do their best to forge a single-payer, wholly government-controlled system.

Obamacare aggressively expands eligibility for Medicaid/CHIP (Children's Health Insurance Program) - adding 25 million Americans in its first year into that failing public insurance program, a program in which patients can't find doctors because almost half already refuse patients because of low payment schedules. The plan's exchanges will screen all persons who apply for coverage. If eligible, they'll automatically be enrolled in Medicaid or CHIP. Despite Obamacare's furthering dependence on government insurance with its mandates, insurance exchanges, definitions of essential coverage and price-fixing, costs still will escalate. Because the government forbids sensible insurance pricing for higher-risk consumers and adds a litany of new coverage mandates such as "free" screening for all, insurance costs necessarily will increase.

Congressional Democrats anticipate this and already have asked the Congressional Budget Office to price a more formal public plan for 2014. The proposal's co-sponsor, Rep. Raul Grijalva, Arizona Democrat, said, "By reintroducing it, we make sure that people don't forget this is a viable option. ... As the health bill is implemented, more and more people are going to come to the realization that cost containment and competition aren't as robust as they should be, because of the absence of the public option." It is not insignificant that Dr. Donald Berwick, the new Centers for Medicare and Medicaid Services administrator, waxes passionately about the single-payer National Health Service of Britain, the poster child of government restricting choice and access.

Watch for the federal government to restrict doctors from practicing, or possibly even criminalize them, unless they accept patients with insurance paying government-defined rates for medical tests and treatments.

As more Americans are shifted into government insurance, prices for medical services will be forced lower and lower - indeed, the new health law is overtly configured to cut payments for Medicare services by 30 percent over the next three years; by 2019, payments for senior-citizen care will be even lower than Medicaid. While government arrogantly assumes doctors will swallow government-dictated low reimbursements, surely more and more physicians will refuse to see patients under such health plans. This already has happened to varying degrees across the country. But this might not be tolerable to Mrs. Sebelius, Dr. Berwick and our president. It is not unimaginable that the federal government will soon tie all medical licensure to accepting the new edicts, as is already contemplated in Massachusetts, where medical licensure may be contingent on accepting the state insurance plan.

When Congress passed the health legislation plan that the president sought, it radically changed health care in the United States and audaciously imposed a strong-armed federal government onto perhaps the most personal of all segments of American life. In the ensuing months, the opposition has tried to understand what it can do when governmental power is enacted despite the will of the people. Legal battles questioning the constitutionality of the legislation are already under way in more than 20 states. Political activists are targeting the rogue politicians who flaunted their own agenda in the face of the constituents who elected them in the first place. But indications are that this Congress and this administration may not care what the American public wants. Ultimately, they may be prepared to commit political suicide in a last-ditch effort to push their unwanted agenda on the nation.

Dr. Scott W. Atlas is a professor at the Stanford University Medical Center and a senior fellow at the school's Hoover Institution.