By: G. Keith Smith, M.D.,
The Supreme Court’s decision on what I call the Unaffordable Care Act or UCA reminds me of the comment by the late Joseph Sobran: “If Iraq needs a constitution let them have ours…we’re not using it.”
Although every Congressman takes an oath to uphold the Constitution, a majority of them voted for the UCA, some even stating they didn’t know whether it was Constitutional. That was the Court’s job to decide.
As usual, the Court has mostly deferred to Congress on its mission to expand government power. To see the effects of the ruling, it is useful to review the reasons this legislation was passed in the first place.
The bill served at least two purposes, both unrelated to health care: a tax increase and a “return on investment.”
Insurance works much like our tax system : We pay taxes, hoping to get a bridge or road, and we pay premiums, hoping that when the day comes that we file a claim, some of our premiums will be returned. With the government acting as the only “collector of premiums”—either receiving them directly or serving as the collection agent to enforce payment to approved “private” entities, customers (patients) are disarmed, unable to retaliate against the IRS-like poor service. To the extent that claims are denied or delayed this amounts to a simple tax increase. As demand outstrips supply, the program will become bankrupt, the bankruptcy assuming the form of long lines for care.
The political hacks that engineered the UCA, still fat from their bribes, will be long gone, leaving future politicians to deal with the politically impossible chore of dismantling a federal program, or alternatively will be smeared as mismanagers of the earlier politicians’ great idea. FDR understood this. To this day he is considered one of the great ones because he introduced the Ponzi scheme of old-age pensions, a program that threatens to bankrupt us today.
The UCA has already brought, or soon will bring, a great return on investment to the special interests that promoted it: health information technology (HIT) companies, big pharma, big hospitals, and big insurance companies.
HIT vendors got Uncle Sam to declare the purchase of their products mandatory. Incredibly, $20 billion dollars in taxpayer subsidies were doled out to buy this product. I like to refer to this as a “bail in,” as opposed to a “bail out.” Close negotiations with the big pharma lobbyists insured maintenance of their profits. Big hospitals were granted the upper hand in hostile takeovers of physician practices and smaller hospitals because of the intentionally expensive mandates that the little guys couldn’t handle. The big insurance companies supported this effort in anticipation of the country being carved up into regions over which these big boys will have complete control. The medical loss ratio provision of the bill insures that their smaller rivals will be destroyed, a political gift, the deception of which cannot be overstated.
This cabal of “investors” will manage the death by rationing, the favorite budget-balancing tool in the universal health care bag.
The state insurance Exchanges deserve special mention, in that their desirability on both sides of the aisle provides particular insight into the sickness of Washington. The darling of the large insurance companies, a mechanism meant to crush small competitors, the Exchanges will probably remain even if the Act is repealed, as the UCA-opposing Republicans are heavily “influenced” by the insurance lobby.
As the pundits pound on the details of what the Court’s decision means, I think we should continue to remind ourselves why this bill was passed, and that with or without the Court’s approval, the UCA has made millionaires and billionaires already, in industry and Congress. That is what politicians do: make already rich folks (who agree to kick back bribes) richer.
Dr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Oklahoma, owned by 40 of the top physicians and surgeons in central Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.
In 2009, Dr. Smith launched a website displaying all-inclusive pricing for various surgical procedures, a move that has gained him and the facility, national and even international attention. Many Canadians and uninsured Americans have been treated at his facility, taking advantage of the low and transparent pricing available.
Operation of this free market medical practice, arguably the only one of its kind in the U.S., has gained the endorsement of policymakers and legislators nationally. More and more self-funded insurance plans are taking advantage of Dr. Smith’s pricing model, resulting in significant savings to their employee health plans. His hope is for as many facilities as possible to adopt a transparent pricing model, a move he believes will lower costs for all and improve quality of care.
