The Diagnosis of Obamacare


Dr. Jeffrey Oppenheim, mayor of Montebello, has repeatedly warned of potentially disastrous consequences of Obamacare, including tax hikes, scarcity and rationing of service, doctors dropping out of the profession and the inevitability of even further government control of health care
Dr. Jeffrey Oppenheim, mayor of Montebello, has repeatedly warned of potentially disastrous consequences of Obamacare, including tax hikes, scarcity and rationing of service, doctors dropping out of the profession and the inevitability of even further government control of health care

In 2010, former speaker of the House of Representatives, Nancy Pelosi, said of the then pending Obamacare bill, “we have to pass the [health care] bill so that you can find out what is in it.”

These words may live in infamy as the country begins now to discover the terrible consequences of perhaps the most unpopular partisan legislation ever imposed on the citizens of the United States. Toying around with such a large part of our economy and such an important part of every citizens health is not trivial. The consequences will include higher taxes, bureaucratic health care rationing, and a permanent drag on the economy of our county and our country.

As a physician I recognize that every citizen is better off with health insurance. However, universal government mandates and selective subsidies are less likely to incentivize appropriate cost savings and more likely to motivate people to lay atop the government’s largess. Long-term, we will become the victims of a centralized bureaucracy that is indifferent, inept, and intransigent. Imagine trying to get your health care at the Department of Motor Vehicles. Even Democratic Senator Max Baucus, a chief author of Obamacare, has warned that it is becoming a “train wreck!”

Obamacare is going to cost a fortune. Of course, much of the money is simply going to be passed along to the next generation with hundreds of billions of dollars of debt. But even today, some higher taxes are already evident: higher Medicare payroll taxes, a surtax on investment income (both dividend and capital gains), a tax on medical devices, a tax on drug manufacturers, a new cap on medical expense deductions, a tax on tanning services, new limits and taxes on the use of HSA and FSA accounts, etc. In January we will see new excise taxes on individuals who fail to abide by the government mandates (recall that the Supreme Court clarified that these euphemistically defined “penalties” were really taxes). In 2015, these excise taxes will also be levied upon businesses. The consequences of higher taxes are well known: slower economic growth and fewer jobs.

Not surprisingly, special interest groups that supported Obamacare are falling off the kayak. For example, unions such as the the United Food and Commercial Workers International Union (a 1.3 million-member group that endorsed Obama for president), The United Union of Roofers, Waterproofers and Allied Workers, and even the National Treasury Employees Union (which represents IRS workers), are worried. Some are realizing that the Obamacare exemption for part-time workers means that companies are incentivized to reduce worker hours or hire only part-time help. Jimmy Hoffa, leader of the Teamsters, writes that Obamacare is going to “…destroy the foundation of the 40 hour work week that is the backbone of the American middle class.”

Traditional health insurance benefit packages negotiated by unions are generally far superior to those that will be provided in the Obamacare exchanges. That is why the NTEU is afraid that Obamacare is going to, “…push federal employees out of the Federal Employees Health Benefits Program (FEHBP) and into the insurance exchanges.” Even more problematic for the unions is the disparity in the treatment of workers at small versus large firms. At small firms exempt from the employer mandate, workers will receive significant subsidies not available to comparably paid large firm workers. The Urban Institute calculates that a worker earning $24,000 at a small firm will receive an $18,432 government subsidy for insurance while a similarly paid worker at a large firm will receive no subsidy. This is effectively a tax on workers at large firms. It’s no wonder unions are realizing that supporting Obamacare was a mistake.

In Rockland County, Obamacare will likely cause higher local taxes. Consider that property taxes and sales taxes pay for the activities of our county government, including subsidies for Medicaid. As the number of people on Medicaid in Rockland increases, the cost to our county rises. This is one reason that our county budget is in trouble. Given that approximately half of the newly insured persons under Obamacare will be entering the Medicaid program, it is reasonable to assume that Rockland County will ultimately be obliged to spend even more money for Medicaid. This will further deepen our financial problems and create a pressure for higher sales and property taxes.

Health care rationing and a bigger bureaucracy are certainly on the horizon with Obamacare. For example, the new ICD coding system, which doctors must consult for every patient encounter, is becoming vastly more complex. Instead of 18,000 unique codes to describe every ailment, the new system includes more than 140,000 diagnoses. The increased time required to find the correct code will certainly reduce the time spent on patient care. Consider that there are more than 70 codes just to describe injuries caused by birds. Imagine a physician having to investigate whether an emu or an ostrich caused a scratch!

Sarah Palin was ridiculed and maligned for suggesting that Obamacare included “death panels” that would ration and deny care. Her critics may owe her an apology once the Independent Paymant Advisory Board (IPAB) begins to issue edicts. Under Obamacare, IPAB will have the power to issue decisions that will determine your health care options and Congress will have limited ability to reverse their decisions. If they cut funding for critical life saving services then those services simply won’t be available. A physician leader from the American Academy of Neurology warns, “The sole function of the IPAB is to cut spending with little guarantee of maintaining quality, access, and scientifically proven care.”

This sounds a lot like what Sarah Palin was warning us about. Furthermore, Obama-friendly economist Paul Krugman has openly called for “death panels” on more than one occasion, perhaps using that term to be sardonic, but conveying the truth of Palin’s warning nonetheless.

A majority of Americans oppose Obamacare for good reason. They recognize that they will be worse off under this law. Even those fortunate enough to keep their traditional insurance will be facing harsh rules and higher taxes. It is not surprising, then, that enthusiastic roars from the law’s few remaining supporters are fading as they become more familiar with the details. Nancy Pelosi’s fatuous prescription to approve legislation before its contents are understood may become a blemish on her reputation, but the impact on society will more likely resemble a tumor.

Dr. Jeffrey Oppenheim is the mayor of Montebello and a longtime brain surgeon

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